Yonsei Med J.  2019 Feb;60(2):174-181. 10.3349/ymj.2019.60.2.174.

Prognostic Value of Lymphovascular Invasion in Node-Negative Upper Urinary Tract Urothelial Carcinoma Patients Undergoing Radical Nephroureterectomy

• Liu W
• Zhou Z
• Dong D
• Sun L
• Zhang G

• KMID: 2431634
• DOI: http://doi.org/10.3349/ymj.2019.60.2.174

Abstract

PURPOSE
This study aimed to evaluate the prognostic impact of lymphovascular invasion (LVI) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC).
MATERIALS AND METHODS
We collected data from 180 patients who were treated with RNU from 2005 to 2013 at our institution. The Kaplan-Meier method with log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses.
RESULTS
LVI was present in 28 patients (15.6%), which was associated with higher pathological tumor stage (p < 0.001), tumor necrosis (p=0.012), lymph node metastasis (p=0.017) and multifocality (p=0.012). On multivariate analysis, LVI was an independent prognostic factor of recurrence-free survival [RFS: hazard ratio (HR)=2.954; 95% confidence interval (CI)=1.539-5.671; p=0.001] and cancer-specific survival (CSS: HR=3.530; 95% CI=1.701-7.325; p=0.001) in all patients. In patients with node-negative UTUC, LVI was also a significant predictor of RFS (HR=3.732; 95% CI 1.866-7.464; p < 0.001) and CSS (HR=3.825; 95% CI=1.777-8.234; p=0.001).
CONCLUSION
LVI status was an independent predictor in patients with UTUC who underwent RNU. The estimate of LVI could help physicians identify high-risk patients and make a better medication regimen of adjuvant chemotherapy.

Keyword

Urinary tract; prognosis; neoplasm invasiveness; carcinoma, transitional cell; lymph nodes

MeSH Terms

Carcinoma, Transitional Cell
Chemotherapy, Adjuvant
Humans
Lymph Nodes
Methods
Multivariate Analysis
Necrosis
Neoplasm Invasiveness
Neoplasm Metastasis
Prognosis
Urinary Tract*

Figure

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  Fig. 1 Lymphovascular invasion (arrow) in upper urinary tract urothelial carcinoma was shown in hematoxylin and eosin staining (A) and immunohistochemical staining (CD31) (B); ×400.

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  Fig. 2 Kaplan-Meier curves of disease RFS (A) and CSS (B) stratified by LVI in 180 patients with upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy. RFS, recurrence-free survival; CSS, cancer-specific survival; LVI, lymphovascular invasion.

• 

  Fig. 3 Kaplan-Meier curves of disease RFS (A) and CSS (B) stratified by LVI in 169 patients with node-negative upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy. RFS, recurrence-free survival; CSS, cancer-specific survival; LVI, lymphovascular invasion.

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