Yair Lotan1,2,3, Amit Gupta1,2,3, Shahrokh F. Shariat1,2,3, Ganesh S. Palapattu1,2,3, Amnon Vazina1,2,3, Pierre I. Karakiewicz1,2,3, Boris Hadaschik1,2,3, Craig Rogers1,2,3, Gilad E. Amiel1,2,3, Paul Perotte1,2,3, Mark Schoenberg1,2,3, Seth P. Lerner1,2,3, Arthur I. Sagalowsky1,2,3
1Department of Urology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, J8.112, Dallas, TX 75390-9110;
2From the Department of Urology, University of Texas Southwestern Medical Center, Dallas; Baylor College of Medicine, Houston, TX; The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD; Centre Hospitalier de l'Université de Montréal, Campus St-Luc, Montreal, Quebec, Canada
3The James Buchanan Brady Urological Institute
Tóm tắt
Purpose We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.
