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Gercek O, Senkol M, Yazar VM, Topal K. The Effect of Lymphovascular Invasion on Short-Term Tumor Recurrence and Progression in Stage T1 Bladder Cancer. Cureus 2024; 16:e54844. [PMID: 38533164 PMCID: PMC10964124 DOI: 10.7759/cureus.54844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Lymphovascular invasion (LVI) is the most important stage for tumor spread and metastasis. The role of LVI in transurethral resection is not yet clear. In this study, the progression and recurrences of patients who underwent transurethral resection bladder tumor (TUR-BT) and T1 high-grade tumor and concomitant LVI were detected in pathology results and were evaluated. Methods Our study included 58 patients, who underwent TUR-BT with the suspicion of bladder cancer and were pathologically diagnosed with T1 stage bladder cancer and who did not undergo radical surgery, in the Urology Clinic of Afyonkarahisar Health Sciences University, Turkey. The patient's age, gender, tumor size, tumor grade, presence of LVI, second resection, recurrence, and progression rates at three months and one year were compared. Results LVI was detected in the pathology specimens of nine (15.5%) of the 58 patients who were included in the study. When the one-year progression was evaluated, progression to T2 tumor was detected in six (66.7%) patients in the group with LVI and five (10.2%) patients in the group without LVI, and the progression was significantly higher in the group with LVI (p=0.001). In logistic regression analysis, the only significant predictor for one-year progression was the presence of LVI (p=0.001). Conclusion According to the results of our study, the presence of LVI in the pathology specimens of patients with T1 high grade significantly increases the progression. Suggesting radical cystectomy and neoadjuvant chemotherapy to patients with LVI in the early period seems to be a more accurate approach, considering the course of the disease.
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Affiliation(s)
- Osman Gercek
- Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Melih Senkol
- Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Veli Mert Yazar
- Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Kutay Topal
- Urology, Afyonkarahisar State Hospital, Afyonkarahisar, TUR
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Yoneda K, Utsumi T, Wakai K, Oka R, Endo T, Yano M, Kamiya N, Hiruta N, Suzuki H. Preoperative Clinical Predictors of Lymphovascular Invasion of Bladder Tumors at Transurethral Resection Pathology. Curr Urol 2020; 14:135-141. [PMID: 33224006 DOI: 10.1159/000499247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The assessment of lymphovascular invasion (LVI) on the specimens of a transurethral resection of bladder tumors (TURBT) is very important for risk stratification and decision-making on further treatment for bladder cancer. Objectives The present study aimed to identify clinical predictors associated with the risk of bladder cancer with LVI before a first TURBT. Methods A total of 291 patients underwent a first TURBT for bladder cancer at Toho University Sakura Medical Center between January 2012 and December 2016. We analyzed predictors of LVI based on data from 217 patients and predictors of high grade and ≥ pT1 tumors based on data from the medical records of 237 patients for comparison with LVI risk factors. Results Univariate analysis significantly associated LVI with episodes of gross hematuria, positive urinary cytology, and larger, non-papillary and sessile tumors. Multivariate analysis selected larger tumors [odds ratio (OR) 1.39; 95 % confidence interval (CI) 1.08-1.78; p = 0.01], and non-papillary (OR 10.05; 95% CI 3.75-26.91; p < 0.01) and sessile (OR 2.65; 95% CI 1.18-5.93; p = 0.02) tumors as significant predictors of LVI. Some predictors such as tumor size and non-papillary tumors overlapped between high-grade and ≥ pT1 bladder cancer. Conclusions These predictors can help clinicians to identify patients with, or who are at high-risk for LVI before undergoing a first TURBT and to determine priorities for preoperative evaluation and scheduling consecutive treatments.
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Affiliation(s)
- Kei Yoneda
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Ken Wakai
- Department of Urology, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba
| | - Ryo Oka
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Takumi Endo
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Masashi Yano
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
| | - Nobuyuki Hiruta
- Department of Surgical Pathology, Toho University Sakura Medical Center, Shimoshizu, Sakura, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Shimoshizu, Sakura
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Abstract
Stage T1 bladder cancers invade the lamina propria of the bladder and, despite sharing many of the genetic features of muscle-invasive bladder cancers, are classified as non-muscle-invasive or 'superficial' tumours. Yet, patients with T1 bladder cancer have an overall mortality of 33% and a cancer-specific mortality of 14% at three years after diagnosis, suggesting that these patients have a high risk of progression and, accordingly, require meticulous surgery, endoscopic surveillance and clinical decision-making. We hypothesize that the variability in the outcomes of patients with T1 bladder cancer is a result of both tumour heterogeneity and pathological staging, as well as inconsistencies in risk stratification, endoscopic resection and schedules of delivery of BCG. Owing to limitations in clinical staging, patients with T1 bladder cancer are at risk of both undertreatment with persistent use of BCG despite recurrence, and overtreatment with early cystectomy. Understanding the molecular features of T1 bladder cancers and how they respond to BCG therapy could improve biomarkers for risk stratification to align therapy with biological risk.
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Poor prognostic value of lymphovascular invasion for pT1 urothelial carcinoma with squamous differentiation in bladder cancer. Sci Rep 2016; 6:27586. [PMID: 27279531 PMCID: PMC4899777 DOI: 10.1038/srep27586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022] Open
Abstract
Lymphovascular invasion (LVI) is the primary and essential step in the systemic dissemination of cancer cells. The aim of our study was to assess the independent prognostic role of LVI for pT1 urothelial carcinoma with squamous differentiation in bladder cancer. We retrospectively analyzed the clinical and pathological information of 206 patients diagnosed pT1 urothelial carcinoma with squamous differentiation. Of the 206 patients, LVI was detected in 57 (27.6%) patients. The 5 year cancer specific survival (CSS) rates were 87.2% in LVI (−) and 52.4% in LVI (+) (p < 0.001). According to univariate analysis, tumor multiplicity, tumor size, recurrence and LVI were the prognostic factors associated with CSS. Additionally, tumor size and LVI significantly influenced the CSS in multivariate analysis. TURBT had shorter median CSS than RC in recurred patients with LVI (+). Our study suggested that LVI is an important predictor for survival of pT1 urothelial carcinoma with squamous differentiation. LVI positive status and tumor size ≥3 cm led to a higher risk of death. RC should be routinely performed in recurred LVI (+) bladder cancer patients of pT1 urothelial carcinoma with squamous differentiation.
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Huang Q, Luo K, Chen C, Wang G, Jin J, Kong M, Li B, Liu Q, Li J, Rong T, Chen H, Zhang L, Chen Y, Zhu C, Zheng B, Wen J, Zheng Y, Tan Z, Xie X, Yang H, Fu J. Identification and Validation of Lymphovascular Invasion as a Prognostic and Staging Factor in Node-Negative Esophageal Squamous Cell Carcinoma. J Thorac Oncol 2016; 11:583-92. [PMID: 26792626 DOI: 10.1016/j.jtho.2015.12.109] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/06/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Lymphovascular invasion (LVI) is a histopathological feature that is associated with an increased risk for micrometastasis. The aim of this study was to determine the prognostic and staging value of LVI among patients with esophageal squamous cell carcinoma (ESCC) undergoing esophagectomy. METHODS A prospective database of patients with ESCC was used to retrospectively analyze 666 cases to identify the relationship between LVI and survival, and to evaluate predictive accuracy of prognosis after combining LVI and the tumor, node, and metastasis (TNM) system. Pathological slides were reassessed by gastrointestinal pathologists according to the strict criteria; 1000-bootstrap resampling was used for internal validation, and 222 cases from an independent multicenter database were used for external validation. RESULTS LVI was present in 33.8% of patients, and the proportion increased with advancing T and N classification. LVI was an independent predictor of unfavorable disease-specific survival (DSS) (hazard ratio = 1.59, 95% confidence interval: 1.30-1.94) and disease-free survival (DFS) (hazard ratio = 1.62, 95% confidence interval: 1.32-1.98) after T classification. Among node-negative patients, LVI and T classification were two independent predictors of DSS and DFS (p < 0.001). The risk score model combing LVI and T classification improved the predictive accuracy of the TNM system for DSS and DFS by 3.5% and 4.8%, respectively (p < 0.001). The external validation showed congruent results. The DSS of TxN0MO disease with LVI was similar to the DSS of TxN1M0 (both p > 0.05). In contrast, LVI was not associated with DSS or DFS among node-positive patients. CONCLUSIONS The independent prognostic significance of LVI existed only in node-negative patients with ESCC, and the combination of LVI and the TNM system enhanced the predictive accuracy of prognosis. After confirmation, node-negative patients with LVI might be considered for upstaging in pathological staging.
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Affiliation(s)
- Qingyuan Huang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Kongjia Luo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Chun Chen
- Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Geng Wang
- Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Jietian Jin
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Min Kong
- Taizhou Hospital, Taizhou, People's Republic of China
| | - Bifeng Li
- Fujian Medical University Union Hospital, Fuzhou, People's Republic of China; Xiamen Traditional Hospital, Xiamen, People's Republic of China
| | - Qianwen Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Jinhui Li
- School of Public Health, the University of Hong Kong, Hong Kong, People's Republic of China
| | - Tiehua Rong
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Haiquan Chen
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lanjun Zhang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Yuping Chen
- Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Chengchu Zhu
- Taizhou Hospital, Taizhou, People's Republic of China
| | - Bin Zheng
- Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Jing Wen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Yuzhen Zheng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Zihui Tan
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Xiuying Xie
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Hong Yang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China
| | - Jianhua Fu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China; Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China.
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Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH. Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: A systematic review and meta-analysis. Urol Oncol 2014; 32:1191-9. [PMID: 24954108 DOI: 10.1016/j.urolonc.2014.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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Berman DM, Kawashima A, Peng Y, Mackillop WJ, Siemens DR, Booth CM. Reporting trends and prognostic significance of lymphovascular invasion in muscle-invasive urothelial carcinoma: a population-based study. Int J Urol 2014; 22:163-70. [PMID: 25197026 DOI: 10.1111/iju.12611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/03/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To investigate reporting patterns and outcomes associated with lymphovascular invasion in a general population setting. METHODS We identified all cystectomy patients with muscle-invasive urothelial cancer in Ontario, Canada, 1994-2008. Surgical pathology reports were analyzed for pathological variables including lymphovascular invasion. Lymphovascular invasion reporting patterns were described over time. A Cox proportional hazards model was used to evaluate the association of lymphovascular invasion with survival. RESULTS Of the 2802 cases identified, lymphovascular invasion status was reported in 75%. Lymphovascular invasion reporting significantly improved over the study period and was correlated with poor prognostic pathological features (T stage and N stage). Comprehensive cancer center status was not consistently associated with lymphovascular invasion reporting. Patients with lymphovascular invasion had substantially lower survival than patients who were lymphovascular invasion-negative or whose lymphovascular invasion status was unstated (P < 0.001). Lymphovascular invasion was independently associated with survival in patients regardless of lymph node metastasis. After adjusting for age, stage, comorbidity, margin status and adjuvant chemotherapy, lymphovascular invasion remained strongly associated with reduced survival (hazard ratio 1.98, 95% confidence interval 1.71-2.29). CONCLUSIONS Although routine reporting of lymphovascular invasion has improved over the years, pathologists appear to be biased towards evaluating lymphovascular invasion in patients with high-stage disease. Despite this bias, lymphovascular invasion remains an important prognostic factor among patients treated by cystectomy. Pathologists in general practice should report lymphovascular invasion status more consistently and urologists should hold their pathology colleagues to a higher standard.
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Affiliation(s)
- David M Berman
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Division of Cancer Biology and Genetics, Queen's University, Kingston, Ontario, Canada
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Yossepowitch O, Ehrlich Y, Lubin M, Tal R, Konichezsky M, Baniel J. Lymphovascular invasion in testicular germ cell tumors: clinicopathological correlates. Cent European J Urol 2013; 66:266-70. [PMID: 24707361 PMCID: PMC3974483 DOI: 10.5173/ceju.2013.03.art5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 06/27/2013] [Accepted: 08/20/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction We assessed clinical–pathological correlates of lymphovascular invasion in testicular germ–cell tumors. Material and methods Archived pathology specimens from 145 patients treated by radical orchiectomy for testicular germ cell tumors at our institution in 1995–2006 were reanalyzed by a dedicated urologic pathologist, and the corresponding medical records were reviewed. The association of lymphovascular invasion with clinical and pathological parameters was tested using stepwise logistic regression analysis. Results Lymphovascular invasion was identified in 38 (26%) patients and was associated with younger age, testicular pain at presentation, elevated serum tumor markers, nonseminoma histology, and advanced clinical stage. Orchalgia was indicated as the impetus for referral in 67 (46%) patients and characterized as a dull aching sensation, persistent or intermittent in nature. Among the 98 men diagnosed with clinical stage I, those presenting with testicular pain had a 1.8X–higher likelihood of lymphovascular invasion than those without pain (95% CI 1.13–14.9, p = 0.02), and patients with elevated serum tumor markers had an 8.5–fold increased probability of lymphovascular invasion than those presenting with normal tumor markers (CI 1.1–54.2, p = 0.05). Among men with nonseminoma histology, elevated tumor markers was the strongest predictor of lymphovascular invasion in both univariate and multivariate analyses (OR 5.05, 95% CI 1.16–21.8, p = 0.03). Conclusion Providing pathologists with information on pre–orchiectomy tumor marker levels and, possibly, testicular pain at presentation may increase their vigilance in searching for lymphovascular invasion, potentially improving their diagnostic accuracy. Whether it may also translate into improved oncological outcomes needs further evaluation.
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Affiliation(s)
- Ofer Yossepowitch
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Ehrlich
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marc Lubin
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Tal
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Konichezsky
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Institute of Urology and Department of Pathology (MK), Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hansel DE, Amin MB, Comperat E, Cote RJ, Knüchel R, Montironi R, Reuter VE, Soloway MS, Umar SA, Van der Kwast TH. A Contemporary Update on Pathology Standards for Bladder Cancer: Transurethral Resection and Radical Cystectomy Specimens. Eur Urol 2013; 63:321-32. [DOI: 10.1016/j.eururo.2012.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
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Resnick MJ, Bergey M, Magerfleisch L, Tomaszewski JE, Malkowicz SB, Guzzo TJ. Longitudinal evaluation of the concordance and prognostic value of lymphovascular invasion in transurethral resection and radical cystectomy specimens. BJU Int 2010; 107:46-52. [DOI: 10.1111/j.1464-410x.2010.09635.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Antonio Lopez-Beltran
- Unit of Anatomic Pathology, Department of Surgery, Faculty of Medicine, Cordoba University Medical School, Cordoba, Spain
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Bolenz C, Herrmann E, Bastian PJ, Michel MS, Wülfing C, Tiemann A, Buchner A, Stief CG, Fritsche HM, Burger M, Wieland WF, Höfner T, Haferkamp A, Hohenfellner M, Müller SC, Ströbel P, Trojan L. Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial. BJU Int 2010; 106:493-9. [DOI: 10.1111/j.1464-410x.2009.09166.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kunju LP, You L, Zhang Y, Daignault S, Montie JE, Lee CT. Lymphovascular Invasion of Urothelial Cancer in Matched Transurethral Bladder Tumor Resection and Radical Cystectomy Specimens. J Urol 2008; 180:1928-32; discussion 1932. [DOI: 10.1016/j.juro.2008.07.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Lakshmi P. Kunju
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Li You
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Yingxi Zhang
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Stephanie Daignault
- Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - James E. Montie
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Cheryl T. Lee
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Streeper NM, Simons CM, Konety BR, Muirhead DM, Williams RD, O'Donnell MA, Joudi FN. The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer. BJU Int 2008; 103:475-9. [PMID: 18990174 DOI: 10.1111/j.1464-410x.2008.08011.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the hypothesis that patients with bladder cancer who had evidence of lymphovascular invasion (LVI) in their transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens would have a worse prognosis and higher likelihood of clinical understaging, and to assess the effect of LVI discovered at RC on subsequent disease-related mortality, as the prognostic significance of LVI in TURBT or RC specimens of patients treated for urothelial carcinoma of the bladder is not completely established. PATIENTS AND METHODS We retrospectively reviewed the records of 163 patients with urothelial carcinoma of the bladder seen at our institution, and who had TURBT (69) or RC (94) between 1995 and 2005. We compared patients with LVI on TURBT and/or RC specimens to a group of controls who did not have LVI on TURBT (34) or RC (32). RESULTS Patients with LVI present in their TURBT specimen had a shorter disease-specific survival than those without LVI, with a 5-year survival of 33.6% vs 62.9% (log-rank test P = 0.027; hazard ratio 2.21). LVI at TURBT varied with clinical stage (P = 0.049). Patients with LVI and who were clinical stage I or II had lower survival than those without LVI (P = 0.049; hazard ratio 2.68). LVI did not affect survival among those with clinical stage III or IV (P = 0.29). There was a trend for patients with LVI at TURBT to be clinically understaged compared to those without LVI (75% vs 46%) but the difference was not significant (P = 0.086). Patients with LVI detected in their RC specimen were significantly more likely to have cancer recurrence than were those with no evidence of LVI (48% vs 19%, P = 0.006). For the RC group there was also a significant difference in survival distribution between patients with evidence of LVI vs those without (5-year survival 45.5% vs 78.4%, P = 0.017). Those with LVI were significantly more likely to die from the disease than those without LVI (P = 0.017; hazard ratio 2.92). CONCLUSIONS Our findings suggest that LVI is a histological feature that might be associated with a poorer prognosis in patients with urothelial carcinoma of the bladder. The presence of LVI in TURBT specimens predicts shorter survival for patients with stage I or II disease. The presence of LVI in RC specimens predicts recurrence of disease and shorter survival. Further studies are needed to determine whether this group of patients would benefit from early RC and/or perioperative chemotherapy to improve clinical outcomes.
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Affiliation(s)
- Necole M Streeper
- Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA
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Re: Location of Extrarenal Tumor Extension Does Not Impact Survival of Patients With pT3a Renal Cell Carcinoma. J Urol 2008; 180:409; author reply 409-10. [DOI: 10.1016/j.juro.2008.03.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Indexed: 11/18/2022]
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Colombo R. Re: Lymphatic Invasion is a Prognostic Factor for Bladder Cancer Treated with Radical Cystectomy. Eur Urol 2007; 52:1797-8. [DOI: 10.1016/j.eururo.2007.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Lymphovascular invasion has been correlated with the metastatic ability of the cancer. It has been studied in urological tumours at every location, but it has only been included as a prognostic factor in the TNM (tumour, lymph nodes and metastasis) classification of germ cell testicular tumours. The purpose of this evaluation is to look into the predictive value of lymphovascular invasion in locally advanced bladder cancer. RECENT FINDINGS Studies carried out in patients who underwent cystectomy report a lymphovascular invasion incidence of 30-50% of the cases. All of them agree that there is a correlation between the presence of lymphovascular invasion and disease evolution, but some authors consider that only blood vessel invasion is a statistically significant independent prognostic factor, and others find that this happens only in lymph node-negative cases. SUMMARY All papers stress the prognostic value of lymphovascular invasion, most of them as an independent factor, but there are still some doubts as to its use in clinical decision making, owing to the poor diagnosis reproducibility. This is why it would be necessary to reach a consensus on strict diagnostic criteria as soon as possible to be able to incorporate this prognostic factor in clinical practice.
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Affiliation(s)
- Ferran Algaba
- Section of Pathology, Fundació Puigvert, Department of Morphology, Medicine School, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Pathologists play an important role in the management of urinary bladder cancer by making a careful morphologic assessment of the primary tumor and its relation to adjacent structures. Ideally, evaluation of the primary site will segregate patients into groups with distinct clinical features, biologic behavior, and response to therapy. Traditionally, to accomplish this goal, pathologists have relied on factors such as histologic tumor type, grade, depth of invasion, and presence or absence of vascular invasion. Recently, in an effort to enhance our ability to subclassify these patients, we have introduced new modalities, such as flow cytometry, monoclonal antibodies, assessment of proliferative rate, and cytogenetics and molecular genetics. Without question we are advancing into an era in which tumors will be classified based on their molecular "fingerprint." Nevertheless, at this time, morphology remains the "gold standard" and, consequently, the best tool to assess the biologic potential of early bladder cancer. Despite this undeniable fact, there are many problems with the pathologic evaluation of these tumors, mostly because of the inherent subjectivity of the field and the lack of universal, standardized criteria for the evaluation of the above-mentioned morphologic parameters. Publications in peer-reviewed journals and the proliferation of educational opportunities by way of seminars, conferences, and web-based tutorials play an important role in keeping the practicing pathologist informed and up to date. As novel concepts and modern techniques are reported, their clinical value must be validated prospectively. Expert pathology review and establishment of exportable practice standards play an important role in the process.
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Affiliation(s)
- Victor E Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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