Shariat Shahrokh F, Khoddami Seyed M, Saboorian Hossein, Koeneman Kenneth S, Sagalowsky Arthur I, Cadeddu Jeffrey A, McConnell John D, Holmes Marisa N, Roehrborn Claus G
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Urol. 2004 Mar;171(3):1122-7. doi: 10.1097/01.ju.0000113249.82533.28.
We examined whether invasion of lymphatic and/or vascular vessels (LVI), or perineural spaces (PNI) is associated with prostate cancer features and outcome.
A total of 630 consecutive men underwent radical retropubic prostatectomy for clinically localized disease. LVI and PNI examination was part of the routine specimen evaluation.
Foci of LVI were identified in 32 patients (5%) and 381 (60.5%) had PNI. LVI and PNI were associated with clinical stage T2 disease, higher biopsy and final Gleason sum, extraprostatic extension, seminal vesicle involvement, positive surgical margins and a higher percent of positive biopsy cores (p <0.001). LVI was associated with metastases to regional lymph nodes and higher preoperative serum prostate specific antigen (p <0.001 and 0.004, respectively). PNI and LVI were associated with an increased risk of rapid biochemical progression after radical prostatectomy on univariate (p <0.001 and 0.001, respectively) but not on multivariate analysis. LVI was associated with shorter prostate specific antigen doubling time after biochemical progression (p = 0.012) and higher probabilities of failed local salvage radiation therapy (p = 0.0169), distant metastases (p <0.001) and death (p <0.001).
Only LVI is associated with metastases to regional and distant sites, and most importantly with overall survival. LVI and PNI are associated with established markers of biologically aggressive disease and rapid biochemical progression in patients who underwent radical prostatectomy. Our findings support the routine evaluation of LVI status in radical prostatectomy specimens and its inclusion in predictive models for clinical outcomes, since it appears to be a pathological marker of the lethal phenotype of prostate cancer.
我们研究了淋巴管和/或血管侵犯（LVI）或神经周围间隙侵犯（PNI）是否与前列腺癌的特征及预后相关。
共有630例连续的男性因临床局限性疾病接受了耻骨后根治性前列腺切除术。LVI和PNI检查是常规标本评估的一部分。
32例患者（5%）发现有LVI病灶，381例（60.5%）有PNI。LVI和PNI与临床分期T2疾病、更高的活检及最终Gleason评分、前列腺外侵犯、精囊受累、手术切缘阳性以及更高比例的活检阳性核心相关（p<0.001）。LVI与区域淋巴结转移及更高的术前血清前列腺特异性抗原相关（分别为p<0.001和0.004）。单因素分析显示，PNI和LVI与根治性前列腺切除术后快速生化进展风险增加相关（分别为p<0.001和0.001），但多因素分析未显示相关。LVI与生化进展后前列腺特异性抗原倍增时间缩短相关（p = 0.012），局部挽救性放疗失败、远处转移（p<0.001）及死亡（p<0.001）的概率更高。
只有LVI与区域和远处转移相关，最重要的是与总生存期相关。LVI和PNI与接受根治性前列腺切除术患者中具有生物学侵袭性疾病和快速生化进展的既定标志物相关。我们的研究结果支持在根治性前列腺切除标本中对LVI状态进行常规评估，并将其纳入临床结局预测模型，因为它似乎是前列腺癌致死表型的病理标志物。
