Cheng Liang, Jones Timothy D, Lin Haiqun, Eble John N, Zeng Gordon, Carr Matthew D, Koch Michael O
Departments of Pathology and Laboratory Medicine, Indiana University School of Medicine, Medical Center, University Hospital 3465, 550 North University Boulevard, Indianapolis, IN 46202, USA.
J Urol. 2005 Dec;174(6):2181-5. doi: 10.1097/01.ju.0000181215.41607.c3.
Gleason grade and tumor stage are well established prognostic factors in prostate cancer. Histological demonstration of tumor in lymphovascular spaces has been associated with poor prognosis in many tumor types but it is not included in current prostate cancer grading and staging schemes. Whether lymphovascular invasion is an independent prognostic factor for disease progression in prostate cancer is uncertain. We retrospectively investigated lymphovascular invasion as a predictive factor for biochemical failure and cancer specific survival following radical prostatectomy.
The records of 504 patients with prostatic adenocarcinoma undergoing radical prostatectomy were reviewed for lymphovascular invasion. Clinical followup data were available on 459 cases. Mean followup was 44 months (range 1.5 to 144). Multivariate analysis was performed using the Cox model.
Lymphovascular invasion was identified in 106 cases (21%). Univariate analysis showed a significant association between lymphovascular invasion and higher preoperative serum prostate specific antigen (PSA), advanced pathological stage, higher Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion, lymph node metastasis and perineural invasion (each p <0.001). No association was observed between lymphovascular invasion and patient age at surgery, prostate weight or high grade prostatic intraepithelial neoplasia. Lymphovascular invasion was an independent predictor of PSA recurrence (HR 1.6, 95% CI 1.12 to 2.38, p = 0.01) and cancer specific survival (HR 2.75, 95% CI 1.04 to 2.28, p = 0.041) after controlling for tumor stage, surgical margins and Gleason grade on multivariate analysis. Five-year cancer specific survival was 90% in men with lymphovascular invasion compared to 98% in those without lymphovascular invasion (p <0.001).
Lymphovascular invasion can be identified in approximately 20% of prostate cancer cases. Lymphovascular invasion is an independent risk factor for PSA recurrence and cancer death in patients with prostate cancer.
Gleason分级和肿瘤分期是前列腺癌中已明确的预后因素。肿瘤在淋巴管间隙中的组织学表现与许多肿瘤类型的不良预后相关，但目前前列腺癌的分级和分期方案中并未包含这一因素。淋巴管侵犯是否为前列腺癌疾病进展的独立预后因素尚不确定。我们回顾性研究了淋巴管侵犯作为根治性前列腺切除术后生化复发和癌症特异性生存的预测因素。
回顾504例行根治性前列腺切除术的前列腺腺癌患者的记录以评估淋巴管侵犯情况。459例患者有临床随访数据。平均随访时间为44个月（范围1.5至144个月）。使用Cox模型进行多变量分析。
106例（21%）患者存在淋巴管侵犯。单变量分析显示，淋巴管侵犯与术前血清前列腺特异性抗原（PSA）水平较高、病理分期较晚、Gleason评分较高、手术切缘阳性、前列腺外侵犯、精囊侵犯、淋巴结转移及神经周围侵犯均显著相关（均p<0.001）。未观察到淋巴管侵犯与患者手术年龄、前列腺重量或高级别前列腺上皮内瘤变之间存在关联。在多变量分析中，在控制肿瘤分期、手术切缘和Gleason分级后，淋巴管侵犯是PSA复发（风险比1.6，95%置信区间1.12至2.38，p = 0.01）和癌症特异性生存（风险比2.75，95%置信区间1.04至2.28，p = 0.041）的独立预测因素。有淋巴管侵犯的男性患者5年癌症特异性生存率为90%，无淋巴管侵犯的患者为98%（p<0.001）。
约20%的前列腺癌病例可发现淋巴管侵犯。淋巴管侵犯是前列腺癌患者PSA复发和癌症死亡的独立危险因素。
