Akao Jumpei, Matsuyama Hideyasu, Yamamoto Yoshiaki, Hara Tomohiko, Kawai Yoshihisa, Sakano Shigeru, Ohmi Chietaka, Gondo Toshikazu, Naito Katsusuke
Department of Urology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
BJU Int. 2008 Aug 5;102(5):572-5. doi: 10.1111/j.1464-410X.2008.07749.x. Epub 2008 May 15.
To clarify the significance of lymphovascular invasion (LVI) in patients with pT3N0M0 upper urinary tract (UUT) urothelial carcinoma (UC) relative to prognosis in terms of disease-specific survival, as LVI, which implies both blood vessel and lymph vessel involvement, is reportedly a poor prognostic factor in patients with UUT-UC.
The clinical records of 90 patients who had surgery for UUT-UC were reviewed retrospectively. The median patient age was 71 years and the median follow-up was 42 months. The prognostic significances of LVI (with vs without), T stage (< 1 vs 2-4), grade (1-2 vs 3), N stage (0 vs 1-2), age (< or = 70 vs > 70 years), gender and tumour location (renal pelvis vs ureter) for survival time were evaluated.
LVI of UUT-UC was found in 34 patients (37.8%). There were significantly higher frequencies of LVI with advancing stage and lymph node metastasis. Kaplan-Meier analysis showed that LVI was strongly associated with disease-specific survival in all patients (P < 0.001) and in patients with pT3N0M0 disease (P < 0.001). Univariate analyses showed that LVI, T stage, N stage and tumour grade were significantly related to disease-specific survival in all patients (P < 0.001, < 0.001, 0.003 and 0.007, respectively). Multivariate analysis using Cox proportional hazards model showed that LVI was the only prognostic factor with independent significance for disease-specific survival (P < 0.001).
LVI appears to be an important and independent prognostic factor for UUT-UC in patients treated by nephroureterectomy. Our data suggest that the LVI status might be a predictive marker for disease-specific survival in patients with T3N0M0 UTT-UC.
鉴于血管淋巴管侵犯（LVI）（意味着同时累及血管和淋巴管）据报道是上尿路（UUT）尿路上皮癌（UC）患者的不良预后因素，故本研究旨在阐明pT3N0M0期UUT-UC患者中LVI相对于疾病特异性生存预后的意义。
回顾性分析90例行UUT-UC手术患者的临床记录。患者年龄中位数为71岁，中位随访时间为42个月。评估LVI（有或无）、T分期（<1期与2-4期）、分级（1-2级与3级）、N分期（0期与1-2期）、年龄（≤70岁与>70岁）、性别及肿瘤位置（肾盂与输尿管）对生存时间的预后意义。
90例患者中34例（37.8%）发现有UUT-UC的LVI。LVI的发生率随分期进展和淋巴结转移而显著升高。Kaplan-Meier分析显示，LVI与所有患者（P<0.001）及pT3N0M0期患者（P<0.001）的疾病特异性生存密切相关。单因素分析显示，LVI、T分期、N分期及肿瘤分级与所有患者的疾病特异性生存均显著相关（分别为P<0.001、<0.001、0.003及0.007）。使用Cox比例风险模型进行的多因素分析显示，LVI是疾病特异性生存唯一具有独立意义的预后因素（P<0.001）。
对于接受肾输尿管切除术治疗的UUT-UC患者，LVI似乎是一个重要且独立的预后因素。我们的数据表明，LVI状态可能是T3N0M0期UUT-UC患者疾病特异性生存的预测指标。
