Streeper Necole M, Simons Christopher M, Konety Badrinath R, Muirhead DeSirae M, Williams Richard D, O'Donnell Michael A, Joudi Fadi N
Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA.
BJU Int. 2009 Feb;103(4):475-9. doi: 10.1111/j.1464-410X.2008.08011.x. Epub 2008 Oct 6.
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.
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).
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).
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.
检验以下假设，即在经尿道膀胱肿瘤切除术（TURBT）和根治性膀胱切除术（RC）标本中有淋巴管侵犯（LVI）证据的膀胱癌患者预后较差且临床分期不足的可能性更高，并评估在RC时发现的LVI对随后疾病相关死亡率的影响，因为LVI在接受膀胱尿路上皮癌治疗患者的TURBT或RC标本中的预后意义尚未完全明确。
我们回顾性分析了1995年至2005年间在我院就诊的163例膀胱尿路上皮癌患者的记录，这些患者接受了TURBT（69例）或RC（94例）。我们将TURBT和/或RC标本中有LVI的患者与TURBT（34例）或RC（32例）中无LVI的一组对照患者进行比较。
TURBT标本中有LVI的患者的疾病特异性生存期短于无LVI的患者，5年生存率分别为33.6%和62.9%（对数秩检验P = 0.027；风险比2.21）。TURBT时的LVI随临床分期而异（P = 0.049）。临床分期为I期或II期且有LVI的患者的生存率低于无LVI的患者（P = 0.049；风险比2.68）。LVI对临床分期为III期或IV期的患者的生存率无影响（P = 0.29）。与无LVI的患者相比，TURBT时有LVI的患者临床分期不足有一定趋势（75%对46%），但差异无统计学意义（P = 0.086）。RC标本中检测到LVI的患者癌症复发的可能性显著高于无LVI证据的患者（48%对19%，P = 0.006）。对于RC组，有LVI证据的患者与无LVI证据的患者的生存分布也有显著差异（5年生存率45.5%对78.4%，P = 0.017）。有LVI的患者死于该疾病的可能性显著高于无LVI的患者（P = 0.017；风险比2.92）。
我们的研究结果表明，LVI是一种组织学特征，可能与膀胱尿路上皮癌患者预后较差有关。TURBT标本中存在LVI预示着I期或II期疾病患者生存期较短。RC标本中存在LVI预示着疾病复发和生存期较短。需要进一步研究以确定这组患者是否能从早期RC和/或围手术期化疗中获益以改善临床结局。
