University of Padua, Padua, Italy.
Eur Urol. 2010 Jun;57(6):1064-71. doi: 10.1016/j.eururo.2009.12.029. Epub 2010 Jan 6.
Lymphovascular invasion (LVI) identified following pathologic slide review has been shown to be an independent predictor of recurrence-free survival (RFS) and cancer-specific survival (CSS) in a multicenter series of patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). However, the validity of LVI in everyday practice, where pathologic re-review of all slides is uncommon, has not been assessed.
Our aim was to evaluate the prognostic role of LVI in an international cohort of patients treated with RNU for UTUC without pathologic slide review.
DESIGN, SETTING, AND PARTICIPANTS: Data from 762 patients treated with RNU for UTUC without neoadjuvant chemotherapy were collected at nine centers located in Europe, Asia, and Canada.
We evaluated patients' characteristics, RFS, and CSS.
LVI was present in 148 patients (19.4%). At a median follow-up of 34 mo, 23.5% of the patients developed disease recurrence and 19.8% died of UTUC. The 5-yr RFS and CSS rates were 79.3% and 82.1%, respectively, in the absence of LVI compared with 45.1% and 45.8%, respectively, in the presence of LVI (p values <0.0001). On multivariable Cox regression analyses, LVI was an independent predictor of RFS (hazard ratio [HR]: 3.3; p=0.005) and CSS (HR: 5.9; p<0.0001). Similarly, among patients with pN0/Nx disease, LVI was an independent predictor of RFS (HR: 2.1; p=0.001) and CSS (HR: 2.3; p<0.0001).
In a large multicenter series of patients treated with RNU for UTUC and for which no pathologic slide review was performed, LVI was present in approximately 20% and was an independent predictor of both RFS and CSS. LVI status should always be included in the pathologic report of RNU specimens, and patients with LVI should be considered for adjuvant therapy studies.
在一项多中心接受根治性肾输尿管切除术（RNU）治疗上尿路上皮癌（UTUC）患者的系列研究中，病理切片复查后发现的淋巴血管侵犯（LVI）已被证实是无复发生存率（RFS）和癌症特异性生存率（CSS）的独立预测因素。然而，在日常实践中，病理切片复查并不常见，因此尚未评估 LVI 的有效性。
我们旨在评估 LVI 在未经病理切片复查的接受 RNU 治疗 UTUC 的国际患者队列中的预后作用。
设计、地点和参与者：在欧洲、亚洲和加拿大的 9 个中心收集了 762 例未经新辅助化疗接受 RNU 治疗 UTUC 的患者的数据。
我们评估了患者的特征、RFS 和 CSS。
148 例（19.4%）患者存在 LVI。在中位随访 34 个月时，23.5%的患者出现疾病复发，19.8%的患者死于 UTUC。在没有 LVI 的情况下，5 年 RFS 和 CSS 率分别为 79.3%和 82.1%，而在有 LVI 的情况下分别为 45.1%和 45.8%（p 值均<0.0001）。多变量 Cox 回归分析显示，LVI 是 RFS（风险比[HR]：3.3；p=0.005）和 CSS（HR：5.9；p<0.0001）的独立预测因素。同样，在 pN0/Nx 疾病患者中，LVI 是 RFS（HR：2.1；p=0.001）和 CSS（HR：2.3；p<0.0001）的独立预测因素。
在一项接受 RNU 治疗 UTUC 且未进行病理切片复查的大型多中心患者系列研究中，约 20%的患者存在 LVI，并且是 RFS 和 CSS 的独立预测因素。LVI 状态应始终包含在 RNU 标本的病理报告中，并且应考虑将存在 LVI 的患者纳入辅助治疗研究。
