University of Texas Southwestern Medical Center, Dallas, Texas, USA.
BJU Int. 2010 May;105(10):1402-12. doi: 10.1111/j.1464-410X.2010.09217.x. Epub 2010 Feb 2.
To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).
We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium-lined space.
LVI was detected in 1407 patients (33.1%); the proportion of LVI increased with advancing stage, higher grade, soft-tissue surgical margin involvement, and lymph node metastasis (P < 0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P < 0.001) and cancer-specific mortality (1.45, P < 0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer-specific mortality (by 1.1% and 1.2%, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P < 0.001; +2.3%) and cancer-specific mortality (1.70, P < 0.001; +2.4%). By contrast, in 1071 node-positive patients, LVI only marginally improved the prediction of cancer-specific recurrence (hazard ratio 1.20, P < 0.001; +0.2%) and survival (1.23, P < 0.001; +0.5%).
LVI is strongly associated with clinical outcome in node-negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB.
在一个接受根治性膀胱切除术(RC)治疗的大型国际膀胱癌患者队列中,对淋巴管浸润(LVI)的预后价值进行外部验证。
我们收集了 12 个中心的 4257 例未接受新辅助化疗的膀胱癌患者接受 RC 和盆腔淋巴结清扫术的数据。LVI 的定义为肿瘤细胞巢位于内皮衬里的空间内。
1407 例(33.1%)患者检测到 LVI;随着分期的进展、分级的提高、软组织手术切缘受累和淋巴结转移,LVI 的比例增加(所有 P < 0.001)。在标准多变量模型中,LVI 与疾病复发(风险比 1.43,P < 0.001)和癌症特异性死亡率(1.45,P < 0.001)相关。在整个队列中,将 LVI 添加到包含标准特征的基础模型中,仅略微提高了其对复发和癌症特异性死亡率的预测准确性(分别提高了 1.1%和 1.2%)。在 3122 例淋巴结阴性患者中,LVI 仍然与复发的标准预测因子独立相关,并提高了其预测准确性(风险比 1.68,P < 0.001;增加 2.3%)和癌症特异性死亡率(1.70,P < 0.001;增加 2.4%)。相比之下,在 1071 例淋巴结阳性患者中,LVI 仅略微改善了癌症特异性复发(风险比 1.20,P < 0.001;增加 0.2%)和生存(1.23,P < 0.001;增加 0.5%)的预测。
LVI 与接受 RC 治疗的淋巴结阴性患者的临床结果密切相关。LVI 的评估可能有助于识别接受 RC 后可能受益于辅助治疗的患者。在不同人群中得到确认后,LVI 应被纳入膀胱癌的分期。