Department of Urology, University of Bologna, S Orsola-Malpighi General Hospital, Pelagio Palagi 9 Street, 40138 Bologna, Italy.
Anticancer Res. 2010 Jul;30(7):2973-6.
Bladder cancer is the fourth most frequently diagnosed cancer among males and the eleventh among females. At present, radical cystectomy is considered the standard therapy in patients with muscle invasive disease or in some cases of high-grade superficial cancer. TNM classification includes as independent predictors of disease-specific survival the grade, the pathological stage and the presence of lymph node involvement, whilst the prognostic value of lymphovascular invasion (LVI) still remains controversial. The aim of the study was to assess the prognostic role of LVI at final pathology.
From June 1995 to January 2007, 340 consecutive patients underwent radical cystectomy. Surgical specimens were examined according to our pathological protocol. Patients with a non-transitional cell carcinoma or submitted to a salvage procedure or neoadjuvant/adjuvant chemo-radiotherapy were excluded. The follow-up consisted of abdominal ultrasound every 3 months, blood sampling every six months and both computerized tomography and urethroscopy yearly.
The median patient age was 69 years. Of the 265 patients, 218 were males and 47 females. LVI was present in 77 pathological specimens (29.1%). LVI was not significantly associated with age (p=0.908) or sex (p=0.382), but was significantly associated with high pathological grade (p=0.028) and stage (p<0.001), and the presence of node metastasis (p<0.001). At the multivariate analysis, pathological staging, presence of LVI and node metastasis were independent significant prognostic factors for disease-specific survival.
In our series, LVI is an independent prognostic factor for disease specific survival in patients who underwent radical cystectomy for transitional cell carcinoma.
膀胱癌是男性中第四大常见癌症，女性中则为第十一常见癌症。目前，根治性膀胱切除术被认为是肌层浸润性疾病或某些高级别表浅性癌症患者的标准治疗方法。TNM 分期将肿瘤分级、病理分期和淋巴结受累情况作为疾病特异性生存的独立预测因素，而淋巴血管侵犯（LVI）的预后价值仍存在争议。本研究旨在评估最终病理 LVI 的预后作用。
1995 年 6 月至 2007 年 1 月，连续 340 例患者接受了根治性膀胱切除术。手术标本根据我们的病理方案进行检查。排除非移行细胞癌患者、接受挽救性手术或新辅助/辅助放化疗的患者。随访包括每 3 个月进行一次腹部超声检查、每 6 个月进行一次血液采样以及每年进行一次计算机断层扫描和尿道镜检查。
患者中位年龄为 69 岁。在 265 例患者中，218 例为男性，47 例为女性。77 例病理标本中存在 LVI（29.1%）。LVI 与年龄（p=0.908）或性别（p=0.382）无显著相关性，但与高病理分级（p=0.028）和分期（p<0.001）以及淋巴结转移（p<0.001）显著相关。多因素分析显示，病理分期、LVI 存在和淋巴结转移是疾病特异性生存的独立显著预后因素。
在我们的系列中，LVI 是接受根治性膀胱切除术治疗移行细胞癌患者疾病特异性生存的独立预后因素。
