Mitsuzuka K, Narita S, Koie T, Kaiho Y, Tsuchiya N, Yoneyama T, Kakoi N, Kawamura S, Tochigi T, Ohyama C, Habuchi T, Arai Y
1] Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan [2] Michinoku Japan Urological Cancer Study Group, Sendai, Japan.
1] Michinoku Japan Urological Cancer Study Group, Sendai, Japan [2] Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Prostate Cancer Prostatic Dis. 2015 Mar;18(1):25-30. doi: 10.1038/pcan.2014.40. Epub 2014 Oct 21.
The significance of lymphovascular invasion (LVI) remains controversial, and the association of LVI with biochemical relapse was investigated in men treated with radical prostatectomy according to pathological results.
Data from 1268 patients undergoing radical prostatectomy between 2000 and 2009 were retrospectively reviewed. Clinicopathological variables were compared between LVI-negative and LVI-positive patients. Multivariate analyses by Cox proportional hazard model and Kaplan-Meier method were performed to identify risk factors for biochemical relapse in all patients, patients with pT2N0 and pT2N0 negative resection margin (RM).
LVI information was available in 1160 cases, and LVI was seen in 121 cases (10.4%). Clinicopathological variables were significantly worse in LVI-positive patients than in LVI-negative patients. On multivariate analyses, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, pathological T stage ⩾3, lymph node metastasis, positive RM and LVI were independent predictors for biochemical relapse in all patients. In patients with pT2N0, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, positive RM and LVI were independent predictors for biochemical relapse. In patients with pT2N0 negative RM, LVI and pathological Gleason score ⩾8 were independent predictors for biochemical relapse (LVI; hazard ratio 3.809, 95% confidence interval 1.900-7.635, P-value<0.001, Gleason score ⩾8; hazard ratio 2.189, 95% confidence interval 1.199-3.999, P-value=0.011). With a median follow-up of 50 months, 5-year biochemical relapse-free survival in patients with pT2N0 negative RM was 95.7% in those with negative LVI in comparison to 85.3% in those with positive LVI (P<0.001, log rank).
LVI was consistently a significant predictor for biochemical relapse after radical prostatectomy in not only all patients but also in patients with pT2N0 and pT2N0 negative RM. These results strongly support the significance of LVI as a predictor for biochemical relapse.
淋巴管浸润（LVI）的意义仍存在争议，本研究根据病理结果对接受根治性前列腺切除术的男性患者中LVI与生化复发的相关性进行了调查。
回顾性分析了2000年至2009年间1268例行根治性前列腺切除术患者的数据。比较了LVI阴性和LVI阳性患者的临床病理变量。采用Cox比例风险模型和Kaplan-Meier方法进行多因素分析，以确定所有患者、pT2N0患者以及pT2N0且切缘阴性（RM）患者生化复发的危险因素。
1160例患者有LVI信息，其中121例（10.4%）存在LVI。LVI阳性患者的临床病理变量明显比LVI阴性患者差。多因素分析显示，在所有患者中，PSA⩾10 ng/ml(-1)、病理Gleason评分⩾8、病理T分期⩾3、淋巴结转移、RM阳性和LVI是生化复发的独立预测因素。在pT2N0患者中，PSA⩾10 ng/ml(-1)、病理Gleason评分⩾8、RM阳性和LVI是生化复发的独立预测因素。在pT2N0且RM阴性的患者中，LVI和病理Gleason评分⩾8是生化复发的独立预测因素（LVI；风险比3.809，95%置信区间1.900 - 7.635，P值<0.001，Gleason评分⩾8；风险比2.189，95%置信区间1.199 - 3.999，P值 = 0.011）。中位随访50个月，pT2N0且RM阴性患者中，LVI阴性者5年生化无复发生存率为95.7%，而LVI阳性者为85.3%（P<0.001，对数秩检验）。
LVI不仅在所有患者中，而且在pT2N0患者以及pT2N0且RM阴性的患者中，始终是根治性前列腺切除术后生化复发的重要预测因素。这些结果有力地支持了LVI作为生化复发预测因素的重要性。
