Fajkovic Harun, Mathieu Romain, Lucca Ilaria, Hiess Manuela, Hübner Nicolai, Al Hussein Al Awamlh Bashir, Lee Richard, Briganti Alberto, Karakiewicz Pierre, Lotan Yair, Roupret Morgan, Rink Michael, Kluth Luis, Loidl Wolfgang, Seitz Christian, Klatte Tobias, Kramer Gero, Susani Martin, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France.
Urol Oncol. 2016 May;34(5):233.e1-6. doi: 10.1016/j.urolonc.2015.10.013. Epub 2016 Mar 10.
To validate the impact of lymphovascular invasion (LVI) on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) in a large multiinstitutional cohort.
Retrospective data from 6,678 patients treated with a RP and bilateral lymphadenectomy for prostate cancer (PC) from 8 centers were collected. The primary endpoint was BCR.
Overall, 767 patients (11.5%) had LVI. Patients with LVI had significantly higher Gleason scores (P = 0.01). After a median follow-up of 28 months (interquartile range: 21-44), patients with LVI had a 1.66 fold increased risk of BCR (P<0.001). The 1-, 2- and 5-year biochemical recurrence-free survival probabilities for LVI vs. no LVI were 94% vs. 97%, 91% vs. 94%, and 76% vs. 84%, respectively. On multivariable analysis that adjusted for the effects of established prognostic factors, LVI was an independent predictor of BCR (hazard ratio = 1.42, P<0.001). Adding LVI to a multivariable base model increased the discrimination by a small but significant margin (+0.2%, P = 0.0005). In subgroup analyses, LVI remained an independent predictor for BCR in patients with worse pathological features.
About 10% of patients with localized PC have LVI on their RP specimen. We confirm that LVI is associated with features of biologic aggressive PC such as high Gleason grade and BCR after RP. Adverse further studies with strict definitions of LVI and longer follow-up periods are needed to determine the prognostic and predictive utility of LVI in the management of PC.
在一个大型多机构队列中，验证淋巴结血管浸润（LVI）对接受根治性前列腺切除术（RP）患者生化复发（BCR）的影响。
收集来自8个中心的6678例接受RP及双侧淋巴结清扫术治疗前列腺癌（PC）患者的回顾性数据。主要终点为BCR。
总体而言，767例患者（11.5%）存在LVI。有LVI的患者Gleason评分显著更高（P = 0.01）。中位随访28个月（四分位间距：21 - 44个月）后，有LVI的患者BCR风险增加1.66倍（P<0.001）。有LVI与无LVI患者的1年、2年和5年无生化复发生存概率分别为94%对97%、91%对94%和76%对84%。在对既定预后因素的影响进行校正的多变量分析中，LVI是BCR的独立预测因素（风险比 = 1.42，P<0.001）。将LVI添加到多变量基础模型中可使判别能力有小幅但显著的提高（+0.2%，P = 0.0005）。在亚组分析中，LVI在病理特征较差的患者中仍是BCR的独立预测因素。
约10%的局限性PC患者的RP标本存在LVI。我们证实LVI与生物学侵袭性PC的特征相关，如高Gleason分级及RP后的BCR。需要进行关于LVI严格定义及更长随访期的进一步研究，以确定LVI在PC管理中的预后和预测效用。
