Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Department of Urology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000 Rennes, France.
Nat Rev Urol. 2016 Aug;13(8):471-9. doi: 10.1038/nrurol.2016.126. Epub 2016 Jul 19.
Outcome prediction in patients with bladder cancer has improved through the development of nomograms and predictive models. However, integration of further characteristics such as lymphovascular invasion (LVI) might increase the accuracy and clinical utility of these instruments. Assessment and reporting of LVI in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy in patients with non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) might enable improved staging, prognostication and clinical decision-making. In NMIBC, presence of LVI in TURBT and biopsy samples seems to be associated with understaging and increased risks of disease recurrence and progression. In MIBC, presence of LVI is associated with features of aggressive disease and predicts recurrence and survival. Integration of LVI status into predictive models might aid clinical decision-making regarding intravesical instillation schedules and regimens, early radical cystectomy in patients with high-grade T1 disease and perioperative chemotherapy. However, LVI assessment is hampered by insufficient reproducibility and reliability, lack of routine evaluation and limited concordance between findings in TURBT and radical cystectomy specimens. Standardization of the pathological criteria defining LVI is warranted to improve its reporting in routine clinical practice and its utility as a care-changing prognostic marker.
通过列线图和预测模型的发展，膀胱癌患者的预后预测得到了改善。然而，进一步整合诸如淋巴血管侵犯（LVI）等特征可能会提高这些工具的准确性和临床实用性。在非肌肉浸润性膀胱癌（NMIBC）或肌肉浸润性膀胱癌（MIBC）患者的经尿道膀胱肿瘤切除术（TURBT）或活检标本中评估和报告 LVI ，可能会改善分期、预后和临床决策。在 NMIBC 中，TURBT 和活检样本中存在 LVI 似乎与分期不足以及疾病复发和进展的风险增加有关。在 MIBC 中，LVI 的存在与侵袭性疾病的特征有关，并预测复发和生存。将 LVI 状态纳入预测模型可能有助于辅助临床决策，包括膀胱内灌注方案和方案、高级别 T1 疾病患者的早期根治性膀胱切除术以及围手术期化疗。然而，LVI 评估受到重现性和可靠性不足、常规评估缺乏以及 TURBT 和根治性膀胱切除术标本之间发现的一致性有限的阻碍。有必要标准化病理标准定义 LVI，以提高其在常规临床实践中的报告质量，并提高其作为改变治疗预后的标志物的实用性。
