Muppa Prasuna, Gupta Sounak, Frank Igor, Boorjian Stephen A, Karnes R Jeffrey, Thompson R Houston, Thapa Prabin, Tarrell Robert F, Herrera Hernandez Loren P, Jimenez Rafael E, Cheville John C
Departments of Laboratory Medicine and Pathology, United States.
Department of Surgery, United States.
Pathology. 2017 Apr;49(3):259-266. doi: 10.1016/j.pathol.2016.12.347. Epub 2017 Mar 1.
In radical cystectomy specimens with bladder cancer, lymphatic and vascular invasion are often reported as 'angiolymphatic' or 'lymphovascular' invasion, terms that combine the findings of tumour within simple endothelial-lined lymphatic spaces and tumour within muscle-lined blood vessels. It is unclear if these patterns of invasion have different prognostic significance. In addition, there are conflicting data regarding the significance of lymphatic, vascular and perineural invasion in patients with bladder cancer. Herein, we studied 1504 patients treated by radical cystectomy for bladder cancer at our institution and followed for a mean of 10.6 years. Cases were re-reviewed by a urological pathologist for lymphatic invasion defined as tumour within a non-muscle-lined endothelial-lined lymphatic space, vascular invasion defined as tumour in a muscle-lined blood vessel, and perineural invasion defined as tumour within the perineural sheath. Associations of clinical and pathological features with bladder cancer death were evaluated using Cox proportional hazards regression models and summarised with hazard ratios and 95% confidence intervals. Survival was estimated by the Kaplan-Meier method. Multivariate analysis showed that lymphatic and vascular invasion but not perineural invasion were significantly associated with cancer specific survival (p<0.0001 and p=0.02, respectively). There was a significant association of lymphatic and vascular invasion but not perineural invasion with involved regional lymph nodes (p<0.0001 and p=0.004, respectively). In patients with metastasis to regional lymph nodes, lymphatic invasion remained significantly associated with outcome (p=0.02). The frequency of lymphatic and vascular invasion varied amongst histological subtypes of bladder cancer. Vascular and lymphatic invasion should be clearly defined and reported for radical cystectomy specimens containing bladder cancer.
在患有膀胱癌的根治性膀胱切除术标本中，淋巴管和血管侵犯通常被报告为“血管淋巴管”或“淋巴血管”侵犯，这些术语将肿瘤在单纯内皮衬里的淋巴间隙中的发现与肿瘤在肌性血管中的发现结合在一起。目前尚不清楚这些侵犯模式是否具有不同的预后意义。此外，关于膀胱癌患者淋巴管、血管和神经周围侵犯的意义，存在相互矛盾的数据。在此，我们研究了在我们机构接受根治性膀胱切除术治疗膀胱癌的1504例患者，平均随访10.6年。由泌尿外科病理学家对病例进行重新评估，以确定淋巴管侵犯（定义为肿瘤位于非肌性内皮衬里的淋巴间隙内）、血管侵犯（定义为肿瘤位于肌性血管内）和神经周围侵犯（定义为肿瘤位于神经鞘内）。使用Cox比例风险回归模型评估临床和病理特征与膀胱癌死亡的关联，并以风险比和95%置信区间进行总结。采用Kaplan-Meier法估计生存率。多变量分析显示，淋巴管和血管侵犯而非神经周围侵犯与癌症特异性生存显著相关（分别为p<0.0001和p=0.02）。淋巴管和血管侵犯而非神经周围侵犯与区域淋巴结受累显著相关（分别为p<0.0001和p=0.004）。在发生区域淋巴结转移的患者中，淋巴管侵犯仍与预后显著相关（p=0.02）。膀胱癌组织学亚型中淋巴管和血管侵犯的频率各不相同。对于含有膀胱癌的根治性膀胱切除术标本，应明确界定并报告血管和淋巴管侵犯情况。
