Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Sci Rep. 2018 Oct 29;8(1):15928. doi: 10.1038/s41598-018-34299-6.
To determine the prognostic value of lymphovascular invasion (LVI) in patients with bladder cancer who underwent radical cystectomy. Total of 747 patients underwent radical cystectomy; of these, only 164 did not undergo lymph node dissection (LND). The patients were divided into 4 groups: N0, N1, LVI without LND, and non-LVI without LND. Patients in the N1 and LVI groups had significantly higher T stages and grades, as well 1.5- to 2-fold higher recurrence and mortality rates. Overall survival (OS) was significantly poorer in the N1 group, compared with the N0 and non-LVI groups (p = 0.001 and 0.012), and in the LVI group relative to the N0 and non-LVI groups (p = < 0.001 and <0.001). Recurrence-free survival (RFS) was also significantly poorer in the N1 group relative to the N0 and non-LVI groups (p = < 0.001 and <0.001), and in the LVI group relative to the N0 and non-LVI groups (p = < 0.001 and <0.001). Among patients undergoing radical cystectomy, the clinical results predicted by LVI were similar to those predicted by lymph node involvement. Therefore, the role of adjuvant chemotherapy or immunotherapy may need to be prospectively evaluated in LVI-positive patients regardless of T stage after radical cystectomy.
为了确定接受根治性膀胱切除术的膀胱癌患者中淋巴管浸润（LVI）的预后价值。共有 747 名患者接受了根治性膀胱切除术；其中，只有 164 名患者未行淋巴结清扫术（LND）。患者被分为 4 组：N0、N1、无 LND 的 LVI 和无 LND 的非 LVI。N1 组和 LVI 组患者的 T 分期和分级明显更高，复发率和死亡率也高出 1.5-2 倍。与 N0 和非 LVI 组相比，N1 组的总生存率（OS）明显更差（p=0.001 和 0.012），与 N0 和非 LVI 组相比，LVI 组的 OS 也更差（p<0.001 和 <0.001）。与 N0 和非 LVI 组相比，N1 组的无复发生存率（RFS）也明显更差（p<0.001 和 <0.001），与 N0 和非 LVI 组相比，LVI 组的 RFS 也更差（p<0.001 和 <0.001）。在接受根治性膀胱切除术的患者中，LVI 预测的临床结果与淋巴结受累预测的结果相似。因此，无论根治性膀胱切除术后 T 分期如何，LVI 阳性患者可能需要前瞻性评估辅助化疗或免疫治疗的作用。
