Vattikuti Urology Institute Center for Outcomes Research, Analytics, and Evaluation (VCORE), Henry Ford Hospital, Detroit, MI; Wayne State University School of Medicine, Detroit, MI.
Department of Urology, Baylor College of Medicine, Houston, TX.
Urol Oncol. 2023 Oct;41(10):435.e1-435.e9. doi: 10.1016/j.urolonc.2023.07.011. Epub 2023 Aug 23.
Lymph-vascular invasion (LVI) is recognized as an adverse pathological feature in patients with renal cell carcinoma (RCC). However, its impact on overall survival (OS) is not clear and scarcely addressed in the literature. We aimed to assess the prognostic ability of LVI as a predictor of OS in RCC patients using a large, North American cohort.
We included 95,783 cM0 RCC patients, diagnosed between 2010 and 2015, who underwent partial or radical nephrectomy within the National Cancer Database. Kaplan-Meier curves and log-rank tests were used to depict and compare survival curves. Cox regression analysis tested the impact of LVI on OS, after adjusting for all available confounders.
Mean age (SD) was 59 (12), and most patients had pT1 stage (72.2%). Nodal status was pN0, pN1, and pNx, in 14.5%, 2.3%, and 83.3%, respectively. Overall, 9.0% of patients had LVI. The mean (SD) follow-up of the cohort was 39 months (24). At 5 years, OS was 65% in patients with LVI vs. 86% in patients without LVI (p<.0001). When patients were stratified based on nodal stage, these rates were 64% vs. 78% in pN0 patients, 31% vs. 41% in pN1 patients, and 69% vs. 87% in pNx patients (all P < 0.001). On multivariable analysis, and in comparison to patients without LVI, those with LVI had 1.37- (P < 0.001), 1.18- (P = 0.068), and 1.53-fold (P < 0.001) greater risk of death, when also harboring pN0, pN1, and pNx disease, respectively.
Our findings are the first, to our best knowledge, to illustrate the clear detrimental impact of LVI on OS in surgically treated RCC patients. These findings might be useful in postoperative patient counseling and need to be accounted for when designing future clinical trials.
淋巴血管侵犯（LVI）被认为是肾细胞癌（RCC）患者的一种不良病理特征。然而，其对总生存（OS）的影响尚不清楚，文献中也很少涉及。我们旨在使用大型北美队列评估 LVI 作为 RCC 患者 OS 预测指标的预后能力。
我们纳入了 95783 例 cM0 RCC 患者，这些患者于 2010 年至 2015 年间在国家癌症数据库中接受了部分或根治性肾切除术。Kaplan-Meier 曲线和对数秩检验用于描绘和比较生存曲线。Cox 回归分析测试了 LVI 对 OS 的影响，同时调整了所有可用的混杂因素。
平均年龄（标准差）为 59（12）岁，大多数患者为 pT1 期（72.2%）。淋巴结状态为 pN0、pN1 和 pNx，分别占 14.5%、2.3%和 83.3%。总体而言，9.0%的患者有 LVI。该队列的平均（标准差）随访时间为 39 个月（24）。5 年时，LVI 患者的 OS 为 65%，而无 LVI 患者的 OS 为 86%（p<.0001）。当根据淋巴结分期对患者进行分层时，pN0 患者的这些比率为 64% vs. 78%，pN1 患者为 31% vs. 41%，pNx 患者为 69% vs. 87%（均 P<.001）。多变量分析显示，与无 LVI 患者相比，同时患有 pN0、pN1 和 pNx 疾病的患者发生 LVI 的死亡风险分别增加了 1.37 倍（P<.001）、1.18 倍（P=0.068）和 1.53 倍（P<.001）。
据我们所知，我们的研究结果首次表明，LVI 对接受手术治疗的 RCC 患者的 OS 有明显的不利影响。这些发现可能对术后患者咨询有用，并且在设计未来临床试验时需要考虑到这一点。
