Sathianathen Niranjan J, Furrer Marc A, Mulholland Clancy J, Katsios Andreas, Soliman Christopher, Lawrentschuk Nathan, Peters Justin S, Zargar Homi, Costello Anthony J, Hovens Christopher M, Bishop Conrad, Rao Ranjit, Tong Raymond, Steiner Daniel, Moon Daniel, Thomas Benjamin C, Dundee Philip, Calero Jose Antonio Rodriguez, Thalmann George N, Corcoran Niall M
Department of Urology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia.
Department of Urology, University of Bern, 3010 Bern, Switzerland.
Cancers (Basel). 2023 Dec 26;16(1):123. doi: 10.3390/cancers16010123.
Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% ( = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease ( < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.
淋巴管浸润是指在淋巴管或血管腔内发现肿瘤细胞或细胞团，被认为是疾病播散的关键步骤。在一系列癌症中，它已被确立为独立的不良预后指标。因此，我们旨在评估前列腺切除时淋巴管浸润对肿瘤学结局的影响。我们对3495例因局限性前列腺癌接受根治性前列腺切除术的男性进行了一项多中心回顾性队列研究。仅纳入术前分期为阴性的男性。我们使用多变量逻辑回归模型评估淋巴管浸润与不良病理特征之间的关系。绘制Kaplan-Meier曲线和Cox比例风险模型以评估淋巴管浸润对肿瘤学结局的影响。在接受前列腺切除术的男性中，19%（n = 653）被发现有淋巴管浸润。国际泌尿病理学会（ISUP）高分级和非器官局限性疾病的男性中，淋巴管浸润阳性疾病的发生率增加（P < 0.01）。在多变量逻辑回归分析中，淋巴管浸润的存在显著增加了病理淋巴结阳性疾病的可能性（OR 15，95%CI 9.7 - 23.6）。根治性前列腺切除时淋巴管浸润的存在显著增加了生化复发的风险（HR 2.0，95%CI 1.6 - 2.4）。此外，淋巴管浸润在整个队列中显著增加了转移风险（HR 2.2，95%CI 1.6 - 3.0）。在D'Amico风险组中也观察到了相同的关系。根治性前列腺切除时淋巴管浸润的存在与侵袭性前列腺癌疾病特征相关，是不良肿瘤学预后的指标。
