Karwacki Jakub, Łątkowska Małgorzata, Jarocki Michał, Jaworski Arkadiusz, Szuba Przemysław, Poterek Adrian, Lemiński Artur, Kaczmarek Krystian, Hałoń Agnieszka, Szydełko Tomasz, Małkiewicz Bartosz
Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
Department of Ophthalmology, Wrocław Medical University, Wrocław, Poland.
Front Oncol. 2024 May 3;14:1349536. doi: 10.3389/fonc.2024.1349536. eCollection 2024.
Lymphovascular invasion (LVI) is a pivotal histopathological parameter in prostate cancer (PCa), holding significant prognostic implications. Our study pursued a dual objective: firstly, to identify preoperative factors associated with LVI, aiming to unveil markers facilitating the recognition of patients prone to LVI during postoperative examination; and secondly, to assess postoperative outcomes correlated with LVI.
We retrospectively analyzed 861 nonmetastatic PCa patients who underwent radical prostatectomy (RP), investigating preoperative factors and postoperative outcomes. Surgical specimens were processed following established guidelines. Statistical analyses utilized non-parametric tests to assess the association between LVI and both pre- and postoperative factors. Furthermore, logistic regression analyses were utilized to develop models aimed at identifying the most significant predictors of LVI and pN1 status, respectively.
Numerous preoperative factors exhibited significant correlations with LVI, offering valuable clinical insights. Logistic regression identified magnetic resonance imaging (MRI)-based clinical tumor stage (cT) 3-4, biopsy Gleason Grading Group (GGG) 3-5, preoperative prostate specific antigen (PSA) ≥20 and percentage of positive biopsy cores (PPBC) ≥50% as the strongest preoperative predictors of LVI. Additionally, the study uncovered an association between LVI and postoperative outcomes, including postoperative PSA ( value <0.001), extracapsular extension (ECE) (<0.001), positive surgical margins (PSM) (<0.001), perineural invasion (PNI) (<0.001), pathological tumor stage (pT) (<0.001), pathological lymph node status (pN) (<0.001), postoperative GGG (<0.001), and operative time (0.023). Notably, the study revealed a novel and substantial association between LVI and an increased number of positive lymph nodes in pN+ patients in the univariate analysis (<0.001). Furthermore, we have found an association between LVI and pN1 status in the logistic regression analysis (odds ratio [OR] = 23.905; 0.001).
Our findings underscore the pivotal role of LVI in influencing the prognosis of prostate cancer (PCa). The study acknowledges the challenges associated with preoperative LVI assessment and emphasizes the need for future research to unravel the factors associated with this histopathological finding. Significantly, our research stands out as the first, to the best of our knowledge, to reveal the association between LVI and the number of positive lymph nodes in pN+ patients.
淋巴管侵犯（LVI）是前列腺癌（PCa）的一个关键组织病理学参数，具有重要的预后意义。我们的研究有两个目标：第一，确定与LVI相关的术前因素，旨在揭示有助于在术后检查中识别易发生LVI患者的标志物；第二，评估与LVI相关的术后结果。
我们回顾性分析了861例行根治性前列腺切除术（RP）的非转移性PCa患者，调查术前因素和术后结果。手术标本按照既定指南进行处理。统计分析采用非参数检验来评估LVI与术前和术后因素之间的关联。此外，采用逻辑回归分析分别建立旨在识别LVI和pN1状态最重要预测因素的模型。
众多术前因素与LVI表现出显著相关性，提供了有价值的临床见解。逻辑回归确定基于磁共振成像（MRI）的临床肿瘤分期（cT）3 - 4、活检Gleason分级组（GGG）3 - 5、术前前列腺特异性抗原（PSA）≥20以及阳性活检核心百分比（PPBC）≥50%是LVI最强的术前预测因素。此外，该研究发现LVI与术后结果之间存在关联，包括术后PSA（P值<0.001）、包膜外侵犯（ECE）（P<0.001）、手术切缘阳性（PSM）（P<0.001）、神经周围侵犯（PNI）（P<0.001）、病理肿瘤分期（pT）（P<0.001）、病理淋巴结状态（pN）（P<0.001）、术后GGG（P<0.001）和手术时间（P = 0.023）。值得注意的是，该研究在单因素分析中揭示了LVI与pN +患者阳性淋巴结数量增加之间存在新的显著关联（P<0.001）。此外，我们在逻辑回归分析中发现LVI与pN1状态之间存在关联（优势比[OR] = 23.905；P = 0.001）。
我们的研究结果强调了LVI在影响前列腺癌（PCa）预后方面的关键作用。该研究认识到术前LVI评估存在的挑战，并强调未来研究需要阐明与这一组织病理学发现相关的因素。重要的是，据我们所知，我们的研究首次揭示了LVI与pN +患者阳性淋巴结数量之间的关联。
