Musso Giacomo, Garofano Giuseppe, Dabbas Mai, Meagher Margaret F, Yuen Kit L, Birouty Natalie, Baker Benjamin, Saitta Cesare, Guer Melis, Montorsi Francesco, Briganti Alberto, Capitanio Umberto, Larcher Alessandro, Salonia Andrea, Derweesh Ithaar H
IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI), Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
Clin Genitourin Cancer. 2025 Oct;23(5):102412. doi: 10.1016/j.clgc.2025.102412. Epub 2025 Aug 7.
Lymphovascular invasion (LVI) is a recognized adverse pathological feature in renal cell carcinoma (RCC). However, its impact on staging and prognosis remains poorly defined, especially across T-stage subcategories.
We analyzed surgically treated RCC patients from the National Cancer Database (NCDB), including clear cell, papillary and chromophobe RCCs. Data on pathological T-stage and LVI status were retrieved, with overall survival (OS) as the primary outcome. Kaplan-Meier curves (KMA) and log-rank test evaluated survival differences between T-stages with and without LVI. Univariable and multivariable Cox Proportional Hazard Model (CoxPH) were fitted to test the association between LVI and All-cause Mortality (ACM) and the interaction term between LVI and T-stage. Forest plots and regression lines from the CoxPH interaction hazard ratios (HR) illustrated the impact of LVI across T-stages.
Among 159,387 RCC patients, 11.3% showed LVI. LVI was associated with larger and higher-grade tumors, and increased rates of nodal and metastatic disease (P < .001). KMA showed significantly lower 5-year OS among LVI-positive versus LVI-negative patients (61% vs. 85%; P < .001). Across T stages, LVI conferred a "functional upstaging" with survival of T1a+LVI approximating T1b, T1b+LVI resembling T2, T2+LVI approximating T3, and T3a+LVI mirroring T3b outcomes. At univariable and multivariable CoxPH, LVI was an independent predictor of ACM (P < .001), with forest plots indicating its highest relative impact in earlier T-stages.
LVI is an aggressive pathological feature in RCC that impairs survival, especially in lower-stage tumors. Incorporating LVI status into RCC staging may refine risk stratification and guide more intensive surveillance and adjuvant management, particularly for patients with early T-stage disease.
淋巴管浸润（LVI）是肾细胞癌（RCC）中公认的不良病理特征。然而，其对分期和预后的影响仍不明确，尤其是在各个T分期亚组中。
我们分析了来自国家癌症数据库（NCDB）的接受手术治疗的RCC患者，包括透明细胞癌、乳头状癌和嫌色细胞癌。检索了病理T分期和LVI状态的数据，以总生存期（OS）作为主要结局。采用Kaplan-Meier曲线（KMA）和对数秩检验评估有无LVI的T分期之间的生存差异。拟合单变量和多变量Cox比例风险模型（CoxPH）以检验LVI与全因死亡率（ACM）之间的关联以及LVI与T分期之间的交互项。CoxPH交互风险比（HR）的森林图和回归线说明了LVI在各个T分期中的影响。
在159,387例RCC患者中，11.3%表现出LVI。LVI与更大、更高分级的肿瘤以及淋巴结和转移疾病发生率增加相关（P < 0.001）。KMA显示LVI阳性患者的5年OS显著低于LVI阴性患者（61%对85%；P < 0.001）。在各个T分期中，LVI导致“功能上的分期上调”，T1a + LVI的生存期接近T1b，T1b + LVI类似于T2，T2 + LVI接近T3，T3a + LVI反映T3b的结局。在单变量和多变量CoxPH分析中，LVI是ACM的独立预测因素（P < 0.001），森林图表明其在早期T分期中的相对影响最大。
LVI是RCC中的一种侵袭性病理特征，会损害生存，尤其是在低分期肿瘤中。将LVI状态纳入RCC分期可能会优化风险分层，并指导更密集的监测和辅助治疗管理，特别是对于早期T分期疾病的患者。
