Lymphovascular Invasion Predicts Clinical Outcomes in Patients With Node-Negative Upper Tract Urothelial Carcinoma
Lymphovascular Invasion Predicts Clinical Outcomes in Patients With Node-Negative Upper Tract Urothelial Carcinoma
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DOI：
10.1200/jco.2008.17.2361
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发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
--
作者：
Kikuchi, Eiji;Margulis, Vitaly;Shariat, Shahrokh F.
PurposeTo评估淋巴管浸润（LVI）与癌症复发和生存的关系，在一个大型的国际系列的患者接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC.Patients and MethodsData收集了13个学术中心的1，453例接受RNU治疗的患者，并合并到一个相关数据库中。病理切片由泌尿生殖道病理学家根据严格的标准重新审查。LVI被定义为存在的肿瘤细胞内的内皮内衬spaces.ResultsLVI观察349例（24%）。LVI的比例随着肿瘤分期、肿瘤分级、肿瘤坏死、无蒂肿瘤结构和淋巴结转移的出现而增加（均P <0.001）。LVI是疾病复发和生存的独立预测因子（两者P <0.001）。在基础模型（包括病理分期、分级和淋巴结状态）中加入LVI，略微提高了疾病复发和生存的预测准确性（分别为1.1%，P = 0.03和1.7%，P = 0.001）。在淋巴结阴性和未行淋巴结切除术的患者中（n = 1,313），在基础模型中加入LVI使基础模型对疾病复发和生存的预测准确性提高了3%（两者均P <0.001）。与此相反，LVI与淋巴结阳性患者（n = 140）的疾病复发或生存率无关。结论LVI是非转移患者接受RNU UTUC的临床结局的独立预测因素。LVI的评估可能有助于确定哪些患者可以从RNU后的多模式治疗中获益。经证实后，LVI应纳入UTUC分期。
PurposeTo assess the association of lymphovascular invasion (LVI) with cancer recurrence and survival in a large international series of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC).Patients and MethodsData were collected on 1,453 patients treated with RNU at 13 academic centers and combined into a relational database. Pathologic slides were rereviewed by genitourinary pathologists according to strict criteria. LVI was defined as presence of tumor cells within an endothelium-lined space.ResultsLVI was observed in 349 patients (24%). Proportion of LVI increased with advancing tumor stage, high tumor grade, presence of tumor necrosis, sessile tumor architecture, and presence of lymph node metastasis (all P < .001). LVI was an independent predictor of disease recurrence and survival (P < .001 for both). Addition of LVI to the base model (comprising pathologic stage, grade, and lymph node status) marginally improved its predictive accuracy for both disease recurrence and survival (1.1%, P = .03; and 1.7%, P = .001, respectively). In patients with negative lymph nodes and those in whom a lymphadenectomy was not performed (n = 1,313), addition of LVI to the base model improved the predictive accuracy of the base model for both disease recurrence and survival by 3% (P < .001 for both). In contrast, LVI was not associated with disease recurrence or survival in node-positive patients (n = 140).ConclusionLVI was an independent predictor of clinical outcomes in nonmetastatic patients who underwent RNU for UTUC. Assessment of LVI may help identify patients who could benefit from multimodal therapy after RNU. After confirmation, LVI should be included in staging of UTUC.