Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T1 disease and negative lymph nodes after radical cystectomy
Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T1 disease and negative lymph nodes after radical cystectomy
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DOI：
10.1111/j.1464-410x.2012.11455.x
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发表时间：
2013-06-01
影响因子：
4.5
通讯作者：
Gupta, Amit
中科院分区：
文献类型：
--
作者：
Tilki, Derya;Shariat, Shahrokh F.;Gupta, Amit
关于这个问题有什么进展？这项研究增加了什么？血管浸润（LVI）是全身性癌细胞扩散的重要步骤。对于浸润膀胱肌的膀胱尿路上皮癌（UCB）患者，LVI已被证明是疾病复发和癌症特异性生存的独立预测因子。尚未对接受根治性膀胱切除术（RC）的最终病理分期为T1 N 0 UCB的患者单独分析LVI对结局的影响。目的探讨膀胱尿路上皮癌（UCB）根治性膀胱切除术（RC）后T1 N 0期患者的预后，以及淋巴血管浸润（LVI）是否与肿瘤复发和肿瘤特异性生存有关。患者与方法回顾性分析了在三个学术中心接受RC的958例连续患者的记录，共101例淋巴结阴性和终末期患者，T1期UCB（术前临床/经尿道电切术[TUR]和术后病理分期中较高者）。中位（范围）随访时间为38（0.4-177）个月，检查的淋巴结的中位数（范围）为19（9-80）。12/101（11.9%）例患者发生癌症复发，7/101（6.9%）例患者死于癌症。3年无复发生存率（SD）为0.89（0.04）和3年癌症特异性生存概率（SD）为0.96 101例患者中有6例（6%）有LVI，其中4例复发，3例死于膀胱癌。所有复发和死亡均发生在LVI和/或LVI患者中。或伴随原位癌。在多变量分析中，（风险比[HR] 4.9，P = 0.01）和较高的病理分期（HR 8.5，P = 0.04）预测癌症复发和LVI（HR 6.7，P = 0.01）预测的癌症-结论LVI有助于识别具有最终病理性T1 N 0 UCB的患者，这些患者的膀胱癌复发和死亡风险显著增加。应考虑在术后进行密切监测。
What's known on the subject? and What does the study add? Lymphovascular invasion (LVI) is an important step in systemic cancer cell dissemination. LVI has been shown to be an independent predictor of disease recurrence and cancer-specific survival in urothelial carcinoma of the bladder (UCB) for patients with carcinoma invading bladder muscle. Patients with final pathological stage T1N0 UCB who underwent radical cystectomy (RC) have not been separately analysed for influence of LVI on outcomes. Our study shows that LVI predicts disease recurrence and cancer-specific survival in patients with final stage T1 UCB after RC.Objective To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether lymphovascular invasion (LVI) is an independent predictor of prognosis in these patients.Patients and Methods Records of 958 consecutive patients who underwent RC at three academic centres were reviewed.A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified.The median (range) follow-up was 38 (0.4-177) months and the median (range) number of nodes examined was 19 (9-80).Results Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02).Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer.All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ.On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival.Conclusions LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death.These patients should be considered for close monitoring after cystectomy.