Prognostic Role of Lymphovascular Invasion in Patients with Urothelial Carcinoma of the Upper Urinary Tract: An International Validation Study
Prognostic Role of Lymphovascular Invasion in Patients with Urothelial Carcinoma of the Upper Urinary Tract: An International Validation Study
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DOI：
10.1016/j.eururo.2009.12.029
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发表时间：
2010-06-01
期刊：
影响因子：
23.4
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
--
作者：
Novara, Giacomo;Matsumoto, Kazumasa;Shariat, Shahrokh F.
背景资料：在一项多中心系列研究中，病理切片检查后确定的血管浸润（LVI）已被证明是无复发生存期（RFS）和癌症特异性生存期（CSS）的独立预测因子，这些患者接受了根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）。然而，LVI在日常实践中的有效性，其中病理复查所有载玻片是罕见的，还没有assessed.Objective：我们的目的是评估LVI的预后作用，在一个国际队列的患者接受RNU治疗的UTUC没有病理载玻片审查。设计，设置和参与者：在欧洲、亚洲和加拿大的9个中心收集了762名接受RNU治疗UTUC而未接受新辅助化疗的患者的数据。我们评估了患者的特征，RFS，和CSS.Results和局限性：LVI存在于148例（19.4%）。在中位随访34个月时，23.5%的患者发生疾病复发，19.8%死于UTUC。无LVI时5年RFS和CSS率分别为79.3%和82.1%，而存在LVI时分别为45.1%和45.8%（p值< 0.0001）。在多变量考克斯回归分析中，LVI是RFS（风险比[HR]：3.3; p = 0.005）和CSS（HR：5.9; p < 0.0001）的独立预测因子。同样，在pN 0/Nx疾病患者中，LVI是RFS的独立预测因子（HR：2.1; p = 0.001）和CSS（HR：2.3; p < 0.0001）。在一项大型多中心研究中，患者接受了RNU治疗UTUC，并且没有进行病理切片检查，LVI约占20%，是RFS和CSS的独立预测因子。RNU标本的病理报告中应始终包括LVI状态，并应考虑对LVI患者进行辅助治疗研究。(C)2009年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: Lymphovascular invasion (LVI) identified following pathologic slide review has been shown to be an independent predictor of recurrence-free survival (RFS) and cancer-specific survival (CSS) in a multicenter series of patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). However, the validity of LVI in everyday practice, where pathologic re-review of all slides is uncommon, has not been assessed.Objective: Our aim was to evaluate the prognostic role of LVI in an international cohort of patients treated with RNU for UTUC without pathologic slide review.Design, setting, and participants: Data from 762 patients treated with RNU for UTUC without neoadjuvant chemotherapy were collected at nine centers located in Europe, Asia, and Canada.Measurements: We evaluated patients' characteristics, RFS, and CSS.Results and limitations: LVI was present in 148 patients (19.4%). At a median follow-up of 34 mo, 23.5% of the patients developed disease recurrence and 19.8% died of UTUC. The 5-yr RFS and CSS rates were 79.3% and 82.1%, respectively, in the absence of LVI compared with 45.1% and 45.8%, respectively, in the presence of LVI (p values < 0.0001). On multivariable Cox regression analyses, LVI was an independent predictor of RFS (hazard ratio [HR]: 3.3; p = 0.005) and CSS (HR: 5.9; p < 0.0001). Similarly, among patients with pN0/Nx disease, LVI was an independent predictor of RFS (HR: 2.1; p = 0.001) and CSS (HR: 2.3; p < 0.0001).Conclusions: In a large multicenter series of patients treated with RNU for UTUC and for which no pathologic slide review was performed, LVI was present in approximately 20% and was an independent predictor of both RFS and CSS. LVI status should always be included in the pathologic report of RNU specimens, and patients with LVI should be considered for adjuvant therapy studies. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.