Prognostic value of perinodal lymphovascular invasion following radical cystectomy for lymph node-positive urothelial carcinoma

TY - JOUR

T1 - Prognostic value of perinodal lymphovascular invasion following radical cystectomy for lymph node-positive urothelial carcinoma

AU - Fritsche, Hans-Martin

AU - May, Matthias

AU - Denzinger, Stefan

AU - Otto, Wolfgang

AU - Siegert, Sabine

AU - Giedl, Christian

AU - Giedl, Johannes

AU - Eder, Fabian

AU - Agaimy, Abbas

AU - Novotny, Vladimir

AU - Wirth, Manfred

AU - Stief, Christian

AU - Brookman-May, Sabine

AU - Hofstädter, Ferdinand

AU - Gierth, Michael

AU - Aziz, Atiqullah

AU - Kocot, Arkadius

AU - Riedmiller, Hubertus

AU - Bastian, Patrick J

AU - Toma, Marieta

AU - Wieland, Wolf F

AU - Hartmann, Arndt

AU - Burger, Maximilian

N1 - Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2013/4/1

Y1 - 2013/4/1

N2 - BACKGROUND: Metastasis of urothelial carcinoma of the bladder (UCB) into regional lymph nodes (LNs) is a key prognosticator for cancer-specific survival (CSS) after radical cystectomy (RC). Perinodal lymphovascular invasion (pnLVI) has not yet been defined.OBJECTIVE: To assess the prognostic value of histopathologic prognostic factors, especially pnLVI, on survival.DESIGN, SETTING, AND PARTICIPANTS: A total of 598 patients were included in a prospective multicentre study after RC for UCB without distant metastasis and neoadjuvant and/or adjuvant chemotherapy. En bloc resection and histopathologic evaluation of regional LNs were performed based on a prospective protocol. The final study group comprised 158 patients with positive LNs (26.4%).INTERVENTION: Histopathologic analysis was performed based on prospectively defined morphologic criteria of LN metastases.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional hazard regression models determined prognostic impact of clinical and histopathologic variables (age, gender, tumour stage, surgical margin status, pN, diameter of LN metastasis, LN density [LND], extranodal extension [ENE], pnLVI) on CSS. The median follow-up was 20 mo (interquartile range: 11-38).RESULTS AND LIMITATIONS: Thirty-one percent of patients were staged pN1, and 69% were staged pN2/3. ENE and pnLVI was present in 52% and 39%, respectively. CSS rates after 1 yr, 3 yr, and 5 yr were 77%, 44%, and 27%, respectively. Five-year CSS rates in patients with and without pnLVI were 16% and 34% (p<0.001), respectively. PN stage, maximum diameter of LN metastasis, LND, and ENE had no independent influence on CSS. In the multivariable Cox model, the only parameters that were significant for CSS were pnLVI (hazard ratio: 2.47; p=0.003) and pT stage. However, pnLVI demonstrated only a minimal gain in predictive accuracy (0.1%; p=0.856), and the incremental accuracy of prediction is of uncertain clinical value.CONCLUSIONS: We present the first explorative study on the prognostic impact of pnLVI. In contrast to other parameters that show the extent of LN metastasis, pnLVI is an independent prognosticator for CSS.

AB - BACKGROUND: Metastasis of urothelial carcinoma of the bladder (UCB) into regional lymph nodes (LNs) is a key prognosticator for cancer-specific survival (CSS) after radical cystectomy (RC). Perinodal lymphovascular invasion (pnLVI) has not yet been defined.OBJECTIVE: To assess the prognostic value of histopathologic prognostic factors, especially pnLVI, on survival.DESIGN, SETTING, AND PARTICIPANTS: A total of 598 patients were included in a prospective multicentre study after RC for UCB without distant metastasis and neoadjuvant and/or adjuvant chemotherapy. En bloc resection and histopathologic evaluation of regional LNs were performed based on a prospective protocol. The final study group comprised 158 patients with positive LNs (26.4%).INTERVENTION: Histopathologic analysis was performed based on prospectively defined morphologic criteria of LN metastases.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional hazard regression models determined prognostic impact of clinical and histopathologic variables (age, gender, tumour stage, surgical margin status, pN, diameter of LN metastasis, LN density [LND], extranodal extension [ENE], pnLVI) on CSS. The median follow-up was 20 mo (interquartile range: 11-38).RESULTS AND LIMITATIONS: Thirty-one percent of patients were staged pN1, and 69% were staged pN2/3. ENE and pnLVI was present in 52% and 39%, respectively. CSS rates after 1 yr, 3 yr, and 5 yr were 77%, 44%, and 27%, respectively. Five-year CSS rates in patients with and without pnLVI were 16% and 34% (p<0.001), respectively. PN stage, maximum diameter of LN metastasis, LND, and ENE had no independent influence on CSS. In the multivariable Cox model, the only parameters that were significant for CSS were pnLVI (hazard ratio: 2.47; p=0.003) and pT stage. However, pnLVI demonstrated only a minimal gain in predictive accuracy (0.1%; p=0.856), and the incremental accuracy of prediction is of uncertain clinical value.CONCLUSIONS: We present the first explorative study on the prognostic impact of pnLVI. In contrast to other parameters that show the extent of LN metastasis, pnLVI is an independent prognosticator for CSS.

KW - Aged

KW - Cystectomy

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lymphatic Metastasis

KW - Lymphatic Vessels

KW - Male

KW - Middle Aged

KW - Neoplasm Invasiveness

KW - Neoplasm Recurrence, Local

KW - Prognosis

KW - Prospective Studies

KW - Survival Rate

KW - Treatment Outcome

KW - Urinary Bladder Neoplasms

KW - Urothelium

U2 - 10.1016/j.eururo.2012.09.053

DO - 10.1016/j.eururo.2012.09.053

M3 - SCORING: Journal article

C2 - 23079053

VL - 63

SP - 739

EP - 744

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 4

ER -