1075 LYMPHOVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA - ASSOCIATION WITH DISEASE FREE AND CANCER SPECIFIC SURVIVAL

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (III)1 Apr 20131075 LYMPHOVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA - ASSOCIATION WITH DISEASE FREE AND CANCER SPECIFIC SURVIVAL Michael Belsante, Oussama Darwish, Ramy Youssef, Aditya Bagrodia, Payal Kapur, Arthur Sagalowsky, Yair Lotan, and Vitaly Margulis Michael BelsanteMichael Belsante Dallas, TX More articles by this author , Oussama DarwishOussama Darwish Dallas, TX More articles by this author , Ramy YoussefRamy Youssef Dallas, TX More articles by this author , Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Payal KapurPayal Kapur Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the impact of lymphovascular invasion (LVI) on disease free (DFS)and cancer specific survival (CSS) in patients with clinically localized clear cell renal cell carcinoma (ccRCC). METHODS Patients with ccRCC who were treated surgically in 1997-2010 were identified. Retrospective chart review was performed to identify clinical outcomes. Independent pathologic re-review was performed by a single pathologist to confirm LVI status. Pathologic features were correlated with clinical outcomes using Kaplan Meier and Cox Regression analyses. RESULTS 419 patients with non-metastatic ccRCC comprised the study cohort. 333 of these patients had organ confined (pT1-2, N anyNx/N0, M0) disease. LVI was present in 14.3% of all non-metastatic patients. In all patients with non-metastatic ccRCC, presence of LVI was correlated with significantly shorter DFS (p<0.001) and CSS (p=0.001) on Kaplan Meier analysis. In cases of organ confined, non-metastatic ccRCC, presence of LVI was a significant predictor of DFS (HR=4.0, p=0.026) and CSS (HR=12.7, p=0.01) on multivariate analysis. Patients with organ confined RCC who were LVI positive, had similar DFS (p=0.957) and CSS (p=0.799) to patients with locally advanced tumors (pT3-pT4, N any, M0) on Kaplan Meier analysis. CONCLUSIONS The presence of LVI is an independent predictor of both DFS and CSS in organ confined, non-metastatic ccRCC. LVI positivity in patients with otherwise pathologically organ confined ccRCC confers oncologic outcomes similar to those of patients with locally advanced disease. If confirmed by others, future revisions to the TNM staging system may incorporate LVI status into the prognostic algorithm of RCC patients. Table. Univariate and Multivariate Analyses of Patients with Non-Metastatic ccRCC Univariate Analysis Multivariate Analysis Cancer Specific Survival in Non-Metastatic ccRCC (n=419) Advanced grade (3-4) HR 8.5 (p=0.001; 95% CI: 2.4-30.2) HR 5.5 (p=0.01; 95% CI: 1.4-20.8) Advanced stage (pT3a or >) HR 4.8 (p=0.003; 95% CI: 1.7-13.4) HR 1.9 (p=0.27; 95% CI: 0.6-6.1) LVI present HR: 5.8 (p=0.001; 95% CI: 2.1-16.2) HR 2.7 (p=0.09; 95% CI: 0.9-8.4) Disease Free Survival in Non-Metastatic ccRCC (n=419) Advanced grade (3-4) HR 5.7 (p<0.001; 95% CI: 2.7-11.8) HR 3.6 (p=0.002; 95% CI: 1.6-8.0) Advanced stage (pT3a or >) HR 4.9 (p<0.001; 95% CI: 2.5-9.6) HR 2.5 (p=0.019; 95% CI: 1.2-5.4) LVI present HR 4.0 (p<0.001; 95% CI: 2.0-8.0) HR 1.7 (p=0.20; 95% CI: 0.77-3.6) Cancer Specific Survival in Organ Confined (pT1-2), Non-Metastatic ccRCC (n=333) Advanced grade (3-4) HR 3.1 (p=0.17; 95% CI: 0.6-15.2) HR 0.37 (p=0.4; 95% CI: 0.04-3.8) Tumor Size HR 1.2 (p<0.001; 95% CI: 1.1-1.3) HR 1.2 (p=0.001; 95% CI: 1.1-1.4) LVI present HR 8.3 (p=0.015; 95% CI: 1.5-45.3) HR: 12.7 (p=0.01; 95% CI: 1.7-92.7) Disease Free Survival in Organ Confined (pT1-2), Non-Metastatic ccRCC (n=333) Advanced grade (3-4) HR 5.1 (p=0.002; 95% CI: 1.8-14.3) HR 2.2 (p=0.22; 95% CI: 0.6-7.6) Tumor Size HR 1.1 (p<0.001; 95% CI: 1.1-1.2) HR 1.1 (p=0.003; 95% CI: 1.0-1.2) LVI present 6.0 (p=0.002; 95% CI: 1.9-18.9) HR 4.0 (p=0.026; 95% CI: 1.2-13.7) © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e441-e442 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Belsante Dallas, TX More articles by this author Oussama Darwish Dallas, TX More articles by this author Ramy Youssef Dallas, TX More articles by this author Aditya Bagrodia Dallas, TX More articles by this author Payal Kapur Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...