Abstract
(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.
Highlights
The presence of lymphovascular invasion (LVI) has been suggested to predict poor prognosis of bladder cancer, such as more advanced disease and recurrence, and has been reported as a poor prognostic factor even for other carcinomas [1,2,3,4,5,6,7,8,9,10]
The present study aimed to evaluate the relationship between LVI on both transurethral resection of bladder tumor (TURBT) and Radical cystectomy (RC), as well as overall survival (OS) and cancer-specific survival (CSS)
The rate of LVI at TURBT has been reported as 6%–70%, and the rate of LVI at RC has been reported to range from 30% to 50% [1]
Summary
The presence of lymphovascular invasion (LVI) has been suggested to predict poor prognosis of bladder cancer, such as more advanced disease and recurrence, and has been reported as a poor prognostic factor even for other carcinomas [1,2,3,4,5,6,7,8,9,10]. Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), and the presence of LVI in RC specimens has been associated with poor prognosis [14,15,16,17]. LVI has been described as a risk factor in the guidelines of the American Urological Association Those guidelines define high-grade and T1 tumors, recurrent highgrade and Ta tumors, high-grade Ta and large (>3 cm) tumor, multifocal high-grade Ta tumor, any carcinoma in situ (CIS), any Bacille de Calmette et Guérin failure in high-grade cases, any variant history, any high-grade prostatic urethral involvement, and any LVI as high-risk factors [18]. For patients after RC, assessment of LVI at RC is suggested to help in determining adjuvant therapy
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