MP69-18 EVALUATING THE ROLE OF LYMPHVASCULAR INVASION AS AN INDICATOR FOR ADVERSE OUTCOMES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AND ITS HISTOLOGICAL SUBTYPES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP69-18 EVALUATING THE ROLE OF LYMPHVASCULAR INVASION AS AN INDICATOR FOR ADVERSE OUTCOMES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AND ITS HISTOLOGICAL SUBTYPES Ivan Rakic, Matthew Davis, Nicholas Corsi, Alexander Stephens, Sohrab Arora, Nikola Rakic, Taylor Malchow, Chase Morrison, Rafe Affas, Akshay Sood, Craig Rogers, and Firas Abdollah Ivan RakicIvan Rakic More articles by this author , Matthew DavisMatthew Davis More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Alexander StephensAlexander Stephens More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Nikola RakicNikola Rakic More articles by this author , Taylor MalchowTaylor Malchow More articles by this author , Chase MorrisonChase Morrison More articles by this author , Rafe AffasRafe Affas More articles by this author , Akshay SoodAkshay Sood More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymphvascular invasion (LVI) is recognized as an adverse prognostic factor in many cancers. However, its utility in upper tract urothelial carcinoma (UTUC) has not been well-defined. Our aim is to assess the prognostic ability of LVI in UTUC urothelial carcinoma (UC) and micropapillary urothelial carcinoma (MPUC) subtypes as a predictor of overall survival (OS) using a large North American cohort. METHODS: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to estimate the OS. Cox regression analysis tested the impact of LVI status on OS after accounting for covariates: age, sex, race, year of diagnosis, Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor, and pN status. RESULTS: Mean (SD) age was 70.90±10.9 years. Overall, 14.4% had LVI, and 6.77% had pN+ (pN1-3) disease. The rate of advanced stage (pT3 or higher), and pN+ disease was 78.8%% and 18.1% in patients with LVI vs. 34.7% and 3.32% in patients without LVI. The histological subtypes were UC, pure squamous, sacromatoid/spindle cell carcinoma, and MPUC in respectively 49.8%, 0.608%, 0.708%, and 48.9% of patients. The mean (SD) follow-up was 42.9±35.3 months. In patients with UC at 5-years post-RNU, the OS rates were 60.2%, 29.9%, 28.9%, and 20.8% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). In patients with MPUC at 5-years post-RNU, the OS rates were 65.3%, 40.2%, 54.7%, and 36.5% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). On multivariable analysis, LVI was an independent predictor of less favorable OS outcomes, as those with LVI had a 1.82-fold higher risk of death (95% CI: 1.21-1.54, p<0.001), when compared to their counterpart without LVI. CONCLUSIONS: To the best of our knowledge, our report is the first to examine the impact of LVI on OS in a large North American nationwide cohort. Our results indicate that LVI is associated with less favorable survival outcomes in patient with UTUC who are treated surgically, and can be utilized for counseling after RNU and as a risk-stratification tool for future clinical trials. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e972 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ivan Rakic More articles by this author Matthew Davis More articles by this author Nicholas Corsi More articles by this author Alexander Stephens More articles by this author Sohrab Arora More articles by this author Nikola Rakic More articles by this author Taylor Malchow More articles by this author Chase Morrison More articles by this author Rafe Affas More articles by this author Akshay Sood More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...