MP77-18 CAN LYMPHOVASCULAR INVASION BE USED AS A SURROGATE FOR LYMPH NODE INVOLVEMENT IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA?

Abstract

INTRODUCTION AND OBJECTIVES: NCCN guideline recommends adjuvant chemotherapy for upper tract urothelial carcinoma (UT-UC) based upon pT stage and the presence of lymph node (LN) involvement. However, lymph dissection (LD) for UT-UC is not universally performed. Lymphovascular invasion (LVI) is characterized by the presence of tumor cells inside small lymphatic channels and veins and its association with LN involvement has been described in other genitorurinary tumors. Herein we sought to evaluate if LVI can be used as a prognostic surrogate for LN involvement in patients without LD during surgery. METHODS: Patients undergoing surgical treatment for UT-UC at Indiana University from 1994-2012 were evaluated. Clinicopathologic outcomes, and follow up was obtained through medical records and the IU cancer registry data. Survival analysis was performed using the logrank test and multivariable Cox proportional hazards. Primary outcome was disease-specific survival (DSS). RESULTS: We identified 131 patients with median follow up of 61.5 months. pT stage was T2 or less in 88 (67.7%) patients and 100 (76.3%) had high grade disease. LD was performed in 62 (47.3%) patients: 43 (32.8%) were node negative (N0) and 19 (14.5%) node positive (N+); 69 (52.7%) did not have LD (Nx). LVI was present in 29 patients of whom 5 were N0, 12 N+ and 12 Nx. The specificity of LVI for N+ disease in the LD group was 88.4% (95% CI 74.1-95.6). Compared to N0,Nx LVI negative patients had similar DSS (p1⁄40.882), while N+ and NxLVI+ patients had significantly worse DSS (p<0.001 each). No survival difference was verified between N+ and Nx LVI + patients (3yrs DSS 10.1% vs. 11.7%p1⁄40.343, respectively). When controlling for factors in the table, LVI remained significant in the Nx group (p1⁄40.007). CONCLUSIONS: LVI is associated with LN involvement in patients with UT-UC and may be used as surrogate marker in patients that do not undergo LD at time of surgery. LVI positive UT-UC patients without LD may be candidates for adjuvant chemotherapy. Further studies are needed to confirm these initial findings. Multivariable analysis evaluating DSS in the patients without lymph node dissection at time of surgery