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Prognostic Role of Lymphovascular Invasion in Patients with Urothelial Carcinoma of the Upper Urinary Tract

Manel Mellouli, Slim Charfi, Walid Smaoui, Rim Kallel, Abdelmajid Khabir, Mehdi Bouacida, Mohamed Nabil Mhiri, Tahya Sellami Boudawara
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Abstract

Purpose: To evaluate the impact of lymphovascular invasion on the prognosis of patients treated for upper urinary tract urothelial carcinomas.

Materials and methods: Clinical records of 49 patients treated surgically at our institute for upper urinary tract urothelial carcinomas were reviewed retrospectively. LVI was defined as the presence of cancer cells within an endotheluim-lined space without underlying muscular walls. Actuarial survival curves were analysed by Kaplan-Meier method. Multivariate analysis was performed using Cox’s proportional hazard model.

Results: Median follow-up was 32 months. Lymphovascular invasion was present in 26 (53%) patients. Lymphovascular invasion was associated with higher pathological tumor stage (pT) and higher tumor grade. The disease-free and overall survival rates of the patients with lymphovascular invasion were significantly worse than those of the patients without lymphovascular invasion (p < 0.001 and p = 0.027 respectively). Multivariate analysis revealed that lymphovascular invasion as well as tumor grade and pathological tumor stage were significant prognostic
factors for disease-free and overall survival.

Conclusion: The presence of lymphovascular invasion was a strong predictor of a poor outcome for UTUC. This finding could help identify patients at greater risk for disease recurrence who would benefit from close follow-up and early adjuvant therapy.


References

Rouprêt M, Zigeuner R, Palou J, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 2011;59:584-94.

Eng MK, Shalhav AL. Laparoscopic nephroureterectomy: long-term outcomes. Curr Opin Urol. 2008;18:157-62.

Colin P, Verhasselt-Crinquette M, Ouzzane A, et al. Prognostic significance of lymphovascular invasion in upper urinary tract carcinoma: a retrospective monocentric analysis. Prog Urol. 2010;22:331-8.

Kikuchi E, Margulis V, Karakiewicz PI, et al. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothélial carcinoma. J Clin Oncol. 2009;27:612-8.

Novara G, Matsumoto K, Kassouf W, et al. Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol. 2010;57:1064-71.

Saito K, Kawakami S, Fujii Y, Sakura M, Masuda H, Kihara K. Lymphovascular invasion is independently associated with poor prognosis in patients with localized upper urinary tract urothelial carcinoma treated surgically. J Urol. 2007; 178:2291-6.

Kim DS, Lee YH, Cho KS, Cho NH, Chung BH, Hong SJ. Lymphovascular invasion and pT stage are prognostic factors in patients treated with radical nephroureterectomy for localized upper urinary tract transitional cell carcinoma. Urology. 2010;75:328-32.

Lin WC, Hu FC, Chung SD, Chueh SC, Pu YS, Huang KH. The role of lymphovascular invasion in predicting the prognosis of clinically localized upper tract urothelial carcinoma (pT1-3 N0M0). J Urol. 2008;180:879-84.

Sobin LH, Godspodarowicz M, Wittekind C. TNM classification of malignant tumours. Wiley-Blackwell, New York; 2009.

Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Pathology and genetics of tumours of the urinary system and male genital organs. IARC. Lyon; 2004.

Novara G, De Marco V, Gottardo F, et al. Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centers. Cancer. 2007;110:1715-22.

Li CC, Chang TH, Wu WJ, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in taiwanese patients. Eur Urol. 2008;54:1127-34.

Lughezzani G1, Jeldres C, Isbarn H, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009;45:3291-7.

Lughezzani G1, Burger M, Margulis V, et al. Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol. 2012;62:100-14.

Inman BA, Tran VT, Fradet Y, Lacombe L. Carcinoma of the upper urinary tract: predictors of survival and competing causes of mortality. Cancer. 2009;115:2853-62.

Bolenz C, Fernández MI, Trojan L, et al. Lymphangiogenesis occurs in upper tract urothelial carcinoma and correlates with lymphatic tumour dissemination and poor prognosis. BJU Int. 2009 103:1040-6.

Kikuchi E, Horiguchi Y, Nakashima J, et al. Lymphovascular invasion independently predicts increased disease specific survival in patients with transitional cell carcinoma of the upper urinary tract. J Urol. 2005;174:2120–23.

Hong B, Park S, Hong JH, Kim CS, Ro JY, Ahn H. Prognostic value of lymphovascular invasion in transitional cell carcinoma of upper urinary tract. Urology. 2005; 65: 692–6.




DOI: http://dx.doi.org/10.22037/uj.v14i5.3673

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