Sang Hun Song1, Chang Hee Ye1, Sangchul Lee1, Sung Kyu Hong1,2, Seok-Soo Byun1,2, Sang Eun Lee1, Jong Jin Oh3,4. 1. Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea. 2. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea. urojin@snu.ac.kr. 4. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. urojin@snu.ac.kr.
Abstract
PURPOSE: To determine the association between lymphovascular invasion (LVI) and upper tract urothelial carcinoma (UTUC) among patients who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: From 2003 and 2018, retrospective data of 453 patients treated for UTUC with open, laparoscopic, or robotic RNU were collected. Pathological specimens were assessed for LVI through hematoxylin and eosin staining. According to presence of LVI, patients were stratified into two groups and compared for perioperative characteristics. Kaplan-Meier analysis was used to assess progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Uni- and multivariate Cox regression models were used to find significance of LVI to survival. RESULTS: LVI was present in 132 (29.1%) of patients and was associated with higher age and lower preoperative GFR. Pathological outcomes included significantly higher tumor grade, higher rates of lymph node invasion and more positive surgical margins. During median 23.2 months follow-up (mean 37.1 months), 59.2% (n = 268) of total patients had tumor recurrence, with highest incidences in lymph nodes (51.5%). 5-year PFS, CSS, and OS were estimated at 35.4%, 94.6%, and 91.1% in LVI-negative patients and 17.2%, 75.1%, and 70.8% in LVI-positive patients, respectively (all p < 0.001). Multivariate analysis showed LVI to be an independent predictor of PFS (HR = 1.480; p = 0.018). CONCLUSION: LVI is an independent predictor of adverse PFS and is associated with poor CSS and OS in patients undergoing RNU for UTUC. These results may guide clinicians in selecting patients for adjuvant chemotherapy. Future prospective trials are necessary to further validate our results.
PURPOSE: To determine the association between lymphovascular invasion (LVI) and upper tract urothelial carcinoma (UTUC) among patients who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: From 2003 and 2018, retrospective data of 453 patients treated for UTUC with open, laparoscopic, or robotic RNU were collected. Pathological specimens were assessed for LVI through hematoxylin and eosin staining. According to presence of LVI, patients were stratified into two groups and compared for perioperative characteristics. Kaplan-Meier analysis was used to assess progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Uni- and multivariate Cox regression models were used to find significance of LVI to survival. RESULTS:LVI was present in 132 (29.1%) of patients and was associated with higher age and lower preoperative GFR. Pathological outcomes included significantly higher tumor grade, higher rates of lymph node invasion and more positive surgical margins. During median 23.2 months follow-up (mean 37.1 months), 59.2% (n = 268) of total patients had tumor recurrence, with highest incidences in lymph nodes (51.5%). 5-year PFS, CSS, and OS were estimated at 35.4%, 94.6%, and 91.1% in LVI-negative patients and 17.2%, 75.1%, and 70.8% in LVI-positive patients, respectively (all p < 0.001). Multivariate analysis showed LVI to be an independent predictor of PFS (HR = 1.480; p = 0.018). CONCLUSION:LVI is an independent predictor of adverse PFS and is associated with poor CSS and OS in patients undergoing RNU for UTUC. These results may guide clinicians in selecting patients for adjuvant chemotherapy. Future prospective trials are necessary to further validate our results.
Authors: Matthew R Danzig; Katherine Mallin; James M McKiernan; Walter M Stadler; Srikala S Sridhar; Todd M Morgan; Bernard H Bochner; Cheryl T Lee Journal: Cancer Date: 2018-04-06 Impact factor: 6.860
Authors: Thomas Seisen; Ross E Krasnow; Joaquim Bellmunt; Morgan Rouprêt; Jeffrey J Leow; Stuart R Lipsitz; Malte W Vetterlein; Mark A Preston; Nawar Hanna; Adam S Kibel; Maxine Sun; Toni K Choueiri; Quoc-Dien Trinh; Steven L Chang Journal: J Clin Oncol Date: 2017-01-03 Impact factor: 44.544
Authors: Byron H Lee; Emily C Zabor; Daniel Tennenbaum; Helena Furberg; Nicole Benfante; Jonathan A Coleman; Edgar A Jaimes; Paul Russo Journal: World J Urol Date: 2017-12-05 Impact factor: 4.226
Authors: Atul B Shinagare; Fiona M Fennessy; Nikhil H Ramaiya; Jyothi P Jagannathan; Mary Ellen Taplin; Annick D Van den Abbeele Journal: J Comput Assist Tomogr Date: 2011 Mar-Apr Impact factor: 1.826
Authors: Andrea Mari; Shoji Kimura; Beat Foerster; Mohammad Abufaraj; David D'Andrea; Kilian M Gust; Shahrokh F Shariat Journal: Urol Oncol Date: 2018-04-21 Impact factor: 3.498
Authors: Romain Mathieu; Tobias Klatte; Vitaly Margulis; Jose A Karam; Morgan Rouprêt; Christian Seitz; Pierre I Karakiewicz; Harun Fajkovic; Christopher G Wood; Alon Z Weizer; Jay D Raman; Mesut Remzi; Nathalie Rioux-Leclercq; Andrea Haitel; Karim Bensalah; Yair Lotan; Michael Rink; Luis A Kluth; Douglas S Scherr; Brian D Robinson; Shahrokh F Shariat Journal: Urol Oncol Date: 2015-07-27 Impact factor: 3.498