Impact of lymphovascular invasion on oncological outcomes in patients with upper tract urothelial carcinoma after radical nephroureterectomy. (12th April 2013)

• Record Type: Journal Article
• Authors: Hurel, Sophie; Rouprêt, Morgan; Ouzzane, Adil; Rozet, François; Xylinas, Evanguelos; Zerbib, Marc; Berod, Alexis Arvin; Ruffion, Alain; Adam, Emilie; Cussenot, Olivier; Houlgatte, Alain; Phé, Véronique; Nouhaud, François‐Xavier; Bensadoun, Henri; Delage, Francky; Guillotreau, Julien; Guy, Laurent; Karsenty, Gilles; De La Taille, Alexandre; Colin, Pierre
• Is Part Of: BJU international. Volume 111:Number 8(2013:Apr.)
• Page Start: 1199
• Page End: 1207
• Publication Date: 2013-04-12
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12116
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12116-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12116-list-0001" list-type="bullet"> <list-item> <p>To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer‐specific survival (CSS), recurrence‐free survival and metastasis‐free survival (MFS).</p> </list-item> <list-item> <p>To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse.</p> </list-item> </list> </p> </sec> <sec id="bju12116-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12116-list-0002" list-type="bullet"> <list-item> <p>A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010.</p> </list-item> <list-item> <p>LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis.</p> </list-item> </list> </p> </sec> <sec id="bju12116-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12116-list-0003" list-type="bullet"> <list-item> <p>Overall, 551 patients were included and were divided into two groups: those without LVI (LVI−), <italic>n</italic> = 388 and those with LVI (LVI+), <italic>n</italic> = 163.</p> </list-item> <list-item> <p>LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (<italic>P</italic> < 0.001).</p> </list-item> <list-item> <p>The 5‐year CSS and MFS rates were significantly worse in the LVI+ group than in LVI− group (52.2 vs 84.5%, <italic>P</italic> < 0.001 and 43.8 vs 82.7%, <italic>P</italic> < 0.001, respectively).</p> </list-item> <list-item> <p>In multivariate analysis, LVI+ status was an independent prognostic factor for CSS and MFS (<italic>P</italic> = 0.04 and <italic>P</italic> < 0.001). These findings were confirmed for the pN0/x patient subgroup (<italic>n</italic> = 504, <italic>P</italic> < 0.001).</p> </list-item> <list-item> <p>In the pN0/x patient subgroup, we described a prognostic tool for MFS based on independent factors that permitted us to stratify patients into groups of high, intermediate or low risk of metastasis relapse.</p> </list-item> </list> </p> </sec> <sec id="bju12116-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12116-list-0004" list-type="bullet"> <list-item> <p>The presence of LVI was a strong predictor of a poor outcome for UTUC.</p> </list-item> <list-item> <p>When a lymphadenectomy has not been achieved, the report of LVI status is crucial to identfiy those patients at higher risk for metastatic relapse.</p> </list-item> </list> </p> </sec> </abstract>