Prognostic Value of the Lymphovascular Invasion in High-Grade Stage pT1 Bladder Cancer
Branchereau J, Larue S, Vayleux B, Karam G, Bouchot O, Rigaud J. Clin Genitourin Cancer. 2012 Dec 28. pii: S1558-7673(12)00232-7. doi: 10.1016/j.clgc.2012.10.002. [Epub ahead of print]

Source

Department of Urology, CHU Nantes Hôtel Dieu, Nantes, France. Electronic address: Julien.branchereau@chu-nantes.fr.

Abstract

PURPOSE:

High-grade (HG) stage pT1 bladder cancers have the highest recurrence and progression rates of all non-muscle-invasive bladder cancers. Some prognostic factors for recurrence and progression have been identified: multifocal HG pT1, concomitant carcinome in situ, tumor diameter >3 cm, infiltration of the deep lamina propria, and persistence of pT1 tumor on a second transurethral resection of the bladder. The objective of this study was to determine whether the presence of lymphovascular invasion (LVI) is also a prognostic factor that must be taken into account.

MATERIALS AND METHODS:

This retrospective study was performed with 108 patients with HG stage pT1 bladder cancer: 89 patients were treated conservatively (transurethral resection of the bladder plus bacille Calmette-Guérin therapy), and 19 patients underwent early cystectomy. The mean (SD) follow-up was 47.8 ± 41.2 months. Classic prognostic factors and LVI were analyzed in terms of overall survival, specific survival, recurrence-free survival, and progression-free survival.

RESULTS:

Thirty-six percent of patients had LVI on the chips of the first transurethral resection of the bladder. Five-year overall survival and specific survival were 40% and 75%, respectively. Multivariate analysis of risk factors showed a significant reduction of overall survival in the presence of LVI (P = .007). The presence of LVI was also a factor of poor prognosis in the case of delayed cystectomy (P = .010) but not in the case of early cystectomy.

CONCLUSIONS:

Identification of LVI on the first resection of a HG stage pT1 bladder cancer is a significant prognostic factor for overall survival.