Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

Authors

  • Eun Sang Yoo
  • Yun-Sok Ha
  • Jun Nyung Lee
  • Bum Soo Kim
  • Bup Wan Kim
  • Seok-Soo Byun
  • Young Deuk Choi
  • Ho Won Kang
  • Seok-Joong Yun
  • Wun-Jae Kim
  • Jeong Hyun Kim
  • Tae Gyun Kwon

DOI:

https://doi.org/10.5489/cuaj.3557

Abstract

Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC).

Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4).

Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study.

Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.

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Published

2016-07-12

How to Cite

Yoo, E. S., Ha, Y.-S., Lee, J. N., Kim, B. S., Kim, B. W., Byun, S.-S., Choi, Y. D., Kang, H. W., Yun, S.-J., Kim, W.-J., Kim, J. H., & Kwon, T. G. (2016). Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?. Canadian Urological Association Journal, 10(7-8), E229–36. https://doi.org/10.5489/cuaj.3557

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Section

Original Research