International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy

Shahrokh F. Shariat, Robert S. Svatek, Derya Tilki, Eila Skinner, Pierre I. Karakiewicz, Umberto Capitanio, Patrick J. Bastian, Bjoern G. Volkmer, Wassim Kassouf, Giacomo Novara, Hans Martin Fritsche, Jonathan I. Izawa, Vincenzo Ficarra, Seth P. Lerner, Arthur I. Sagalowsky, Mark P. Schoenberg, Ashish M. Kamat, Colin P. Dinney, Yair Lotan, Michael J. Marberger & 1 others Yves Fradet

Research output: Contribution to journalArticle

Abstract

Objective To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium-lined space. RESULTS LVI was detected in 1407 patients (33.1%); the proportion of LVI increased with advancing stage, higher grade, soft-tissue surgical margin involvement, and lymph node metastasis (P <0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P <0.001) and cancer-specific mortality (1.45, P <0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer-specific mortality (by 1.1% and 1.2%, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P <0.001; +2.3%) and cancer-specific mortality (1.70, P <0.001; +2.4%). By contrast, in 1071 node-positive patients, LVI only marginally improved the prediction of cancer-specific recurrence (hazard ratio 1.20, P <0.001; +0.2%) and survival (1.23, P <0.001; +0.5%). Conclusions LVI is strongly associated with clinical outcome in node-negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB.

Original languageEnglish (US)
Pages (from-to)1402-1412
Number of pages11
JournalBJU International
Volume105
Issue number10
DOIs
StatePublished - May 2010

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Cystectomy
Recurrence
Urinary Bladder
Neoplasms
Carcinoma
Mortality
Lymph Nodes
Lymph Node Excision
Endothelium
Neoplasm Metastasis
Drug Therapy
Survival
Population

Keywords

  • Bladder cancer
  • Lymphovascular invasion
  • Prognosis
  • Recurrence
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Shariat, S. F., Svatek, R. S., Tilki, D., Skinner, E., Karakiewicz, P. I., Capitanio, U., ... Fradet, Y. (2010). International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU International, 105(10), 1402-1412. https://doi.org/10.1111/j.1464-410X.2010.09217.x

International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. / Shariat, Shahrokh F.; Svatek, Robert S.; Tilki, Derya; Skinner, Eila; Karakiewicz, Pierre I.; Capitanio, Umberto; Bastian, Patrick J.; Volkmer, Bjoern G.; Kassouf, Wassim; Novara, Giacomo; Fritsche, Hans Martin; Izawa, Jonathan I.; Ficarra, Vincenzo; Lerner, Seth P.; Sagalowsky, Arthur I.; Schoenberg, Mark P.; Kamat, Ashish M.; Dinney, Colin P.; Lotan, Yair; Marberger, Michael J.; Fradet, Yves.

In: BJU International, Vol. 105, No. 10, 05.2010, p. 1402-1412.

Research output: Contribution to journalArticle

Shariat, SF, Svatek, RS, Tilki, D, Skinner, E, Karakiewicz, PI, Capitanio, U, Bastian, PJ, Volkmer, BG, Kassouf, W, Novara, G, Fritsche, HM, Izawa, JI, Ficarra, V, Lerner, SP, Sagalowsky, AI, Schoenberg, MP, Kamat, AM, Dinney, CP, Lotan, Y, Marberger, MJ & Fradet, Y 2010, 'International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy', BJU International, vol. 105, no. 10, pp. 1402-1412. https://doi.org/10.1111/j.1464-410X.2010.09217.x
Shariat, Shahrokh F. ; Svatek, Robert S. ; Tilki, Derya ; Skinner, Eila ; Karakiewicz, Pierre I. ; Capitanio, Umberto ; Bastian, Patrick J. ; Volkmer, Bjoern G. ; Kassouf, Wassim ; Novara, Giacomo ; Fritsche, Hans Martin ; Izawa, Jonathan I. ; Ficarra, Vincenzo ; Lerner, Seth P. ; Sagalowsky, Arthur I. ; Schoenberg, Mark P. ; Kamat, Ashish M. ; Dinney, Colin P. ; Lotan, Yair ; Marberger, Michael J. ; Fradet, Yves. / International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. In: BJU International. 2010 ; Vol. 105, No. 10. pp. 1402-1412.
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abstract = "Objective To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium-lined space. RESULTS LVI was detected in 1407 patients (33.1{\%}); the proportion of LVI increased with advancing stage, higher grade, soft-tissue surgical margin involvement, and lymph node metastasis (P <0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P <0.001) and cancer-specific mortality (1.45, P <0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer-specific mortality (by 1.1{\%} and 1.2{\%}, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P <0.001; +2.3{\%}) and cancer-specific mortality (1.70, P <0.001; +2.4{\%}). By contrast, in 1071 node-positive patients, LVI only marginally improved the prediction of cancer-specific recurrence (hazard ratio 1.20, P <0.001; +0.2{\%}) and survival (1.23, P <0.001; +0.5{\%}). Conclusions LVI is strongly associated with clinical outcome in node-negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB.",
keywords = "Bladder cancer, Lymphovascular invasion, Prognosis, Recurrence, Survival, Urothelial carcinoma",
author = "Shariat, {Shahrokh F.} and Svatek, {Robert S.} and Derya Tilki and Eila Skinner and Karakiewicz, {Pierre I.} and Umberto Capitanio and Bastian, {Patrick J.} and Volkmer, {Bjoern G.} and Wassim Kassouf and Giacomo Novara and Fritsche, {Hans Martin} and Izawa, {Jonathan I.} and Vincenzo Ficarra and Lerner, {Seth P.} and Sagalowsky, {Arthur I.} and Schoenberg, {Mark P.} and Kamat, {Ashish M.} and Dinney, {Colin P.} and Yair Lotan and Marberger, {Michael J.} and Yves Fradet",
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TY - JOUR

T1 - International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy

AU - Shariat, Shahrokh F.

AU - Svatek, Robert S.

AU - Tilki, Derya

AU - Skinner, Eila

AU - Karakiewicz, Pierre I.

AU - Capitanio, Umberto

AU - Bastian, Patrick J.

AU - Volkmer, Bjoern G.

AU - Kassouf, Wassim

AU - Novara, Giacomo

AU - Fritsche, Hans Martin

AU - Izawa, Jonathan I.

AU - Ficarra, Vincenzo

AU - Lerner, Seth P.

AU - Sagalowsky, Arthur I.

AU - Schoenberg, Mark P.

AU - Kamat, Ashish M.

AU - Dinney, Colin P.

AU - Lotan, Yair

AU - Marberger, Michael J.

AU - Fradet, Yves

PY - 2010/5

Y1 - 2010/5

N2 - Objective To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium-lined space. RESULTS LVI was detected in 1407 patients (33.1%); the proportion of LVI increased with advancing stage, higher grade, soft-tissue surgical margin involvement, and lymph node metastasis (P <0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P <0.001) and cancer-specific mortality (1.45, P <0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer-specific mortality (by 1.1% and 1.2%, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P <0.001; +2.3%) and cancer-specific mortality (1.70, P <0.001; +2.4%). By contrast, in 1071 node-positive patients, LVI only marginally improved the prediction of cancer-specific recurrence (hazard ratio 1.20, P <0.001; +0.2%) and survival (1.23, P <0.001; +0.5%). Conclusions LVI is strongly associated with clinical outcome in node-negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB.

AB - Objective To externally validate the prognostic value of lymphovascular invasion (LVI) in a large international cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Patients and Methods We collected data from 4257 patients treated with RC and pelvic lymphadenectomy for UCB, without neoadjuvant chemotherapy, at 12 centres. LVI was defined as presence of nests of tumour cells within an endothelium-lined space. RESULTS LVI was detected in 1407 patients (33.1%); the proportion of LVI increased with advancing stage, higher grade, soft-tissue surgical margin involvement, and lymph node metastasis (P <0.001 for all). In standard multivariate models, LVI was associated with both disease recurrence (hazard ratio 1.43, P <0.001) and cancer-specific mortality (1.45, P <0.001). In the entire cohort, adding LVI to a base model that included standard features improved only minimally its predictive accuracy for both recurrence and cancer-specific mortality (by 1.1% and 1.2%, respectively). In 3122 patients with negative lymph nodes, LVI remained independently associated with and improved the predictive accuracy of the standard predictors for recurrence (hazard ratio 1.68, P <0.001; +2.3%) and cancer-specific mortality (1.70, P <0.001; +2.4%). By contrast, in 1071 node-positive patients, LVI only marginally improved the prediction of cancer-specific recurrence (hazard ratio 1.20, P <0.001; +0.2%) and survival (1.23, P <0.001; +0.5%). Conclusions LVI is strongly associated with clinical outcome in node-negative patients treated with RC. The assessment of LVI might help to identify patients who could benefit from adjuvant therapy after RC. After confirmation in different populations, LVI should be included in the staging of UCB.

KW - Bladder cancer

KW - Lymphovascular invasion

KW - Prognosis

KW - Recurrence

KW - Survival

KW - Urothelial carcinoma

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