Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy

Yair Lotan, Amit Gupta, Shahrokh F. Shariat, Ganesh S. Palapattu, Amnon Vazina, Pierre I. Karakiewicz, Patrick J. Bastian, Craig G. Rogers, Gilad Amiel, Paul Perotte, Mark P. Schoenberg, Seth P. Lerner, Arthur I Sagalowsky

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Abstract

Purpose: We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods: A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results: LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion: LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.

Original languageEnglish (US)
Pages (from-to)6533-6539
Number of pages7
JournalJournal of Clinical Oncology
Volume23
Issue number27
DOIs
StatePublished - Sep 20 2005

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Cystectomy
Lymph Nodes
Recurrence
Survival
Urinary Bladder Neoplasms
Baltimore
Transitional Cell Carcinoma
Endothelium
Retrospective Studies
Regression Analysis
Medicine
Neoplasm Metastasis
Drug Therapy
Mortality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. / Lotan, Yair; Gupta, Amit; Shariat, Shahrokh F.; Palapattu, Ganesh S.; Vazina, Amnon; Karakiewicz, Pierre I.; Bastian, Patrick J.; Rogers, Craig G.; Amiel, Gilad; Perotte, Paul; Schoenberg, Mark P.; Lerner, Seth P.; Sagalowsky, Arthur I.

In: Journal of Clinical Oncology, Vol. 23, No. 27, 20.09.2005, p. 6533-6539.

Research output: Contribution to journalArticle

Lotan, Yair ; Gupta, Amit ; Shariat, Shahrokh F. ; Palapattu, Ganesh S. ; Vazina, Amnon ; Karakiewicz, Pierre I. ; Bastian, Patrick J. ; Rogers, Craig G. ; Amiel, Gilad ; Perotte, Paul ; Schoenberg, Mark P. ; Lerner, Seth P. ; Sagalowsky, Arthur I. / Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 27. pp. 6533-6539.
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abstract = "Purpose: We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods: A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results: LVI was present in 36.4{\%} (273 of 750) overall, involving 26{\%} (151 of 581) and 72{\%} (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0{\%}, 23{\%}, 60{\%}, and 78{\%}, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion: LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.",
author = "Yair Lotan and Amit Gupta and Shariat, {Shahrokh F.} and Palapattu, {Ganesh S.} and Amnon Vazina and Karakiewicz, {Pierre I.} and Bastian, {Patrick J.} and Rogers, {Craig G.} and Gilad Amiel and Paul Perotte and Schoenberg, {Mark P.} and Lerner, {Seth P.} and Sagalowsky, {Arthur I}",
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T1 - Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy

AU - Lotan, Yair

AU - Gupta, Amit

AU - Shariat, Shahrokh F.

AU - Palapattu, Ganesh S.

AU - Vazina, Amnon

AU - Karakiewicz, Pierre I.

AU - Bastian, Patrick J.

AU - Rogers, Craig G.

AU - Amiel, Gilad

AU - Perotte, Paul

AU - Schoenberg, Mark P.

AU - Lerner, Seth P.

AU - Sagalowsky, Arthur I

PY - 2005/9/20

Y1 - 2005/9/20

N2 - Purpose: We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods: A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results: LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion: LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.

AB - Purpose: We hypothesized that bladder cancer patients with associated lymphovascular invasion (LVI) are at increased risk of occult metastases. Methods: A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results: LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an independent predictor of local (HR = 2.03, P = .049), distant (HR = 2.60, P = .0011), and overall (HR = 2.02, P = .0003) recurrence in node-negative patients. LVI was an independent predictor of overall (HR = 1.84, P = .0002) and cause-specific (HR = 2.07, P = .0012) survival in node-negative patients. LVI maintained its independent predictor status in competing risks regression models (P = .013), where other-cause mortality was considered as a competing risk. LVI was not a predictor of recurrence or survival in node-positive patients. Conclusion: LVI is an independent predictor of recurrence and decreased cause-specific and overall survival in patients who undergo cystectomy for invasive bladder cancer and are node-negative. These patients represent a high risk group that may benefit from integrated therapy with cystectomy and perioperative systemic chemotherapy.

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