Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 281-281
Author(s):  
Eugene K. Cha ◽  
Harun Fajkovic ◽  
Claudio Jeldres ◽  
Thomas F. Chromecki ◽  
Michael Rink ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Prognostic Value ◽  
Predictive Accuracy ◽  
Disease Recurrence ◽  
Multivariable Model ◽  
Extranodal Extension ◽  
Specific Mortality ◽  
Multivariable Analyses ◽  
Cancer Specific Mortality

281 Background: The aim of the current study was to assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters in a large multicenter cohort of patients with LN metastasis (LNM) following radical nephroureterectomy (RNU). Methods: Retrospective analysis of 222 patients with LNM treated with RNU for upper tract urothelial carcinoma (UTUC) without neoadjuvant therapy. Microscopically, each LN metastasis was evaluated for presence of ENE. Results: The median number of LNs removed, number of positive LNs, and LN density were 4 (IQR: 8), 2 (IQR: 2), and 51.3% (IQR: 71.7%), respectively. Overall, 110 patients (49.5%) had ENE. Presence of ENE was associated with more advanced pT stage (p=0.026). In multivariable analyses, ENE was associated with disease recurrence (p=0.01) and cancer-specific mortality (p=0.013). LN density, when stratified by 30% cutoff, was associated with disease recurrence and cancer-specific mortality (p=0.048 and p=0.049) in univariable, but not in multivariable analyses. Addition of ENE to a multivariable model including pT stage and tumor architecture improved predictive accuracy for disease recurrence from 70.3% to 74.5% (p<0.001). Addition of ENE to a multivariable model including age, pT stage, and tumor architecture improved predictive accuracy for cancer-specific mortality from 70.6% to 74.4% (p<0.001). Conclusions: ENE is a powerful predictor of clinical outcomes in UTUC patients with LNM. While other LN parameters seem to have limited clinical value, ENE could help risk stratify UTUC patients with LNM for better counseling and clinical trial design.

Rates of lymph node invasion and their impact on cancer specific mortality in upper urinary tract urothelial carcinoma

2019 ◽  
Vol 45 (7) ◽  
pp. 1238-1245 ◽  
Author(s):  
Sebastiano Nazzani ◽  
Elio Mazzone ◽  
Felix Preisser ◽  
Zhe Tian ◽  
Francesco A. Mistretta ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Upper Urinary Tract ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Urinary Tract Urothelial Carcinoma

Prognostic Value of Extranodal Extension and Other Lymph Node Parameters in Patients With Upper Tract Urothelial Carcinoma

2012 ◽  
Vol 187 (3) ◽  
pp. 845-851 ◽  
Author(s):  
Harun Fajkovic ◽  
Eugene K. Cha ◽  
Claudio Jeldres ◽  
Gerhard Donner ◽  
Thomas F. Chromecki ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Prognostic Value ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Extranodal Extension

scholarly journals Lymphovascular Invasion Predicts Clinical Outcomes in Patients With Node-Negative Upper Tract Urothelial Carcinoma

2009 ◽  
Vol 27 (4) ◽  
pp. 612-618 ◽  
Author(s):  
Eiji Kikuchi ◽  
Vitaly Margulis ◽  
Pierre I. Karakiewicz ◽  
Marco Roscigno ◽  
Shuji Mikami ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Clinical Outcomes ◽  
Lymphovascular Invasion ◽  
Predictive Accuracy ◽  
Independent Predictor ◽  
Cancer Recurrence ◽  
Tumor Grade ◽  
Disease Recurrence ◽  
Lymph Node Status

Purpose To assess the association of lymphovascular invasion (LVI) with cancer recurrence and survival in a large international series of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Patients and Methods Data were collected on 1,453 patients treated with RNU at 13 academic centers and combined into a relational database. Pathologic slides were rereviewed by genitourinary pathologists according to strict criteria. LVI was defined as presence of tumor cells within an endothelium-lined space. Results LVI was observed in 349 patients (24%). Proportion of LVI increased with advancing tumor stage, high tumor grade, presence of tumor necrosis, sessile tumor architecture, and presence of lymph node metastasis (all P < .001). LVI was an independent predictor of disease recurrence and survival (P < .001 for both). Addition of LVI to the base model (comprising pathologic stage, grade, and lymph node status) marginally improved its predictive accuracy for both disease recurrence and survival (1.1%, P = .03; and 1.7%, P < .001, respectively). In patients with negative lymph nodes and those in whom a lymphadenectomy was not performed (n = 1,313), addition of LVI to the base model improved the predictive accuracy of the base model for both disease recurrence and survival by 3% (P < .001 for both). In contrast, LVI was not associated with disease recurrence or survival in node-positive patients (n = 140). Conclusion LVI was an independent predictor of clinical outcomes in nonmetastatic patients who underwent RNU for UTUC. Assessment of LVI may help identify patients who could benefit from multimodal therapy after RNU. After confirmation, LVI should be included in staging of UTUC.

Prognostic value of lymphovascular invasion in squamous cell carcinoma of the urinary bladder.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 454-454
Author(s):  
Simone Lucia Vernez ◽  
Kyle Spradling ◽  
Jacob B Morgan ◽  
Yair Lotan ◽  
Ahmed Shokeir ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Urinary Bladder ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Prognostic Value ◽  
Lymphovascular Invasion ◽  
Survival Rates ◽  
Specific Mortality ◽  
Cancer Specific Mortality

454 Background: The prognostic value of lymphovascular invasion (LVI) has been well studied in urothelial carcinoma of the bladder (UCB) but not in squamous cell carcinoma (SCC). Herein, we evaluate the association of LVI with oncologic outcomes of SCC following radical cystectomy (RC). Methods: We retrospectively evaluated 1280 patients who underwent RC and pelvic lymph node dissection (LND) for invasive bladder cancer between 1997– 2003 at a single institution in Mansoura, Egypt. Only patients with pure SCC pathology were included. Prognostic significance of LVI was evaluated for patients with SCC. Results: Our cohort included 360 patients with SCC. Median patient age and follow-up were 55 years (20 – 87) and 44 months (0 – 108), respectively. LVI was present in 47 (13.1%) and lymph node metastasis (LN+) was present in 66 (18.3%). In Kaplan-Meier analyses, 5-year disease free survival rates for LVI-/LN- and LVI+/LN- patients were 80.2±3% and 38.9±12% (p < 0.001), respectively; 5-year cancer specific survival rates were 88.2±2% and 50.4±13% (p < 0.001), respectively. Moreover, cancer specific mortality was highest in LVI+/LN- patients (HR = 3.657; 95% CI: 1.614 – 8.284; p = 0.002). Multivariate Cox-regression analyses showed that LVI+ status was independently associated with disease recurrence (HR = 2.827; 95% CI: 1.451 – 5.509; p = 0.002 and cancer specific mortality in patients with SCC (HR = 3.657; 95% CI: 1.614 – 8.284; p = 0.002). Conclusions: Lymphovascular invasion is a strong independent predictor of oncological outcomes after RC for SCC of the urinary bladder. The incorporation of LVI status into classic prognostic models for SCC of the bladder may lead to improved identification of high-risk patients.

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