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Prognostic Significance of Lymphovascular Invasion in Upper Urinary Tract Urothelial Carcinoma is Influenced by Tumor Location

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To examine the prognostic value of lymphovascular invasion (LVI) in different tumor locations (i.e., renal pelvis and ureter) of upper urinary tract urothelial carcinoma (UTUC).

Methods

Data from a total of 250 patients with nonmetastatic UTUC who received radical nephroureterectomy between 2004 and 2010 at our institution were analyzed retrospectively. The significance of LVI and other relevant factors on cancer-specific survival (CSS), metastasis-free survival (MFS), and intraluminal recurrence-free survival (IRFS) were evaluated.

Results

Lymphovascular invasion was present in 60 patients (24 %) and was related to advanced pathological T stage (P < 0.001), higher tumor grade (P < 0.001), lymph node metastasis (P = 0.005), and pyelocaliceal tumor location (P = 0.002). By Kaplan–Meier analysis, LVI was found to be significantly correlated with worse CSS and MFS but not with IRFS. Multivariate analysis showed that high pathological T stage and regional lymph node involvement were significant prognostic factors for CSS and MFS, and LVI was an independent predictor for MFS (hazard ratio 1.71, 95 % confidence interval 1.00–2.93, P = 0.049). In patients with ureteral tumors, LVI represented the only significant prognosticator for both CSS and MFS in multivariate analysis. The prognostic value of LVI was not observed in pyelocaliceal tumors.

Conclusions

The implication of LVI on prognosis, particularly in ureteral tumors but not in pyelocaliceal tumors, may imply diverse disease characteristics between different tumor locations among UTUC. LVI is essential to identify patients at high risk for metastasis/mortality and can facilitate treatment planning and surveillance strategies, especially in patients with ureteral tumors.

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Acknowledgment

This study was supported by grants from the Kaohsiung Medical University Hospital (KMUH 97-7G06), the Center for Infectious Disease and Cancer Research, Kaohsiung Medical University (KMU-TP103E19), and the Health and Welfare Surcharge of tobacco products, Ministry of Health and Welfare (MOHW103-TD-B-111-05).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Hsiang-Ying Lee MD, MS, Ching-Chia Li MD, Chun-Nung Huang MD, PhD, Hung-Lung Ke MD, MS, Wei-Ming Li MD, MS, Wen-Jeng Wu MD, PhD & Hsin-Chih Yeh MD, MS

  2. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Hsiang-Ying Lee MD, MS, Ching-Chia Li MD & Hsin-Chih Yeh MD, MS

  3. Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Chia Li MD, Chun-Nung Huang MD, PhD, Hung-Lung Ke MD, MS, Wei-Ming Li MD, MS, Wen-Jeng Wu MD, PhD & Hsin-Chih Yeh MD, MS

  4. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Chia Li MD, Hung-Lung Ke MD, MS, Wei-Ming Li MD, MS, Wen-Jeng Wu MD, PhD & Hsin-Chih Yeh MD, MS

  5. Department of Urology, Ministry of Health and Welfare, Pingtung Hospital, Pingtung, Taiwan

    Wei-Ming Li MD, MS

  6. Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Peir-In Liang MD & Sheau-Fang Yang MD

  7. Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Peir-In Liang MD & Sheau-Fang Yang MD

  8. Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Sheau-Fang Yang MD

  9. Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hung-Pin Tu PhD

  10. Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wen-Jeng Wu MD, PhD

  11. Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

    Wen-Jeng Wu MD, PhD

Authors
  1. Hsiang-Ying Lee MD, MS
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  2. Ching-Chia Li MD
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  3. Chun-Nung Huang MD, PhD
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  4. Hung-Lung Ke MD, MS
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  5. Wei-Ming Li MD, MS
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  8. Hung-Pin Tu PhD
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  9. Wen-Jeng Wu MD, PhD
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  10. Hsin-Chih Yeh MD, MS
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Corresponding authors

Correspondence to Wen-Jeng Wu MD, PhD or Hsin-Chih Yeh MD, MS.

Additional information

Hsiang-Ying Lee and Ching-Chia Li contributed equally to this article, and both should be considered first author.

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Lee, HY., Li, CC., Huang, CN. et al. Prognostic Significance of Lymphovascular Invasion in Upper Urinary Tract Urothelial Carcinoma is Influenced by Tumor Location. Ann Surg Oncol 22, 1392–1400 (2015). https://doi.org/10.1245/s10434-014-4103-x

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  • DOI: https://doi.org/10.1245/s10434-014-4103-x

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