World Journal of Urology

, Volume 36, Issue 2, pp 231–240 | Cite as

Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder

  • Mohammad Abufaraj
  • Shahrokh F. ShariatEmail author
  • Beat Foerster
  • Carmen Pozo
  • Marco Moschini
  • David D’Andrea
  • Romain Mathieu
  • Martin Susani
  • Anna K. Czech
  • Pierre I. Karakiewicz
  • Veronika Seebacher
Original Article



To evaluate the concordance rate of lymphovascular invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes.

Patients and methods

Two hundred and sixty-eight patients who underwent TUR and subsequent RC were reviewed. Logistic regression analyses were performed to evaluate the association of LVI and VH with NOC and lymph node metastasis at RC. Cox regression analyses were used to estimate recurrence-free survival (RFS) and cancer-specific survival (CSS).


LVI and VH were detected in 13.8 and 11.2% of TUR specimens, and in 30.2 and 25.4% of RC specimens, respectively. The concordance rate between LVI and VH at TUR and subsequent RC was 69.8 and 83.6%, respectively. They were both associated with adverse pathological features such as lymph node metastasis and advanced stage. TUR LVI and VH were both independently associated with lymph node metastasis and TUR VH was independently associated with NOC. On univariable Cox regression analyses, TUR LVI was associated with RFS and CSS while TUR VH was only associated with RFS. Only TUR LVI was independently associated with RFS.


Detection of LVI is missed in a third of TUR specimens while VH seems more accurately identified. TUR LVI and VH are associated with more advanced disease and LVI predicts disease recurrence. Assessment and reporting of LVI and VH on TUR specimen are important for risk stratification and decision-making.


Urothelial tumor Bladder cancer Transurethral resection Lymphovascular invasion Variant histology Prognosis Prediction Recurrence Survival 


Compliance with ethical standards

Conflict of interest

I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript are the following: Shahrokh Shariat owns or co-owns the following patents: Methods to determine prognosis after therapy for prostate cancer. Granted 2002-09-06. Methods to determine prognosis after therapy for bladder cancer. Granted 2003-06-19. Prognostic methods for patients with prostatic disease. Granted 2004-08-05. Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma. Granted 2010-07-20. He is advisory board member for Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanofi, Urogen and Wolff. He is speaker for Astellas, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi, Wolff.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Mohammad Abufaraj
    • 1
    • 2
  • Shahrokh F. Shariat
    • 1
    • 3
    • 4
    • 5
    Email author
  • Beat Foerster
    • 1
    • 6
  • Carmen Pozo
    • 1
    • 7
  • Marco Moschini
    • 1
    • 8
  • David D’Andrea
    • 1
  • Romain Mathieu
    • 1
    • 9
  • Martin Susani
    • 10
  • Anna K. Czech
    • 1
    • 11
  • Pierre I. Karakiewicz
    • 12
  • Veronika Seebacher
    • 13
  1. 1.Department of Urology, Comprehensive Cancer CenterMedical University of Vienna, Vienna General HospitalViennaAustria
  2. 2.Division of Urology, Department of Special SurgeryJordan University Hospital, The University of JordanAmmanJordan
  3. 3.Karl Landsteiner Institute of Urology and AndrologyViennaAustria
  4. 4.Department of UrologyUniversity of Texas Southwestern Medical CentreDallasUSA
  5. 5.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA
  6. 6.Department of UrologyKantonsspital WinterthurWinterthurSwitzerland
  7. 7.Department of UrologyHospital Universitario Fundación AlcorcónMadridSpain
  8. 8.Department of Urology, Urological Research InstituteVita-Salute University, San Raffaele Scientific InstituteMilanItaly
  9. 9.Department of UrologyUniversity of RennesRennesFrance
  10. 10.Department of PathologyMedical University of ViennaViennaAustria
  11. 11.Department of UrologyJagiellonian University in KrakowKrakowPoland
  12. 12.Department of UrologyUniversity of MontrealMontrealCanada
  13. 13.Department for Gynaecology and Gynaecologic OncologyMedical University of ViennaViennaAustria

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