The association between the lymphovascular invasion in the transurethral resection pathology and recurrence, progression, and metastasis of the disease in patients with t1 bladder cancer

Abstract

Objective: Our study aimed to assess the relationship between lymphovascular invasion (LVI) on transurethral resection of bladder carcinoma (TURB) pathology and disease progression, recurrence and development of metastasis in patients with T1 bladder cancers.

Material and Methods: The clinical records of patients having undergone TURB in our clinic were retrospectively reviewed. Newly diagnosed pT1 patients with urothelial bladder cancer were included in the study. Of the patients; sex, age, initial diagnosis or recurrence, tumor size, tumor number, grade, presence of Cis, presence of intravesical treatment, follow up times, recurrence, progression, metastasis and lymphovascular invasion were recorded. Patients were divided into two groups according to LVI status and compared in terms of recurrence, progression and metastasis.

Results: Ninety three patients with pT1 urothelial bladder cancer were enrolled. The mean age of the patients was 63.96 ± 9.94 (36-84). The mean tumor size was 4.29 ± 2.54 cm (1-10 cm) and the mean number of tumors was 2.46 ± 1.48 (1-5). LVI was detected in 27 patients (29%). Of the 51 patients with recurrence, 18 had LVI and 33 had no LVI (p> 0.05). Of the 22 patients with progression, 14hadLVIand8hadnoLVI(p<0.01).Ofthe15 patients with metastasis, 11 had LVI and 4 had no LVI (p <0.01).

Conclusion: In the patients with T1 bladder cancer, LVI after TURB is associated with the progression and metastasis of disease. Therefore, it is a prognostic factor that can be used when planning the follow-up and treatment of the disease. When planning the treatment of patients with superficial bladder tumors with LVI, we think that they should be more careful and aggressive than non-LVI patients. 

Keywords

• ladder cancer
• Lymphovascular invasion
• Prognosis
• Transurethral resection of bladder tumor

T1 mesane kanserli hastalarda, transüretral rezeksiyon spesimenindeki lenfovasküler invazyonun hastalığın rekürrens, progresyon ve metastazı ile ilişkisi

Abstract

Amaç: Bu çalışmanın amacı, yeni tanı almış T1 mesane kanserli hastalarda transüretral me- sane tümörü rezeksiyonu (TURMT) spesimenindeki lenfovasküler invazyonun (LVİ) hastalığın rekürrens, progresyon ve metastazı ile olan ilişkisini araştırmaktır.

Gereç ve Yöntem: Kliniğimizde TURMT yapılan hastaların kayıtları retrospektif olarak incelendi ve yeni tanı almış pT1 ürotelyal mesane kanserli hastalar çalışmaya dahil edildi. Hastaların; cinsiyet, yaş, ilk tanı veya nüks olduğu, tümör boyutu, tümör sayısı, grade’i, Cis varlığı, intravezikal tedavi alıp almadığı, takip süreleri, rekürrens, progresyon, metastaz bilgileri ve lenfovasküler invazyon bilgileri kayıt edildi. Hastalar, LVİ durumuna göre iki gruba ayırıldı ve rekürrens, progresyon ve metastaz açısından karşılaştırıldı.

Bulgular: Çalışmaya toplam 93 hasta dahil edildi. Hastaların yaş ortalaması 63.96 ± 9.94 idi (36-84). Ortalama tümör boyutu 4.29 ± 2.54 cm (1-10 cm), ortalama tümör sayısı 2.46 ± 1.48 (1-5) idi. 27 hastada (%29) LVİ saptanmıştır. Rekürrens gözlenen 51 hastanın 18’inde LVİ vardı, 33’ünde LVİ yoktu (p >0.05). Progresyon gözlenen 22 hastanın 14’ünde LVİ vardı, 8’inde LVİ yoktu (p <0.01). Metastaz gözlenen 15 hastanın 11’inde LVİ vardı, 4’ünde LVİ yoktu (p <0.01).

Sonuç: T1 mesane kanserli hastalarda TURMT spesimenindeki LVİ varlığı hastalığın progresyon ve metastazı ile ilişkilidir. Dolayısıyla hastalığın takip ve tedavisini planlarken kullanılabilecek prognostik bir faktördür. LVİ olan yüzeyel mesane tümörlü hastalarda tedaviyi planlar- ken LVİ olmayan hastalara göre daha dikkatli ve agresif olunması gerektiğini düşünmekteyiz. 

Keywords

• Lenfovasküler invazyon
• Mesane kanseri
• Prognoz
• Transüretral mesane tümörü rezeksiyonu

References

1. 1. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10-30.
2. 2. Fildler IJ. Critical determinants of cancer metastasis: ratina- le for therapy. Cancer Chemother Pharmacol 1999;43:3-10.
3. 3. Harada K, Sakai I, Hara I, et al. Prognostik significance of vascular invasion in patients with bladder cancer who underwent radical cystectomy. Int J Urol 2005;12:250-5.
4. 4. Hong SK, Kwak C, Jeon HG, et al. Do vascular, lympha- tic, and perineural invasion have prognostic implicati- ons for bladder cancer after radical cystectomy? Urology 2005;65:697-702.
5. 5. Leissner J, Koeppen C and Wolf HK. Prognostic significance of vascular and perineural invasion in urotheli- al bladder cancer treated with radical cystectomy. J Urol 2003;169:955-60.
6. 6. Quek ML, Stein JP, Nichols PW, et al. Prognostic signifi- cance of lymphovascular invasion of bladder cancer treated with radical cystectomy. J Urol 2005;174:103-6.
7. 7. Lopez JI, Angulo JC. The prognostic significance of vas- cular invasion in stage T1 bladder cancer. Histopathology 1995;27:27-33.
8. 8. Larsen MP, Steinberg GD, Brendler CB, et al. Use of Ulex europaeus agglutinin I (UEAI) to distinguish vascular and “pseudovascular” invasion in transitional cell carcino- ma of bladder with lamina propria invasion. Mod Pathol 1990;3:83-88.

9. 9. Allard P, Bernard P, Fradet Y, et al. The early clinical course of primary Ta and T1 bladder cancer: a proposed prognos- tic index. Br J Urol 1998;81:692-8.
10. 10. Lotan Y, Grupta A, Shariat SF, et al. Lymphovascular inva- sion is independently associated with overall survial, cause- specific survial, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. J Clin Oncol 2005;23:6533-9.
11. 11. Manoharan M, Katkoori D. Lymphovascular invasion in radical cystectomy specimen: is it an independent prog- nostic factor in patients without lymph node metastases? World J Urol 2010;28:233-7.
12. 12. Kunju LP, You L, Zhang Y, et al. Lymphovascular invasi- on of urothelial cancer in matched transurethral bladder tumor resection and radical cystectomy specimens. J Urol 2008;180:1928-32.
13. 13. Tilki D, Reich O, Svatek RS, et al. Characteristics and outcomes of patients with clinical carcinoma in situ only treated with radical cystectomy: an international study of 243 pati- ents. J Urol 2010;183:1757-63.
14. 14. Cho KS, Seo KH, Joung JY, et al, Lymphovascular invasion in transurethral resection specimens as predictor of prog- ression and metastasis in patients with newly diagnosed T1 bladder urothelial cancer. J Urol 2009;182:2625-30.
15. 15. Streeper NM, Simons CM, Konety BR, et al. The signifi- cance of lymphovascular invasion in transurethral resec- tion of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer. BJU Int 2009;103:475-9.
16. 16. Andius P, Johansson SL, Holmang S. Prognostic factors in stage T1 bladder cancer: tumor pattern (solid or papillary) and vascular invasion more important than depth of invasi- on. Urology 2007;70:758-62.
17. 17. Lamm DL, Blumenstein BA, Crawford ED, et al. A rando- mized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcino- ma of the bladder. N Engl J Med 1991;325:1205-9.
18. 18. Cookson MS, Herr HW, Zhang ZF, et al. The treated natu- ral history of high risk superficial bladder cancer: 15-year outcome. J Urol 1997;158:62-7.