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

Abufaraj, Mohammad; Shariat, Shahrokh F.; Foerster, Beat; Pozo, Carmen Del; Moschini, Marco; D’Andrea, David; Mathiéu, Romain; Susani, Martin; Czech, Anna; Karakiewicz, Pierre I.; Seebacher, Veronika

doi:10.1007/s00345-017-2116-3

Cited by 40 publications

(28 citation statements)

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“…Anyway, in our study variant histology at TUR was associated to APF after RC at multivariable logistic regression analyses (p = 0.007). Our results are in accordance with Abufaraj et al [20], who reported a significant relationship (p = 0.04) between variant histology at TUR and APF (such as lymph node metastasis and advanced pathological T stage). All these findings support results reported in several previous studies, which have underlined the importance of variant histology as prognostic factor in patients affected by BCa in term of higher risk of APF, worse survival outcomes [21] and also higher risk of progression in patients with non-muscle invasive bladder disease [22] compared to patients affected by standard urothelial histology.…”

Section: Discussionsupporting

confidence: 93%

How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection

et al. 2019

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Purpose To improve patient selection for neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in bladder cancer patients (BCa). Methods Retrospective evaluation of 1057 patients with cT2-4N0M0 BCa treated with RC and pelvic lymph node dissection between 1990 and 2018 at 3 referral centers. Adverse pathologic features (APF) were defined as pT3-pT4/pN + disease at RC. A regression tree model (CART) was used to assess preoperative risk group classes. A multivariable logistic regression (MVA) was performed to identify predictors of APF at RC. Results Median age was 70 years and most of the patients were men (83%). Of the 1057 patients included in our study, 688 (65%) had APF. CART analysis was able to stratify patients into 3 risk groups: low (cT2 and single disease, odds ratio [OR] 0.62), intermediate (cT2 and multiple disease, OR 1.08), and high (cT3-cT4, OR 1.28). On MVA APF were associated with variant histology (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.46-10.83, p = 0.007), multifocality at TUR (OR 2.56, CI 1.27-5.17, p = 0.09), completeness of resection (OR 0.47, CI 0.23-0.96, p = 0.04) and clinical extravesical disease (OR 3.42, CI 1.63-7.14, p = 0.001). Conclusion We defined three pre-operative risk classes. Our results indicate that patients with a cT3-T4 disease are those who might benefit more from NAC whereas those with T2 single disease should be those to whom NAC probably shouldn't be proposed. Given the high rate of understaging in BCa patients, NAC can be proposed in selected cases of cT2/multifocal disease.

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Section: Discussionsupporting

confidence: 93%

How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection

et al. 2019

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“…These rates were comparable to those described in the literature. The rate of LVI at TURBT has been reported as 6-70%, and the rate of LVI at RC has been reported to range from 30-50% [1]. Clinical stage and pathological T stage were higher in the LVI-positive group than in the LVI-negative group at rst TURBT.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of lymphovascular invasion (LVI) has been suggested to predict poor prognosis of bladder cancer, such as more advanced disease and recurrence, and has been reported as a poor prognostic factor even for other carcinomas [1][2][3][4][5][6][7][8][9][10]. As transurethral resection of bladder tumor (TURBT) is a standard treatment for bladder cancer, the utility of identifying LVI in specimens of TURBT has been suggested [1][2][3][4][5][6][7][9][10][11][12][13]. The presence of LVI in TURBT specimens has been associated with pathologic upstaging and reduced recurrence-free survival (RFS) and progression-free survival [11].…”

Section: Introductionmentioning

confidence: 99%

Impact of lymphovascular invasion in bladder cancer ~Comparison of transurethral resection and total cystectomy: a retrospective cohort study

Yoneda

Utsumi

Wakai

et al. 2020

Preprint

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Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. Methods: We reviewed 216 patients who underwent first TURBT and 64 patients who underwent RC at our hospital. Medical records were reviewed uniformly, collecting the following data: age, sex, clinical and pathological T stage, neoadjuvant chemotherapy, grade, metastasis, urinary cytology, carcinoma in situ and LVI. Results: LVI was identified in 22.7% of patients who underwent first TURBT, and 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p=0.009) and LVI at first TURBT (HR 9.205, p=0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, inclusion of G3 and LVI were significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p<0.05). Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

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“…Additional factors not included in the EORTC or the CUETO models might enhance their usefulness. Hydronephrosis as well as micropapillary or neuroendocrine variant histology could help identify patients who are likely to need multimodal intensified therapy [56]. An additional key feature with which to identify patients with aggressive biology and poor outcomes is LVI.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta‐analysis of the impact of lymphovascular invasion in bladder cancer transurethral resection specimens

et al. 2018

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The aim of the present review was to assess the prognostic impact of lymphovascular invasion (LVI) in transurethral resection (TUR) of bladder cancer (BCa) specimens on clinical outcomes. A systematic review and meta-analysis of the available literature from the past 10 years was performed using MEDLINE, EMBASE and Cochrane library in August 2017. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42018084876) and is available in full on the University of York website. Overall, 33 studies (including 6 194 patients) evaluating the presence of LVI at TUR were retrieved. LVI was detected in 17.3% of TUR specimens. In 19 studies, including 2 941 patients with ≤cT1 stage only, LVI was detected in 15% of specimens. In patients with ≤cT1 stage, LVI at TUR of the bladder tumour (TURBT) was a significant prognostic factor for disease recurrence (pooled hazard ratio [HR] 1.97, 95% CI: 1.47-2.62) and progression (pooled HR 2.95, 95% CI: 2.11-4.13), without heterogeneity (I = 0.0%, P = 0.84 and I = 0.0%, P = 0.93, respectively). For patients with cT1-2 disease, LVI was significantly associated with upstaging at time of radical cystectomy (pooled odds ratio 2.39, 95% CI: 1.45-3.96), with heterogeneity among studies (I = 53.6%, P = 0.044). LVI at TURBT is a robust prognostic factor of disease recurrence and progression in non-muscle invasive BCa. Furthermore, LVI has a strong impact on upstaging in patients with organ-confined disease. The assessment of LVI should be standardized, reported, and considered for inclusion in the TNM classification system, helping clinicians in decision-making and patient counselling.

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

Cited by 40 publications

References 30 publications

How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection

How to improve patient selection for neoadjuvant chemotherapy in bladder cancer patients candidate for radical cystectomy and pelvic lymph node dissection

Impact of lymphovascular invasion in bladder cancer ~Comparison of transurethral resection and total cystectomy: a retrospective cohort study

A systematic review and meta‐analysis of the impact of lymphovascular invasion in bladder cancer transurethral resection specimens

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