Prognostic impact of lymphovascular invasion in radical prostatectomy specimens

Abstract

RESULTSLVI was identified in 42 patients (10.2%) and significantly associated with a high preoperative prostate-specific antigen (PSA) level, a high PSA density, high percentage of positive biopsy cores, high Gleason score, and seminal vesicle invasion. Of the 42 patients with LVI, 33 (79%) had a Gleason score of ≥ 7 and 27 (64%) had pathological stage pT3. The 5-year biochemical-free survival was 87.3% for patients with no LVI and 38.3% with LVI on the RP specimen ( P < 0.001). By multivariate analysis, LVI and Gleason score were independent predictors of biochemical failure. CONCLUSIONThese results show that in addition to the Gleason score, only LVI is strongly correlated with biochemical failure after RP. These findings support the routine evaluation of LVI status in RP specimens and provide the option for its incorporation into nomograms predictive of oncological outcome. KEYWORDSprostate cancer, prostatectomy, biochemical failure, lymphovascular invasion OBJECTIVETo estimate the prognostic value of lymphovascular invasion (LVI) in patients with node-negative prostate cancer treated by radical prostatectomy (RP). PATIENTS AND METHODSIn all, 412 patients with prostatic adenocarcinoma who had RP and pN0 status were analysed for all established standard pathological factors and LVI. The influence of these pathological findings on biochemical failure was evaluated by multivariate analysis with the Cox model. The mean (range) followup was 52.5 (10-116) months.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease

“…11,13,15 Although lymphovascular invasion is commonly reported on routine examination (H&E), immunoperoxidase staining using antibody to CD31 (panendothelial marker) or CD34 (blood vessel endothelial marker) has been used by some authors to identify the presence of endothelium, either in equivocal cases of lymphovascular invasion 11 or in cases with foci of lymphovascular invasion identified on routine stains. 15,16 D2-40 (podoplanin) immunostaining (Figure 2b) has been utilized to evaluated the distribution of lymphatic vessels in the prostate, and the presence of peritumoral lymphatic vessels invasion was found significantly associated with regional lymph node metastases. 68,69 To determine how angiogenesis correlated with metastasis in prostate carcinoma, Weidner et al counted microvessels, highlighted by immunostaining of endothelial cells by factor VIII antigen, and reported that the mean microvessel count in tumors from patients with metastases was significantly higher than that for patients without metastasis.…”

“…Lymphovascular invasion has been defined as the unequivocal presence of tumor cells within endothelial-lined spaces with no underlying muscular walls 12,15,18,19 or as the presence of tumor emboli in small intraprostatic vessels 14 ( Figure 2a), as most reports have suggested a predilection of tumor emboli for small vessels defined by their endothelial lining but with little or no underlying muscular wall. 16 In many studies, except two, 17,67 no attempt has been made to distinguish between lymphatic and vascular channels because of the difficulties of differentiating between them on routine light microscopic examination 12,14,[17][18][19] and as, for practical purposes, either lymphatic or venous involvement implies ultimate reach of tumor to the circulatory system.…”

“…10 If lymphovascular invasion is equivocal or tumor cells merely encroach on a vascular space, the finding is considered negative for lymphovascular invasion by most authors. 13,15,16,18 Particular care should be taken to exclude artifacts due to retraction or mechanical displacement of tumor cells into a Extraprostatic prostate cancer C Magi-Galluzzi et al lumen by the scalpel blade (pseudoemboli), tumor within prostatic ducts and tumor within perineural spaces. 11,13,15 Although lymphovascular invasion is commonly reported on routine examination (H&E), immunoperoxidase staining using antibody to CD31 (panendothelial marker) or CD34 (blood vessel endothelial marker) has been used by some authors to identify the presence of endothelium, either in equivocal cases of lymphovascular invasion 11 or in cases with foci of lymphovascular invasion identified on routine stains.…”

“…13,15,16,18 Particular care should be taken to exclude artifacts due to retraction or mechanical displacement of tumor cells into a Extraprostatic prostate cancer C Magi-Galluzzi et al lumen by the scalpel blade (pseudoemboli), tumor within prostatic ducts and tumor within perineural spaces. 11,13,15 Although lymphovascular invasion is commonly reported on routine examination (H&E), immunoperoxidase staining using antibody to CD31 (panendothelial marker) or CD34 (blood vessel endothelial marker) has been used by some authors to identify the presence of endothelium, either in equivocal cases of lymphovascular invasion 11 or in cases with foci of lymphovascular invasion identified on routine stains. 15,16 D2-40 (podoplanin) immunostaining (Figure 2b) has been utilized to evaluated the distribution of lymphatic vessels in the prostate, and the presence of peritumoral lymphatic vessels invasion was found significantly associated with regional lymph node metastases.…”

“…[8][9][10] Few studies have assessed the incidence and the prognostic impact of lymphovascular invasion and to date there are conflicting findings. [11][12][13][14][15][16][17][18][19][20] The prognostic importance of these several features was addressed by consensus conference participants.…”