Prognostic Significance of Lymphovascular Invasion in Clinically Localized Prostate Cancer after Radical Prostatectomy

Abstract

Whether lymphovascular invasion (LVI) is an independent prognostic factor in prostate cancer is still controversial. We retrospectively investigated its predictive role in disease progression following radical prostatectomy. The histological sections of radical prostatectomies from 71 clinically localized, prostatic adenocarcinoma patients were reviewed for LVI. Pre- and postoperative follow-up data were collected. LVI was identified in 15.5% of cases. Univariate analysis showed a significant association between LVI and advanced pathological stage, higher Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis (each p < 0.05). Multivariate analyses pointed to vascular involvement as a strong and independent predictor for PSA failure (p = 0.023), and reduced biochemical progression-free survival (p = 0.019). LVI in radical prostatectomy is an adverse prognostic finding that must be recorded in the pathology report.

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

“…13 Baydar et al classified lymphovascular invasion as intratumoral (55%), at the periphery of the tumor (18%), both intra-and peritumoral (9%) and at a distant site from the tumor (18%). 11 The number of foci of lymphovascular invasion in each case has been shown to range from 1 to 40, with the majority of patients having 1 or 2 foci. 11,13,71 Lymphovascular invasion has been reported to be associated with adverse pathological features in radical prostatectomy specimens, 6 such as higher Gleason score, positive surgical margins, extraprostatic extension and seminal vesicle invasion, 12,16,18,[72][73][74][75] and with decreased time to biochemical progression, 13,16,18,19,72 distant metastases 8,19 and overall survival after radical prostatectomy.…”

“…11 The number of foci of lymphovascular invasion in each case has been shown to range from 1 to 40, with the majority of patients having 1 or 2 foci. 11,13,71 Lymphovascular invasion has been reported to be associated with adverse pathological features in radical prostatectomy specimens, 6 such as higher Gleason score, positive surgical margins, extraprostatic extension and seminal vesicle invasion, 12,16,18,[72][73][74][75] and with decreased time to biochemical progression, 13,16,18,19,72 distant metastases 8,19 and overall survival after radical prostatectomy. 18,19,67 Univariate analyses showed lymphovascular invasion to be a significant predictor of disease recurrence and/or progression following radical prostatectomy, 12,15,17,[72][73][74][75] and multivariate analyses have confirmed that lymphovascular invasion is an independent predictor of disease recurrence, when controlling for other pathological variables known to influence clinical outcome.…”

“…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.…”

Current Histopathologic and Molecular Characterisations of Prostate Cancer: Towards Individualised Prognosis and Therapies

“…LVI has been associated with decreased time to biochemical progression, distant metastases, and overall survival after RP. In addition, LVI has been shown to act as an independent predictor of disease recurrence when controlling for other pathologic variables known to influence clinical outcome [24]. Figure 1c is the map distribution of the tumour whose pathology report is summarised in Table 1.…”