The Prognostic Value of Lymphovascular Invasion in Patients With Upper Tract Urinary Carcinoma After Surgery: An Updated Systematic Review and Meta-Analysis

Abstract

Background and Purpose: Although the prognostic value of lymphovascular invasion (LVI) for upper tract urinary carcinoma (UTUC) has been reported, there is a lack of consensus regarding the prognostic factor of LVI in UTUC after radical nephroureterectomy (RNU). The aim of the present study was to evaluate the contemporary role of LVI using systematic review and meta-analysis.Materials and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic search of Web of Science, PubMed, and EMBASE for all reports published up to July 2019. Cumulative analyses of hazard ratios (HRs)/odds ratios (ORs) and their corresponding 95% confidence intervals were conducted to assess the association between LVI and oncological outcomes and clinicopathological features.Results: Our meta-analysis included 31 eligible studies containing 14,653 patients with UTUC (81-1,363 per study). Our results indicated a significant correlation of LVI with worse cancer-specific survival (HR = 1.59, p < 0.001), overall survival (HR = 1.55, p < 0.001), recurrence-free survival (HR = 1.46, p < 0.001), cancer-specific mortality (HR = 1.25, p = 0.047), and recurrence (HR = 1.23, p = 0.026). LVI was also correlated with advanced tumor stage (III/IV vs. I/II: OR = 7.63, p < 0.001), higher tumor grade (3 vs. 1/2: OR = 5.61, p < 0.001), lymph node metastasis (yes vs. no: OR = 4.95, p < 0.001), carcinoma in situ (yes vs. no: OR = 1.92, p < 0.001), and positive surgical margin (yes vs. no: OR = 4.38, p < 0.001), but not related to gender (male vs. female: OR = 0.98, p = 0.825), and multifocality (multifocal vs. unifocal: OR = 1.09, p = 0.555). The funnel plot test indicated no significant publication bias.Conclusions: This study demonstrated that LVI was associated with aggressive clinicopathological features. LVI may serve as a poor prognostic factor for patients with UTUC after RNU.

The Systemic Immune-Inflammation Index (SII) Increases the Prognostic Significance of Lymphovascular Invasion in Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

“…19 Several studies have demonstrated that LVI in UTUC can serve as a predictive marker of disease recurrence and progression. [20][21][22][23] Moreover, increasing evidence indicated that systemic immune inflammation can mutually modulate cancer invasion and metastasis. 12,24,25 Previous studies have reported that circulating immune-cell concentrations, such as neutrophils, platelets, monocytes, and lymphocytes, played key roles in promoting tumor growth/development and extension.…”

Predictive Value of Preoperative Positive Urine Cytology for Development of Bladder Cancer After Nephroureterectomy in Patients With Upper Urinary Tract Urothelial Carcinoma: A Prognostic Nomogram Based on a Retrospective Multicenter Cohort Study and Systematic Meta-Analysis

“…For patients with UUT-UC and recurrence of bladder cancer, tumor location in the ureter or tumor multifocality has been validated as prognostic factors in the recurrence of non-muscleinvasive bladder cancer (48)(49)(50). The incidence of multiple upper urothelial carcinomas was significantly higher than that of single urothelial carcinomas in patients with urothelial tumor recurrence (51).…”

Impact of Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: A Population Based Analysis

“…Year of diagnosis, sex, race, Hispanic status, insurance status, Charlson comorbidity index, facility type (academic/community), tumor location, and clinical T stage were not statistically significant predictors of OS. LVI has been shown to be an adverse prognostic factor in UTUC in multiple studies; it has been additionally associated with higher pathological tumor stage, grade, and lymph node metastasis [20][21][22]. Further, two recent meta-analyses, with 17 trials (4,896 patients) and 31 trials (14,653 patients) each [21,22], have confirmed a significant correlation with LVI and poorer recurrence-free survival, cancerspecific survival, and overall survival.…”

“…LVI has been shown to be an adverse prognostic factor in UTUC in multiple studies; it has been additionally associated with higher pathological tumor stage, grade, and lymph node metastasis [20][21][22]. Further, two recent meta-analyses, with 17 trials (4,896 patients) and 31 trials (14,653 patients) each [21,22], have confirmed a significant correlation with LVI and poorer recurrence-free survival, cancerspecific survival, and overall survival. However, these studies do not specifically look at the patient population who receive NAC.…”