Prognostic Value of the Lymphovascular Invasion in High-Grade Stage pT1 Bladder Cancer

Is the presence of lymphovascular invasion considered a prognostic factor for high-grade stage pT1 bladder cancer? This retrospective study performed on 108 patients demonstrated a significant reduction of overall survival in the presence of lymphovascular invasion on the transurethral resection of the bladder (P = .007). Purpose: High-grade (HG) stage pT1 bladder cancers have the highest recurrence and progression rates of all non-muscle-invasive bladder cancers. Some prognostic factors for recurrence and progression have been identified: multifocal HG pT1, concomitant carcinome in situ, tumor diameter >3 cm, infiltration of the deep lamina propria, and persistence of pT1 tumor on a second transurethral resection of the bladder. The objective of this study was to determine whether the presence of lymphovascular invasion (LVI) is also a prognostic factor that must be taken into account. Materials and Methods: This retrospective study was performed with 108 patients with HG stage pT1 bladder cancer: 89 patients were treated conservatively (transurethral resection of the bladder plus bacille Calmette-Guerin therapy), and 19 patients underwent early cystectomy. The mean (SD) follow-up was 47.8 +/- 41.2 months. Classic prognostic factors and LVI were analyzed in terms of overall survival, specific survival, recurrence-free survival, and progression-free survival. Results: Thirty-six percent of patients had LVI on the chips of the first transurethral resection of the bladder. Five-year overall survival and specific survival were 40% and 75%, respectively. Multivariate analysis of risk factors showed a significant reduction of overall survival in the presence of LVI (P = .007). The presence of LVI was also a factor of poor prognosis in the case of delayed cystectomy (P = .010) but not in the case of early cystectomy. Conclusions: Identification of LVI on the first resection of a HG stage pT1 bladder cancer is a significant prognostic factor for overall survival. (C) 2013 Elsevier Inc. All rights reserved.