Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

Eun Sang Yoo, Yun Sok Ha, Jun Nyung Lee, Bum Soo Kim, Bup Wan Kim, Seok Soo Byun, Young Deuk Choi, Ho Won Kang, Seok Joong Yun, Wun Jae Kim, Jeong Hyun Kim, Tae Gyun Kwon

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Abstract

Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.

Original languageEnglish
Pages (from-to)E229-E236
JournalCanadian Urological Association Journal
Volume10
Issue number7-8
DOIs
Publication statusPublished - 2016 Jul

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Lymph Nodes
Carcinoma
Lymph Node Excision
Survival
Neoplasm Metastasis
Neoplasms
Multivariate Analysis
Incidence

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Yoo, Eun Sang ; Ha, Yun Sok ; Lee, Jun Nyung ; Kim, Bum Soo ; Kim, Bup Wan ; Byun, Seok Soo ; Choi, Young Deuk ; Kang, Ho Won ; Yun, Seok Joong ; Kim, Wun Jae ; Kim, Jeong Hyun ; Kwon, Tae Gyun. / Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?. In: Canadian Urological Association Journal. 2016 ; Vol. 10, No. 7-8. pp. E229-E236.
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title = "Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?",
abstract = "Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.",
author = "Yoo, {Eun Sang} and Ha, {Yun Sok} and Lee, {Jun Nyung} and Kim, {Bum Soo} and Kim, {Bup Wan} and Byun, {Seok Soo} and Choi, {Young Deuk} and Kang, {Ho Won} and Yun, {Seok Joong} and Kim, {Wun Jae} and Kim, {Jeong Hyun} and Kwon, {Tae Gyun}",
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Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy? / Yoo, Eun Sang; Ha, Yun Sok; Lee, Jun Nyung; Kim, Bum Soo; Kim, Bup Wan; Byun, Seok Soo; Choi, Young Deuk; Kang, Ho Won; Yun, Seok Joong; Kim, Wun Jae; Kim, Jeong Hyun; Kwon, Tae Gyun.

In: Canadian Urological Association Journal, Vol. 10, No. 7-8, 07.2016, p. E229-E236.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

AU - Yoo, Eun Sang

AU - Ha, Yun Sok

AU - Lee, Jun Nyung

AU - Kim, Bum Soo

AU - Kim, Bup Wan

AU - Byun, Seok Soo

AU - Choi, Young Deuk

AU - Kang, Ho Won

AU - Yun, Seok Joong

AU - Kim, Wun Jae

AU - Kim, Jeong Hyun

AU - Kwon, Tae Gyun

PY - 2016/7

Y1 - 2016/7

N2 - Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.

AB - Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.

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