Prognostic significance of lymphatic, vascular and perineural invasion for bladder cancer patients treated by radical cystectomy

• Published in: Pathology 2017-04, Vol.49 (3), p.259-266
• Main Authors: Muppa, Prasuna, Gupta, Sounak, Frank, Igor, Boorjian, Stephen A., Karnes, R. Jeffrey, Thompson, R. Houston, Thapa, Prabin, Tarrell, Robert F., Herrera Hernandez, Loren P., Jimenez, Rafael E., Cheville, John C.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cystectomy - methods; Female; Humans; Lymph Nodes - pathology; lymphatic invasion; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neovascularization, Pathologic; perineural invasion; Prognosis; radical cystectomy; recurrence; survival; Urinary Bladder Neoplasms - blood supply; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urothelial cancer; vascular invasion; Vascular Neoplasms - diagnosis; Vascular Neoplasms - pathology
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1016/j.pathol.2016.12.347

In radical cystectomy specimens with bladder cancer, lymphatic and vascular invasion are often reported as ‘angiolymphatic’ or ‘lymphovascular’ invasion, terms that combine the findings of tumour within simple endothelial-lined lymphatic spaces and tumour within muscle-lined blood vessels. It is unclear if these patterns of invasion have different prognostic significance. In addition, there are conflicting data regarding the significance of lymphatic, vascular and perineural invasion in patients with bladder cancer. Herein, we studied 1504 patients treated by radical cystectomy for bladder cancer at our institution and followed for a mean of 10.6 years. Cases were re-reviewed by a urological pathologist for lymphatic invasion defined as tumour within a non-muscle-lined endothelial-lined lymphatic space, vascular invasion defined as tumour in a muscle-lined blood vessel, and perineural invasion defined as tumour within the perineural sheath. Associations of clinical and pathological features with bladder cancer death were evaluated using Cox proportional hazards regression models and summarised with hazard ratios and 95% confidence intervals. Survival was estimated by the Kaplan–Meier method. Multivariate analysis showed that lymphatic and vascular invasion but not perineural invasion were significantly associated with cancer specific survival (p