Significance Of LVI In TURBT And Cystectomy Specimens On Survival Of Patients With Urothelial Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 10 Jan 2009 - 0:00 PDT

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UroToday.com - Lymphovascular invasion (LVI) in urothelial cancer has recently gained interest in the urology community. Several papers have been published emphasizing the poor prognostic significance of this finding both on TURBT (transurethral resection of bladder tumor) and cystectomy specimens.

We performed a retrospective review of bladder cancer patients and found that patients with LVI in their TURBT specimens had shorter disease-specific survival, especially patients with stage I and II, which may reflect an element of understaging. When we evaluated the patients who subsequently had a cystectomy, patients with LVI on TURBT tended to be understaged (compared to those without LVI) although that was not statistically significant and could be due to the small numbers we had, which is one of the limitations of the paper.

Perhaps the presence of LVI should upstage the cancer, as is the case with testis cancer. Patients with LVI in cystectomy specimens had higher cancer recurrence and were more likely to die from their disease compared to those without LVI ( HR 2.92). Patients undergo TURBT at diagnosis, which provides the clinical staging that we base our subsequent treatment on. More pathologists are documenting the presence or absence of LVI in TURBT specimens and alerting pathologists to the significance of this finding is paramount.

There are limitations to documenting the presence of LVI as we found in our study that it is 79% sensitive. Perhaps the addition of immunohistochemical staining ( CD31 and CD34) could help further improve the sensitivity.

Neoadjuvant chemotherapy has been shown to improve survival in patients with locally advanced bladder cancer. As patients with LVI seem to have worse prognosis, these patients may benefit from neoadjuvant chemotherapy. This needs further study and preferably in a prospective fashion. These findings provided us with an opportunity to evaluate the mechanism of lymphovascular invasion and perhaps a therapeutic intervention to block this process.

Written by Fadi N. Joudi, MD, FRCSC as part of Beyond the Abstract on UroToday.com.

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