AUA 2017: Impact of lymphovascular invasion on Lymph Node Metastasis for T3 patients undergoing Radical Prostatectomy in Consideration of Resection Margins
This study is a retrospective analysis of 1634 patients who underwent a radical prostatectomy between 2005 and 2014 at a single institution. Patients with known nodal involvement and/or distant metastases were excluded from the analysis. Survival analyses using Cox proportional hazard regression analysis were performed to assess the association between LVI with biochemical recurrence (BCR), bone metastases and cancer specific survival. Logistic regression analysis were performed to assess the likelihood of developing nodal metastases.
LVI was detected in 7.4% of the pathological samples evaluated. The median follow-up was 33.1 months. On Kaplan-Meier analysis, LVI was associated with shorter time to BCR (39.2 vs. 82.5 months, p < 0.001), bone metastases free survival (134.4 vs. 156.7 months, p=0.001) and cancer specific survival (122.7 vs. 152.6 months, p=0.034). When controlling for margin status, LVI resulted in significantly shorter time to BCR. In regards to development of nodal metastases LVI was found to be the best predictor with an OR of 4.26 (95% CI 2.07-8.8).
The study provides some compelling data on the importance of LVI in regards to developing biochemical failure, nodal and distant metastases. The study does have some limitations due to its retrospective nature and short median follow-up time. The authors fail to address the fact that while LVI is a good prognostic indicator, the incidence is low for patients presenting with aggressive prostate cancer. Further, studies on the validation of LVI in the setting of the new genomic assays would be important to assess is prognostic value.
Presented By: Young Jin Kang, Severance Hospital, South Korea
Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA