The authors retrospectively reviewed patients who underwent nephroureterectomy for UTUC from 2005 to 2013 without adjuvant or neoadjuvant chemotherapy. The perioperative parameters included age, gender, smoking, clinical stage, pathological grade, tumor location, pathological features and systematic recurrence. The parameters were analyzed in Cox proportional hazards model and Kaplan-Meier analysis. Organ-confined disease was defined as AJCC/UICC stage II or lower.
A total of 730 patients received nephroureterectomy for UTUC with a median follow up time of 44.8 months. Overall, there were 153 (21.0%) Patients who showed LVI in the pathology report. The primary endpoint in this study was systemic disease recurrence after surgical intervention. Multivariate Cox regression analysis showed stage, smoking, and LVI were significant risk factors for systemic recurrence. Kaplan-Meier analysis revealed there were no significant difference regarding systemic recurrence in organ confined UTUC according to the presence of lymphovascular invasion (p=0.230). By contrast, lymphovascular invasion is independently associated with systemic disease recurrence in non-organ confined UTUC (p=0.009).
To conclude, lymphovascular invasion is a stage-specific risk factor for systemic recurrence for UTUC patients after nephroureterectomy. Non-organ confined disease with LVI indicates poor prognosis and it might be an important indicator for early adjuvant chemotherapy intervention.
Presented by: Po Yen Chen
Affiliation: Dept. of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal