Routinely reported 'equivocal' lymphovascular invasion in prostatectomy specimens is associated with adverse outcomes.

To evaluate the significance of routinely reported 'equivocal' lymphovascular invasion in prostatectomy specimens of patients with clinically localised prostate cancer.

Prospectively collected data from men who underwent prostatectomy for clinically localised prostate cancer were retrospectively reviewed. Rates of adverse pathological features and biochemical recurrence were compared between tumours positive, negative or 'equivocal' for lymphovascular invasion. Multivariable Cox regression analysis was performed to identify independent predictors of biochemical recurrence.

In 1310 consecutive cases, lymphovascular invasion was present definitively in 82 (6.3%) and equivocally in 43 (3.3%). Similar to definitive lymphovascular invasion, 'equivocal' lymphovascular invasion was significantly associated with other adverse pathological features, including advanced stage, higher Gleason grade, and surgical margin positivity. Biochemical recurrence occurred more frequently in patients with tumours 'equivocal' (61%) or positive for lymphovascular invasion (71%) than in negative patients (14.7%). In addition, patients with both definitive and equivocal lymphovascular invasion had a significantly shorter biochemical recurrence-free survival compared to negative patients. Multivariable Cox regression analysis indicated that the presence of either definitive or 'equivocal' lymphovascular invasion were independent predictors of disease recurrence (HR 3.32, 95%CIs 2.3-4.8, p <0.001 vs. HR 1.66, 95% CIs 1.05-2.65, p = 0.032 respectively).

In this single institution study, 'equivocal' lymphovascular invasion has a similar association with adverse pathological features and rate of biochemical recurrence compared to definitive lymphovascular invasion. If our observations are validated in an independent cohort, consideration should be given to its inclusion as part of routine pathological reporting. This article is protected by copyright. All rights reserved.

BJU international. 2016 Jul 19 [Epub ahead of print]

Elena Galiabovitch, Christopher M Hovens, Justin S Peters, Anthony J Costello, Shane Battye, Sam Norden, Andrew Ryan, Niall M Corcoran

Departments of Urology and Surgery, The Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., Departments of Urology and Surgery, The Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., Departments of Urology and Surgery, The Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., Departments of Urology and Surgery, The Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., TissuPath Specialist Pathology, Mount Waverley and the Faculty of Medicine, Monash University, Clayton, VIC, Australia., TissuPath Specialist Pathology, Mount Waverley and the Faculty of Medicine, Monash University, Clayton, VIC, Australia., TissuPath Specialist Pathology, Mount Waverley and the Faculty of Medicine, Monash University, Clayton, VIC, Australia., Departments of Urology and Surgery, The Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia.