Microvascular and lymphovascular tumor invasion are associated with poor prognosis and metastatic spread in renal cell carcinoma: A validation study in clinical practice

To validate microvascular (MVI) and lymphovascular (LVI) invasion as a prognostic factor in renal cell carcinoma patients (pts.) MATERIALS AND METHODS: Data of patients with RCC who underwent radical or nephron sparing surgery were prospectively collected from three academic centers. The occurrence of MVI and LVI was determined with standard staining protocols by experienced pathologists at the time of diagnosis. The association of MVI and LVI with clinicopathological data, metastatic spread and cancer-specific survival (CSS) was evaluated with Fisher's exact tests, binary logistic regression analyses and univariable and multivariable Cox proportional hazard regression models.

MVI was present in 201 of 747 (26.9%) pts. and was associated with advanced TNM stages, high Fuhrman grades and sarcomatoid features (each p<0.001). MVI was associated with a higher rate of metastatic spread. LVI was present in 32 of 573 (5.5%) of pts. and was associated with advanced TNM stages, Fuhrman grade, and sarcomatoid features (each: p<0.001). Two-third of LVI+ pts. died (p<0.001). Both LVI and MVI were significantly associated with CSS in all patients, clear cell RCC, and localized RCC in univariable analysis (each p<0.001). On multivariable analysis, presence of MVI was identified as an independent prognostic factor (hazard ratio (HR) 2.09, p=0.001). Moreover, MVI (odds ratio (OR)=2.7; p=0.001) and not macrovascular invasion (V2) (p=0.895) was an independent predictor of metastatic spread. LVI was the strongest factor associated with metastatic spread (odds ratio (OR) 4.73; 95% CI: 1.84 - 12.14; p=0.001) in all patients and the subgroup of ccRCC pts. (p=0.001).

The current study validated LVI and MVI as poor prognostic factors in RCC. These findings recommend an evaluation of both variables in the clinical routine setting to facilitate survival prognostication in follow-up protocols and an assignment to adjuvant treatment trials. This article is protected by copyright. All rights reserved.

BJU international. 2017 Aug 13 [Epub ahead of print]

Jens Bedke, Johannes Heide, Silvia Ribback, Steffen Rausch, Michela de Martino, Marcus Scharpf, Andrea Haitel, Uwe Zimmermann, Maik Pechoel, Hussam Alkhayyat, Shahrokh F Shariat, Frank Dombrowski, Arnulf Stenzl, Martin Burchardt, Tobias Klatte, Nils Kroeger

Dept. of Urology, Eberhard Karls University, Tübingen, Germany., Dept. of Urology, Ernst-Moritz Arndt University of Greifswald., Institute of Pathology, Ernst-Moritz Arndt University of Greifswald, Germany., Dept. of Urology, Medical University of Vienna, Austria., Institute of Pathology, Eberhard Karls University, Tübingen, Germany., Clinical Institute of Pathology, Medical University, Vienna.