Prognostic Value of Lymphovascular Invasion in Node-Negative Upper Urinary Tract Urothelial Carcinoma Patients Undergoing Radical Nephroureterectomy

Purpose: This study aimed to evaluate the prognostic impact of lymphovascular invasion (LVI) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Materials and Methods:We collected data from 180 patients who were treated with RNU from 2005 to 2013 at our institution.The Kaplan-Meier method with log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses.results: LVI was present in 28 patients (15.6%), which was associated with higher pathological tumor stage (p<0.001),tumor necrosis (p=0.012),lymph node metastasis (p=0.017) and multifocality (p=0.012).On multivariate analysis, LVI was an independent prognostic factor of recurrence-free survival [RFS: hazard ratio (HR)=2.954;95% confidence interval (CI)=1.539-5.671;p=0.001] and cancer-specific survival (CSS: HR=3.530; 95% CI=1.701-7.325;p=0.001) in all patients.In patients with node-negative UTUC, LVI was also a significant predictor of RFS (HR=3.732;95% CI 1.866-7.464;p<0.001) and CSS (HR=3.825;95% CI=1.777-8.234;p=0.001).conclusion: LVI status was an independent predictor in patients with UTUC who underwent RNU.The estimate of LVI could help physicians identify high-risk patients and make a better medication regimen of adjuvant chemotherapy.