Impact of lymphovascular invasion on oncological outcomes in patients with upper tract urothelial carcinoma after radical nephroureterectomy

Objectives To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer-specific survival (CSS), recurrence-free survival and metastasis-free survival (MFS). To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse. Patients and Methods A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010. LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis. Results Overall, 551 patients were included and were divided into two groups: those without LVI (LVI-), n=388 and those with LVI (LVI+), n=163. LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P<0.001). The 5-year CSS and MFS rates were significantly worse in the LVI+ group than in LVI- group (52.2 vs 84.5%, P<0.001 and 43.8 vs 82.7%, P<0.001, respectively). In multivariate analysis, LVI+ status was an independent prognostic factor for CSS and MFS (P=0.04 and P<0.001). These findings were confirmed for the pN0/x patient subgroup (n=504, P<0.001). In the pN0/x patient subgroup, we described a prognostic tool for MFS based on independent factors that permitted us to stratify patients into groups of high, intermediate or low risk of metastasis relapse. Conclusions The presence of LVI was a strong predictor of a poor outcome for UTUC. When a lymphadenectomy has not been achieved, the report of LVI status is crucial to identfiy those patients at higher risk for metastatic relapse.