PD18-02 REPORTING AND PROGNOSTIC SIGNIFICANCE OF LYMPHOVASCULAR INVASION IN MUSCLE-INVASIVE BLADDER CANCER: A POPULATION-BASED STUDY
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You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2014PD18-02 REPORTING AND PROGNOSTIC SIGNIFICANCE OF LYMPHOVASCULAR INVASION IN MUSCLE-INVASIVE BLADDER CANCER: A POPULATION-BASED STUDY Atsunari Kawashima, David Berman, Yingwei Peng, William Mackillop, Robert Siemens, and Christopher Booth Atsunari KawashimaAtsunari Kawashima More articles by this author , David BermanDavid Berman More articles by this author , Yingwei PengYingwei Peng More articles by this author , William MackillopWilliam Mackillop More articles by this author , Robert SiemensRobert Siemens More articles by this author , and Christopher BoothChristopher Booth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1497AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Previous reports from centers of excellence have found lymphovascular invasion (LVI) to be a poor prognostic factor in bladder cancer. However, LVI assessment by pathologists is prone to over- and under-reporting; this may be of particular significance in routine clinical practice. Here we present reporting patterns and outcomes associated with LVI in the general population of Ontario, Canada. Methods Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for muscle-invasive bladder cancer (MIBC) in Ontario 1994-2008. Surgical pathology reports were analyzed for pathological variables including LVI. LVI reporting patterns were described over time and the association of LVI with cancer-specific (CSS) and overall (OS) survival was evaluated using a Cox proportional hazards model controlling for patient-, disease-, and treatment-related characteristics. Results 2802 patients with MIBC who underwent cystectomy were included in this study. LVI status was reported in 75% of patients overall, and increased over time (57% 1994-1998; 76% 1999-2003; 85% 2004-2008, p < 0.001). Reporting LVI status was greater among cases treated by high volume surgeons (80% vs 74%, p=0.001) and among those treated at comprehensive cancer centers (78% vs 74%, p=0.016). Cases in which there were no lymph nodes submitted with the surgical specimen were less likely to report LVI (67%) than cases that were node positive (83%) or node negative (75%) (p<0.001). Patients with evidence of LVI had substantially lower survival than patients that were LVI negative or LVI unstated (5-year CSS 19% vs 55% vs 42%, p<0.001 and 5 year OS 18% vs 47% vs 37%, p<0.001). These differences were seen independent of lymph node status. Presence of LVI was strongly associated with reduced survival in adjusted analyses (HR CSS 1.99, 95% CI 1.72-2.31; HR OS 1.77, 95% CI 1.56-2.00). Age, co-morbidity, T & N stage, margin status, surgeon case volume, and use of adjuvant chemotherapy were also independently associated with patient survival. Conclusions Reporting of LVI among patients with MIBC treated in routine clinical practice has improved over time. LVI is an independent and strong prognostic factor for inferior CSS and OS in the general population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e535-e536 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Atsunari Kawashima More articles by this author David Berman More articles by this author Yingwei Peng More articles by this author William Mackillop More articles by this author Robert Siemens More articles by this author Christopher Booth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Keywords:
Lymphovascular invasion
Bladder cancer is one of the most common cancers worldwide causing a significant burden on healthcare system and society. Muscle-invasive bladder cancer (MIBC) is highly fatal, and if untreated, >85% of patients die within 2 years of diagnosis. Although radical cystectomy (RC) is the preferred treatment of choice in patients with MIBC, bladder preservation can be considered in patients who are either not eligible for cystectomy or are not willing to undergo cystectomy. The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain better quality of life including sexual function. Strategies for bladder preservation include partial cystectomy, radical transurethral resection, radiation therapy, and chemotherapy. It is widely accepted that combination of these approaches could result in better outcomes in patients with MIBC. In this review, we describe different approaches for bladder preservation and their outcomes.
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Lymphovascular invasion
Nephrology
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Background and purpose:For muscle-invasive bladder caner patients,the recommended treatment is radical cystectomy.While some patients are not suitable or unwilling to this treatment,bladder preserving treatment provides another choice.This research aimed to assess the curative effect,influencing factors of partial cystectomy plus chemotherapy for muscle-invasive bladder cancer.Methods:From Jan.2002 to Apr.2005,52 patients with muscle-invasive bladder cancer underwent partial cystectomy plus chemotherapy(PC group),contrast to 47 patients which underwent radical cystectomy(RC group).The overall survival rates(OS) of the two groups were analyzed.Results:There is no significant difference of overall survival between the two groups(P=0.279).For stage T3 and recurrent patients the PC group had significantly lower survival rates than RC group(P=0.048).Conclusion:Partial cystectomy plus chemotherapy provides a choice for the treatment of muscle-invasive bladder cancer.
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Bladder cancer is a common malignancy seen in older adults with coexisting medical illnesses. The management of patients with muscle invasive disease includes perioperative chemotherapy and radical cystectomy; however, patients may decline surgery and older patients with comorbid conditions may not be candidates for surgery and thus alternative treatment strategies are needed. Trimodality bladder preservation protocols for muscle invasive bladder cancer have generally included only those patients who are candidates for a salvage cystectomy. In this review, we discuss the current status of bladder preservation treatment options for patients with muscle-invasive disease who are not candidates for cystectomy or who decline surgery and highlight the need for clinical trials investigating novel treatment approaches in this older patient population.
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Objectives: To investigate relationship between the lymphovascular invasion(LVI) and tumor characteristics and to evaluate effect on survival of LVI in patients who underwent radical cystectomy because of bladder cancer. Materials and Methods: Five hundred and six patients were enrolled the study between 1990 and 2013. Patients were divided into two groups in terms of lymphovascular invasion at final pathology after radical cystectomy. There were 108 patients with LVI(group1) and 244 patients without LVI(group2). Both groups were compared in terms of clinicopathologic features and survival. Results: There was no statically different for gender in both group(p=0,222).Lymh node involvement, grade, and p T stage were higher significantly in group 1(p<0,05). Positive lymph node number was 2.3±3.1 in group 1 and 0.6 ± 2.1 in group 2(p<0.001). Lymph node density was 24.3±30.1 in group 1 and 5.6±9.2 in group 2 (p<0.001).Estimated mean survival time was 27.2±3.4 months in group 1 and 80.2 ± 8.1 months in group 2 (p<0.001). Conclusions: Lymphovascular invasion is an independent prognostic factor for disease specific survival and effects survival negatively in patients who underwent radical cystectomy for bladder cancer. Patients with lymphovascular invasion should be considered for close monitoring after cystectomy.
Lymphovascular invasion
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Bladder cancer is the 4th commonest malignancy in the United Kingdom and worldwide there are nearly 400,000 new cases every year with over 150,000 deaths. The gold standard treatment for muscle invasive bladder cancer is radical cystectomy with neoadjuvant chemotherapy. Despite this the overall survival at 5 years is only around 50%. To improve outcomes new pre-clinical models of greater physiological relevance are needed and the ability to translate research from the laboratory to clinical practice needs to be improved. The tyrosine kinase HER2 is an attractive therapeutic target in bladder cancer and has the potential to be used in clinical practice. The hypothesis of this thesis was that HER2 would be a prognostic biomarker in patients with bladder cancer requiring radical cystectomy and that it has a critical role in bladder cancer cell invasiveness. To test this the aims were firstly to create a novel three dimensional cell culture to be used as a more physiological method of studying the invasiveness of bladder cancer. Secondly a tissue micro-array and associated database of cystectomy patients was created for biomarker discovery and to investigate the role of HER2 and its family members as biomarkers in patients with bladder cancer treated with cystectomy. The novel three dimensional organotypic model was successfully optimized and its ability to reproduce invasive characteristics confirmed with primary invasive cancer cells harvested from a cystectomy patient. Lenti-viral knockdown of HER2 failed to affect the invasive nature of the T24 cell line. The TMA consisted of 226 cystectomy patients treated over a 10-year period with a median follow up of 49 months. The 5-year overall survival was 48.8% with a cancer specific survival of 62.1% and 27.4% of patients received neo-adjuvant chemotherapy. 17% of patients overexpressed HER2 and HER2 was an independent risk factor for worse overall survival with a hazard ratio of 1.66. Other biomarkers screened for included Nrf-2, which this TMA suggests predicts response to cisplatin based chemotherapy, AIMP3 which may predict resistance to radiation when down regulated and b-HCG, which demonstrated a potential role as a marker of recurrence when measured in blood serum. In conclusion, HER2 appears to be prognostic of poor outcome in this cohort but is not critical for bladder cancer invasion in the organotypic model. The process of testing this has created two valuable models for biomarker discovery that will be used in future research.
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