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The prognostic role of lymphovascular invasion in urothelial carcinoma of the bladder

Key Points

  • Nomograms and predictive models have improved outcome prediction in patients with bladder cancer but validation and integration of other factors such as lymphovascular invasion (LVI) might further increase their accuracy and clinical utility

  • In patients with non-muscle-invasive bladder cancer, most studies demonstrate an association of LVI presence in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy with understaging, disease recurrence and progression

  • Patients with high-grade T1 disease in whom LVI is found might benefit from undergoing early radical cystectomy

  • In patients with muscle-invasive bladder cancer in whom lymph nodes are not affected, presence of LVI is associated with clinical and pathological features of aggressive disease and can predict patient survival

  • Together with well established prognostic factors, models that include presence of LVI might aid patient selection for intravesical instillation, early radical cystectomy or perioperative chemotherapy

  • The lack of reproducibility and reliability in LVI assessment and concordance between findings in TURBT and radical cystectomy specimens, as well as underreporting, are limitations to the routine use of LVI status in clinical practice

Abstract

Outcome prediction in patients with bladder cancer has improved through the development of nomograms and predictive models. However, integration of further characteristics such as lymphovascular invasion (LVI) might increase the accuracy and clinical utility of these instruments. Assessment and reporting of LVI in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy in patients with non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) might enable improved staging, prognostication and clinical decision-making. In NMIBC, presence of LVI in TURBT and biopsy samples seems to be associated with understaging and increased risks of disease recurrence and progression. In MIBC, presence of LVI is associated with features of aggressive disease and predicts recurrence and survival. Integration of LVI status into predictive models might aid clinical decision-making regarding intravesical instillation schedules and regimens, early radical cystectomy in patients with high-grade T1 disease and perioperative chemotherapy. However, LVI assessment is hampered by insufficient reproducibility and reliability, lack of routine evaluation and limited concordance between findings in TURBT and radical cystectomy specimens. Standardization of the pathological criteria defining LVI is warranted to improve its reporting in routine clinical practice and its utility as a care-changing prognostic marker.

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Figure 1: Different staining techniques to detect vascular invasion of urothelial carcinoma.

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Acknowledgements

We acknowledge Pr Nathalie Rioux-Leclercq, Drs Martin Susani and Andrea Haitel for providing their pathologists' insight to the manuscript writing. R.M. was supported by the European Urological Scholarship Programme. I.L. was supported by the development fund of the CHUV-University Hospital and the European Urological Scholarship Programme.

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R.M. and I.L. researched data for the article. All authors made a substantial contribution to discussion of content, wrote the article and reviewed/edited the manuscript before submission. R.M. and I.L. contributed equally to the preparation of this article.

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Correspondence to Shahrokh F. Shariat.

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Mathieu, R., Lucca, I., Rouprêt, M. et al. The prognostic role of lymphovascular invasion in urothelial carcinoma of the bladder. Nat Rev Urol 13, 471–479 (2016). https://doi.org/10.1038/nrurol.2016.126

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