Lymphovascular Invasion Is a Risk Factor for Understaging in pT1 Urothelial Carcinoma of the Bladder.
Martin Braun, Georgios Gakis, Tilman Todenhofer, Falko Fend, Arnulf Stenzl, Sven Perner. University Hospital Bonn, Germany; University Hospital Tuebingen, Germany
Background: Urothelial carcinoma of the bladder (UCB) is often clinically understaged at primary diagnosis via transurethral resection of the bladder (TURB). Aim of this study was to evaluate the incidence, risk factors and clinical outcome of patients with urothelial carcinoma of the bladder staged pT1 at primary diagnosis via TURB.
Design: Of 275 patients with diagnosed UCB undergoing radical cystectomy (RC), 32 patients had histologically confirmed pT1 UCB at primary diagnosis via TURB. The presence of lymphatic and vascular invasion in TURB specimens and corresponding RC was assessed using conventional H&E staining, as well as immunohistochemical staining (IHC) against the lymphatic endothelium marker D2-40 and vascular endothelium marker CD31. Kaplan-Meier plots with the log-rank test were used to estimate recurrence-free and cancer-specific survival at a mean follow-up of 26.3 months (3-74).
Results: In RC specimens, pT1 stage was confirmed in 15/32 cases (47%). Of these, 17 cases (53%) were understaged in TURB specimens (pT2, pT3, and pT4 in 10, 3, and 4 cases, respectively). Lymphovascular invasion was detected in 8/17 understaged cases (47%) but in no case with confirmed pT1 UCB (p=0.003). In TURB specimens, none of the cases with confirmed pT1 UCB showed lymphovascular invasion, but 2/8 cases with understaged disease (25%)(sensitivity 12%, specificity 100%, PPV 100%, NPV 50%). Of note, on conventional H&E slides, lymphovascular invasion was not detectable in 2 TURB and 6 RC specimens, but detected in subsequent IHC. Actuarial recurrence-free and cancer-specific survival was significantly improved in patients with L0/V0 compared to patients with L1 and/or V1 (p<0.05).
Conclusions: Lymphovascular invasion is associated with decreased recurrence-free and cancer-specific survival. Understaging in pT1 urothelial carcinoma of the bladder is frequent (53%) and significantly more likely when lymphovascular invasion is present at primary or final diagnosis. Further, for patients with UCB, additional immunohistochemical assessment for lymphaticovascular invasion on a regular basis might be indicated. This could decrease understaging in UCB and result in an earlier radical treatment of the disease.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 9:00 AM
Platform Session: Section A, Monday Morning