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Shahrokh F Shariat - One of the best experts on this subject based on the ideXlab platform.
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a systematic review and meta analysis of Lymphovascular Invasion in patients treated with radical cystectomy for bladder cancer
Urologic Oncology-seminars and Original Investigations, 2018Co-Authors: Andrea Mari, Mohammad Abufaraj, Beat Foerster, David Dandrea, Shoji Kimura, Kilian M Gust, Shahrokh F ShariatAbstract:Abstract Purpose Lymphovascular Invasion (LVI) is an important step in bladder cancer cell dissemination. We aimed to perform a systematic review and meta-analysis of the literature to assess the prognostic value of LVI in radical cystectomy (RC) specimens. Patients and methods A systematic review and meta-analysis of the last 10 years was performed using the MEDLINE, EMBASE, and the Cochrane libraries in July 2017. The analyses were performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Results We retrieved 65 studies (including 78,107 patients) evaluating the effect of LVI on oncologic outcomes in patients treated with RC. LVI was reported in 35.4% of patients. LVI was associated with disease recurrence (pooled hazard ratio [HR] = 1.57; 95% CI: 1.45–1.70) and cancer-specific mortality (CSM) (pooled HR = 1.59; 95% CI: 1.48–1.73) in all studies regardless of tumor stage and node status (pT1–4 pN0–2). LVI was associated with recurrence and CSM in patients with node-negative bladder cancer (BC). In patients with node-negative BC, LVI rate increased and was associated with worse oncologic outcome. LVI had a lower but still significant association with disease recurrence and CSM in node-positive BC. Conclusions LVI is a strong prognostic factor of worse prognosis in patients treated with RC for bladder cancer. This association is strongest in node-negative BC, but it is also in node-positive BC. LVI should be part of all pathological reporting and could provide additional information for treatment-decision making regarding adjuvant therapy after RC.
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accuracy and prognostic value of variant histology and Lymphovascular Invasion at transurethral resection of bladder
World Journal of Urology, 2018Co-Authors: Shahrokh F Shariat, R Mathieu, Mohammad Abufaraj, Beat Foerster, Carmen Pozo, Marco Moschini, David DandreaAbstract:To evaluate the concordance rate of Lymphovascular Invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes. Two hundred and sixty-eight patients who underwent TUR and subsequent RC were reviewed. Logistic regression analyses were performed to evaluate the association of LVI and VH with NOC and lymph node metastasis at RC. Cox regression analyses were used to estimate recurrence-free survival (RFS) and cancer-specific survival (CSS). LVI and VH were detected in 13.8 and 11.2% of TUR specimens, and in 30.2 and 25.4% of RC specimens, respectively. The concordance rate between LVI and VH at TUR and subsequent RC was 69.8 and 83.6%, respectively. They were both associated with adverse pathological features such as lymph node metastasis and advanced stage. TUR LVI and VH were both independently associated with lymph node metastasis and TUR VH was independently associated with NOC. On univariable Cox regression analyses, TUR LVI was associated with RFS and CSS while TUR VH was only associated with RFS. Only TUR LVI was independently associated with RFS. Detection of LVI is missed in a third of TUR specimens while VH seems more accurately identified. TUR LVI and VH are associated with more advanced disease and LVI predicts disease recurrence. Assessment and reporting of LVI and VH on TUR specimen are important for risk stratification and decision-making.
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the prognostic role of Lymphovascular Invasion in urothelial carcinoma of the bladder
Nature Reviews Urology, 2016Co-Authors: R Mathieu, Shahrokh F Shariat, Ilaria Lucca, Morgan Roupret, Alberto BrigantiAbstract: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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Lymphovascular Invasion is independently associated with bladder cancer recurrence and survival in patients with final stage t1 disease and negative lymph nodes after radical cystectomy
BJUI, 2013Co-Authors: Derya Tilki, Shahrokh F Shariat, Yair Lotan, Pierre I Karakiewicz, M Rink, Mark P Schoenberg, Seth P Lerner, Guru SonpavdeAbstract:What's known on the subject? and What does the study add? Lymphovascular Invasion (LVI) is an important step in systemic cancer cell dissemination. LVI has been shown to be an independent predictor of disease recurrence and cancer-specific survival in urothelial carcinoma of the bladder (UCB) for patients with carcinoma invading bladder muscle. Patients with final pathological stage T1N0 UCB who underwent radical cystectomy (RC) have not been separately analysed for influence of LVI on outcomes. Our study shows that LVI predicts disease recurrence and cancer-specific survival in patients with final stage T1 UCB after RC. Objective To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether Lymphovascular Invasion (LVI) is an independent predictor of prognosis in these patients. Patients and Methods Records of 958 consecutive patients who underwent RC at three academic centres were reviewed. A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified. The median (range) follow-up was 38 (0.4–177) months and the median (range) number of nodes examined was 19 (9–80). Results Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02). Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer. All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ. On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival. Conclusions LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death. These patients should be considered for close monitoring after cystectomy.
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prognostic significance of Lymphovascular Invasion in radical prostatectomy specimens
BJUI, 2011Co-Authors: David S Yee, Shahrokh F Shariat, William T Lowrance, Alexandra C Maschino, Caroline O S Savage, Angel M Cronin, Peter T Scardino, James A EasthamAbstract:Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The reported incidence of Lymphovascular Invasion (LVI) in radical prostatectomy specimens ranges from 5% to 53%. Although LVI has a strong and significant association with adverse clinicopathologic features, it has almost uniformly not been found to be a predictor of biochemical recurrence (BR) on multivariate analysis. This study confirms that LVI is associated with features of aggressive disease and is an independent predictor of BCR. Given that LVI may play a role in the metastatic process, it may be useful in clinical decision-making regarding adjuvant therapy for patients treated with RP. OBJECTIVES To determine whether Lymphovascular Invasion (LVI) in radical prostatectomy (RP) specimens has prognostic significance. The study examined whether LVI is associated with clinicopathological characteristics and biochemical recurrence (BCR). PATIENTS AND METHODS LVI was evaluated based on routine pathology reports on 1298 patients treated with RP for clinically localized prostate cancer between 2004 and 2007. LVI was defined as the unequivocal presence of tumour cells within an endothelium-lined space. The association between LVI and clinicopathological features was assessed with univariate logistic regression. Cox regression was used to test the association between LVI and BCR. RESULTS LVI was identified in 10% (129/1298) of patients. The presence of LVI increased with advancing pathological stage: 2% (20/820) in pT2N0 patients, 16% (58/363) in pT3N0 patients and 17% (2/12) in pT4N0 patients; and was highest in patients with pN1 disease (52%; 49/94). Univariate analysis showed an association between LVI and higher preoperative prostate-specific antigen levels and Gleason scores, and a greater likelihood of extraprostatic extension, seminal vesicle Invasion, lymph node metastasis and positive surgical margins (all P < 0.001). With a median follow-up of 27 months, LVI was significantly associated with an increased risk of BCR after RP on univariate (P < 0.001) and multivariate analysis (hazard ratio, 1.77; 95% confidence interval, 1.11–2.82; P= 0.017). As a result of the relatively short follow-up, the predictive accuracy of the standard clinicopathological features was high (concordance index, 0.880), and inclusion of LVI only marginally improved the predictive accuracy (0.884). CONCLUSIONS Although associated with features of aggressive disease and BCR, LVI added minimally to established predictors on short follow-up. Further study of cohorts with longer follow-up is warranted to help determine its prognostic significance.
Hsinchih Yeh - One of the best experts on this subject based on the ideXlab platform.
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prognostic significance of Lymphovascular Invasion in upper urinary tract urothelial carcinoma is influenced by tumor location
Annals of Surgical Oncology, 2015Co-Authors: Hsiangying Lee, Chunnung Huang, Peirin Liang, Sheaufang Yang, Hsinchih YehAbstract:Background To examine the prognostic value of Lymphovascular Invasion (LVI) in different tumor locations (i.e., renal pelvis and ureter) of upper urinary tract urothelial carcinoma (UTUC).
Eiji Kikuchi - One of the best experts on this subject based on the ideXlab platform.
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Lymphovascular Invasion predicts clinical outcomes in patients with node negative upper tract urothelial carcinoma
Journal of Clinical Oncology, 2009Co-Authors: Eiji Kikuchi, Vitaly Margulis, P I Karakiewicz, Marco Roscigno, Shuji Mikami, Yair Lotan, Mesut Remzi, Christian Bolenz, Cord Langner, Alon WeizerAbstract:Purpose To assess the association of Lymphovascular Invasion (LVI) with cancer recurrence and survival in a large international series of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Patients and Methods Data were collected on 1,453 patients treated with RNU at 13 academic centers and combined into a relational database. Pathologic slides were rereviewed by genitourinary pathologists according to strict criteria. LVI was defined as presence of tumor cells within an endothelium-lined space. Results LVI was observed in 349 patients (24%). Proportion of LVI increased with advancing tumor stage, high tumor grade, presence of tumor necrosis, sessile tumor architecture, and presence of lymph node metastasis (all P < .001). LVI was an independent predictor of disease recurrence and survival (P < .001 for both). Addition of LVI to the base model (comprising pathologic stage, grade, and lymph node status) marginally improved its predictive accuracy for...
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Lymphovascular Invasion independently predicts increased disease specific survival in patients with transitional cell carcinoma of the upper urinary tract
The Journal of Urology, 2005Co-Authors: Eiji Kikuchi, Naoki Hatakeyama, Mayuko Matsumoto, Toru Nishiyama, Yutaka Horiguchi, Jun Nakashima, Masaru MuraiAbstract:ABSTRACTPurpose: We investigated the prognostic impact of Lymphovascular Invasion (LVI) and traditional prognostic factors for survival in a large series of patients treated surgically for upper tract transitional cell carcinoma (TCC). We also developed a prognostic factors based model for risk stratification of upper tract TCC.Materials and Methods: We identified a study population of 173 consecutive patients treated surgically for upper tract TCC at our institution between 1980 and 2002. We compared LVI with other pathological features and determined the disease specific survival rate.Results: LVI was found in 52 patients (30.1%). As tumor grade and pathological stage increased, the incidence of LVI increased significantly. LVI was found in 12 of 133 patients (9.0%) without lymph node metastasis compared with 40 of 40 patients (100%) with lymph node metastasis. Five and 10-year disease specific survival rates were 84.9% and 80.4% in the absence of LVI, and 40.2% and 21.1% in the presence of LVI, respect...
Yair Lotan - One of the best experts on this subject based on the ideXlab platform.
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validation of Lymphovascular Invasion is an independent prognostic factor for biochemical recurrence after radical prostatectomy
Urologic Oncology-seminars and Original Investigations, 2016Co-Authors: Harun Fajkovic, R Mathieu, Ilaria Lucca, Alberto Briganti, Manuela Hiess, Nicolai Hubner, Richard K Lee, Pierre I Karakiewicz, Yair LotanAbstract:Abstract Objective To validate the impact of Lymphovascular Invasion (LVI) on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) in a large multiinstitutional cohort. Material and methods Retrospective data from 6,678 patients treated with a RP and bilateral lymphadenectomy for prostate cancer (PC) from 8 centers were collected. The primary endpoint was BCR. Results Overall, 767 patients (11.5%) had LVI. Patients with LVI had significantly higher Gleason scores (P = 0.01). After a median follow-up of 28 months (interquartile range: 21–44), patients with LVI had a 1.66 fold increased risk of BCR (P Conclusions About 10% of patients with localized PC have LVI on their RP specimen. We confirm that LVI is associated with features of biologic aggressive PC such as high Gleason grade and BCR after RP. Adverse further studies with strict definitions of LVI and longer follow-up periods are needed to determine the prognostic and predictive utility of LVI in the management of PC.
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Lymphovascular Invasion in clear cell renal cell carcinoma association with disease free and cancer specific survival
Urologic Oncology-seminars and Original Investigations, 2014Co-Authors: Michael Belsante, Yair Lotan, Oussama M Darwish, Ramy F Youssef, Aditya Bagrodia, Payal Kapur, Arthur I Sagalowsky, Vitaly MargulisAbstract:Abstract Objectives The objective is to evaluate the effect of Lymphovascular Invasion (LVI) on disease-free survival (DFS) and cancer-specific survival (CSS) in patients with clinically localized clear cell renal cell carcinoma (ccRCC). Methods Patients with ccRCC who were treated surgically in 1997 to 2010 were identified. Retrospective chart review was performed to identify clinical outcomes. Independent pathologic re-review was performed by a single pathologist to confirm LVI status. Pathologic features were correlated with clinical outcomes using Kaplan-Meier and Cox regression analyses. Results Four hundred and nineteen patients with nonmetastatic ccRCC comprised the study cohort. Three hundred and thirty-three of these patients had an organ-confined (pT1-2, N any, and M0) disease. LVI was present in 14.3% of all nonmetastatic patients. In all patients with nonmetastatic ccRCC, presence of LVI was correlated with significantly shorter DFS ( P P = 0.001) on Kaplan-Meier analysis. In cases of organ-confined, nonmetastatic ccRCC, presence of LVI was a significant predictor of DFS (hazard ratio = 4.0, P = 0.026) and CSS (hazard ratio = 12.7, P = 0.01) on multivariate analysis. Patients with organ-confined RCC who were LVI positive had similar DFS ( P = 0.957) and CSS ( P = 0.799) to patients with locally advanced tumors (pT3-pT4, N any, and M0) on Kaplan-Meier analysis. Conclusions The presence of LVI is an independent predictor of both DFS and CSS in organ-confined, nonmetastatic ccRCC. LVI positivity in patients with otherwise pathologically organ-confined ccRCC confers oncologic outcomes similar to those of patients with locally advanced disease. If confirmed by others, future revisions to the tumor-node-metastasis staging system may incorporate LVI status into the prognostic algorithm of patients with RCC.
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Lymphovascular Invasion is independently associated with bladder cancer recurrence and survival in patients with final stage t1 disease and negative lymph nodes after radical cystectomy
BJUI, 2013Co-Authors: Derya Tilki, Shahrokh F Shariat, Yair Lotan, Pierre I Karakiewicz, M Rink, Mark P Schoenberg, Seth P Lerner, Guru SonpavdeAbstract:What's known on the subject? and What does the study add? Lymphovascular Invasion (LVI) is an important step in systemic cancer cell dissemination. LVI has been shown to be an independent predictor of disease recurrence and cancer-specific survival in urothelial carcinoma of the bladder (UCB) for patients with carcinoma invading bladder muscle. Patients with final pathological stage T1N0 UCB who underwent radical cystectomy (RC) have not been separately analysed for influence of LVI on outcomes. Our study shows that LVI predicts disease recurrence and cancer-specific survival in patients with final stage T1 UCB after RC. Objective To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether Lymphovascular Invasion (LVI) is an independent predictor of prognosis in these patients. Patients and Methods Records of 958 consecutive patients who underwent RC at three academic centres were reviewed. A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified. The median (range) follow-up was 38 (0.4–177) months and the median (range) number of nodes examined was 19 (9–80). Results Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02). Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer. All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ. On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival. Conclusions LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death. These patients should be considered for close monitoring after cystectomy.
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Lymphovascular Invasion predicts clinical outcomes in patients with node negative upper tract urothelial carcinoma
Journal of Clinical Oncology, 2009Co-Authors: Eiji Kikuchi, Vitaly Margulis, P I Karakiewicz, Marco Roscigno, Shuji Mikami, Yair Lotan, Mesut Remzi, Christian Bolenz, Cord Langner, Alon WeizerAbstract:Purpose To assess the association of Lymphovascular Invasion (LVI) with cancer recurrence and survival in a large international series of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Patients and Methods Data were collected on 1,453 patients treated with RNU at 13 academic centers and combined into a relational database. Pathologic slides were rereviewed by genitourinary pathologists according to strict criteria. LVI was defined as presence of tumor cells within an endothelium-lined space. Results LVI was observed in 349 patients (24%). Proportion of LVI increased with advancing tumor stage, high tumor grade, presence of tumor necrosis, sessile tumor architecture, and presence of lymph node metastasis (all P < .001). LVI was an independent predictor of disease recurrence and survival (P < .001 for both). Addition of LVI to the base model (comprising pathologic stage, grade, and lymph node status) marginally improved its predictive accuracy for...
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Lymphovascular Invasion is independently associated with overall survival cause specific survival and local and distant recurrence in patients with negative lymph nodes at radical cystectomy
Journal of Clinical Oncology, 2005Co-Authors: Yair Lotan, Shahrokh F Shariat, Pierre I Karakiewicz, Patrick J Bastian, Amit Gupta, Ganesh S Palapattu, Amnon Vazina, Charlene Rogers, Gilad E Amiel, Paul PerotteAbstract:Purpose We hypothesized that bladder cancer patients with associated Lymphovascular Invasion (LVI) are at increased risk of occult metastases. Methods A multi-institutional group (University of Texas Southwestern [Dallas, TX], Baylor College of Medicine [Houston, TX], Johns Hopkins University [Baltimore, MD]) carried out a retrospective study of 958 patients who underwent cystectomy for bladder cancer between 1984 and 2003. Of patients with transitional-cell carcinoma (n = 776), LVI status was available for 750. LVI was defined as the presence of tumor cells within an endothelium-lined space. Results LVI was present in 36.4% (273 of 750) overall, involving 26% (151 of 581) and 72% (122 of 169) of node-negative and node-positive patients, respectively. Prevalence of LVI increased with higher pathologic stage (9.0%, 23%, 60%, and 78%, for T1, T2, T3, and T4, respectively; P < .001). Using multivariate Cox regression analyses including age, stage, grade, and number of pelvic lymph nodes removed, LVI was an i...
Kazunori Kihara - One of the best experts on this subject based on the ideXlab platform.
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Lymphovascular Invasion is independently associated with poor prognosis in patients with localized upper urinary tract urothelial carcinoma treated surgically
The Journal of Urology, 2008Co-Authors: Kazutaka Saito, Satoru Kawakami, Yasuhisa Fujii, Mizuaki Sakura, Hitoshi Masuda, Kazunori KiharaAbstract:Purpose: We explored the prognostic impact of Lymphovascular Invasion in patients with localized upper urinary tract urothelial carcinoma.Materials and Methods: The clinical records of 135 patients treated surgically for localized upper urinary tract urothelial carcinoma (pTa-3N0M0) were reviewed retrospectively. Lymphovascular Invasion was defined as cancer cells in an endothelium lined space. Actuarial survival curves were calculated by the Kaplan-Meier method. Differences between survival curves were evaluated by the log rank test. Multivariate analysis was performed using the Cox proportional hazard model.Results: Median followup was 55 months (range 3 to 232). Lymphovascular Invasion was present in 57 patients (42.2%) and it was associated with higher pathological T stage and higher tumor grade. Recurrence-free and disease specific survival rates in patients with Lymphovascular Invasion were significantly worse than those in patients without Lymphovascular Invasion (p = 0.001 and 0.001, respectively)...
