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737 Prognostic value of lymphovascular invasion in robot-assisted radical prostatectomy patients with prostate confined, resection margin negative tumour
737
Prognostic value of lymphovascular invasion in robot-assisted radical prostatectomy patients with prostate confined, resection margin negative tumour Eur Urol Suppl 2016;15(3);e737
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Kang Y.J.1 , Jang W.S.1 , Kwon J.K.1 , Yoon C.Y. 1 , Lee J.Y.1 , Cho K.S.1 , Ham W.S.1 , Cho I.R.2 , Choi Y.D. 1 1 Yonsei
University College of Medicine, Dept. of Urology, Seoul, South Korea, 2 Inje University, College of Medicine, Dept. of Urology,
Goyang, South Korea INTRODUCTION & OBJECTIVES: Since the the College of American Pathologists’ recommendation to routinely report Lymphovascular Invasion(LVI) for the radical prostatectomy specimens, numerous studies have been conducted in search for the correlation between the presence of LVI and lymphatic or hematogenous metastasis and disease recurrence, but the evidence so far have been conflicting, somewhat dismal. We hereby focused on the set-up of patients with particular stages, covering T2 and T3a, and T3b, who underwent radical prostatectomy without nodal metastasis at the time of operation to reveal association between the increased risk of biochemical recurrence and LVI when effects of other confounding factors were eliminated or adjusted. MATERIAL & METHODS: Among 1653 patients who went under robot assisted radical prostatectomy at single center from 2005 to 2014, patients with clinically localized or locally advanced prostate cancer were selected. Risk groups have been classified according to EAU 2015 guideline. Presence of lymphovascular invasion was defined as the presence of tumour cells within an endothelium lined space without underlying muscular walls. Equivocal cases were considered negative and a perivascular reaction was not required. Propensitiy scores were calculated to adjust for the confounding factors including age, PSA, Gleason score, and clinical T stage. 1-to-1 matched control group was selected against 24 patients with LVI. Chi-square test and Mann-Whitney U test were used for the comparison of parameters from each group. Multivariate survival analysis was performed to assess biochemical recurrence risk by constructing Cox proportional hazard regression models. RESULTS: Median age were 66 (IQR 60-71), with median follow-up duration was 35 months. LVI was detected in 24 (4.3%) patients. Parameters used for calculation of propensity scores showed no difference between two groups after the matching (age, p=0.918; preoperative PSA, p=0.248; clinical T stage, p=0.066; biopsy Gleason score, p=0.084). No differences were found between number of patients received neoadjuvant hormone-therapy (p=0.386). Where 3-year biochemical recurrence rate did not show significant difference (p=0.771), time interval from operation to recur date showed difference as median 76 months for the group without LVI and median 23 months for the LVI group (p=0.012). In the multivariate Cox regression model, when adjusted for other variables such as initial PSA (hazard ratio[HR] 1.007 95% confidence interval[CI] 1.000-1.014), biopsy Gleason sum (7: HR 2.297 95% CI 1.261-4.183; >7: HR 5.421 95% CI 2.949-9.967), clinical T stage (cT3: HR 1.561 95% CI 1.047-2.328), lymphovascular invasion resulted in 2.1-fold increased risk of BCR (95% CI 1.121-3.965). CONCLUSIONS: Although the absence of LVI alone may harbour little significance in predicting the patient’s prognosis beyond what is known by other proven prognostic factors, detection of LVI in the specimen when the primary tumour was completely removed alerts the presence of aggressive cancer cells that could lead to eventual lymphatic or hematogenous spread. It is recommended from the results of current study that the mechanism through which nodal or distant organ metastasis is established be sought for in this selected group of patients.
Prognostic value of lymphovascular invasion in robot-assisted radical prostatectomy patients with prostate confined, resection margin negative tumour Eur Urol Suppl 2016;15(3);e737
Print! Print!
Kang Y.J.1 , Jang W.S.1 , Kwon J.K.1 , Yoon C.Y. 1 , Lee J.Y.1 , Cho K.S.1 , Ham W.S.1 , Cho I.R.2 , Choi Y.D. 1 1 Yonsei
University College of Medicine, Dept. of Urology, Seoul, South Korea, 2 Inje University, College of Medicine, Dept. of Urology,
Goyang, South Korea INTRODUCTION & OBJECTIVES: Since the the College of American Pathologists’ recommendation to routinely report Lymphovascular Invasion(LVI) for the radical prostatectomy specimens, numerous studies have been conducted in search for the correlation between the presence of LVI and lymphatic or hematogenous metastasis and disease recurrence, but the evidence so far have been conflicting, somewhat dismal. We hereby focused on the set-up of patients with particular stages, covering T2 and T3a, and T3b, who underwent radical prostatectomy without nodal metastasis at the time of operation to reveal association between the increased risk of biochemical recurrence and LVI when effects of other confounding factors were eliminated or adjusted. MATERIAL & METHODS: Among 1653 patients who went under robot assisted radical prostatectomy at single center from 2005 to 2014, patients with clinically localized or locally advanced prostate cancer were selected. Risk groups have been classified according to EAU 2015 guideline. Presence of lymphovascular invasion was defined as the presence of tumour cells within an endothelium lined space without underlying muscular walls. Equivocal cases were considered negative and a perivascular reaction was not required. Propensitiy scores were calculated to adjust for the confounding factors including age, PSA, Gleason score, and clinical T stage. 1-to-1 matched control group was selected against 24 patients with LVI. Chi-square test and Mann-Whitney U test were used for the comparison of parameters from each group. Multivariate survival analysis was performed to assess biochemical recurrence risk by constructing Cox proportional hazard regression models. RESULTS: Median age were 66 (IQR 60-71), with median follow-up duration was 35 months. LVI was detected in 24 (4.3%) patients. Parameters used for calculation of propensity scores showed no difference between two groups after the matching (age, p=0.918; preoperative PSA, p=0.248; clinical T stage, p=0.066; biopsy Gleason score, p=0.084). No differences were found between number of patients received neoadjuvant hormone-therapy (p=0.386). Where 3-year biochemical recurrence rate did not show significant difference (p=0.771), time interval from operation to recur date showed difference as median 76 months for the group without LVI and median 23 months for the LVI group (p=0.012). In the multivariate Cox regression model, when adjusted for other variables such as initial PSA (hazard ratio[HR] 1.007 95% confidence interval[CI] 1.000-1.014), biopsy Gleason sum (7: HR 2.297 95% CI 1.261-4.183; >7: HR 5.421 95% CI 2.949-9.967), clinical T stage (cT3: HR 1.561 95% CI 1.047-2.328), lymphovascular invasion resulted in 2.1-fold increased risk of BCR (95% CI 1.121-3.965). CONCLUSIONS: Although the absence of LVI alone may harbour little significance in predicting the patient’s prognosis beyond what is known by other proven prognostic factors, detection of LVI in the specimen when the primary tumour was completely removed alerts the presence of aggressive cancer cells that could lead to eventual lymphatic or hematogenous spread. It is recommended from the results of current study that the mechanism through which nodal or distant organ metastasis is established be sought for in this selected group of patients.