Evaluating the role of lymphvascular invasion as an indicator for adverse outcomes for patients with upper tract urothelial carcinoma and its histological subtypes

Document Type

Conference Proceeding

Publication Date


Publication Title

Eur Urol


Introduction & Objectives: Lymphvascular invasion (LVI) is recognized as an adverse prognostic factor in many cancers. However, its utility in upper tract urothelial carcinoma (UTUC) has not been well-defined. Our aim is to assess the prognostic ability of LVI in UTUC urothelial carcinoma (UC) and micropapillary urothelial carcinoma (MPUC) subtypes as a predictor of overall survival (OS) using a large North American cohort.

Materials & Methods: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). The main variable of interest was LVI status and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to estimate the OS. Cox regression analysis tested the impact of LVI status on OS after accounting for covariates: age, sex, race, year of diagnosis, Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor, and pN status.

Results: Mean (SD) age was 70.90 10.9 years. Overall, 14.4% had LVI, and 6.77% had pN+ (pN1-3) disease. The rate of advanced stage (pT3 or higher), and pN+ disease was 78.8%% and 18.1% in patients with LVI vs. 34.7% and 3.32% in patients without LVI. The histological subtypes were UC, pure squamous, sacromatoid/spindle cell carcinoma, and MPUC in respectively 49.8%, 0.608%, 0.708%, and 48.9% of patients. The mean (SD) follow-up was 42.9 35.3 months. In patients with UC at 5-years post-RNU, the OS rates were 60.2%, 29.9%, 28.9%, and 20.8% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). In patients with MPUC at 5-years post-RNU, the OS rates were 65.3%, 40.2%, 54.7%, and 36.5% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). On multivariable analysis, LVI was an independent predictor of less favorable OS outcomes, as those with LVI had a 1.82-fold higher risk of death (95% CI: 1.21-1.54, p<0.001), when compared to their counterpart without LVI.

Conclusions: To the best of our knowledge, our report is the first to examine the impact of LVI on OS in a large North American nationwide cohort. Our results indicate that LVI is associated with less favorable survival outcomes in patient with UTUC who are treated surgically, and can be utilized for counseling after RNU and as a risk-stratification tool for future clinical trials.



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