Presentation Authors: Alexander Parker*, Jonathan Weese, Joel Vetter, Zachary Smith, St. Louis, MO
Introduction: The presence of lymphovascular invasion (LVI) at time of transurethral resection of the bladder (TURBT) has been shown to be correlated with poor prognosis and pathological upstaging at the time of radical cystectomy (RC). We sought to further evaluate implications of LVI at the time of TURBT on lymph node (LN) positivity at time of RC.
Methods: In this retrospective study from a tertiary university hospital, we identified 469 patients who underwent RC from 2010 to 2016. Patient cohorts were stratified by presence of LVI on TURBT prior to RC. Clinical variables evaluated included age, BMI, CCI, receipt of neoadjuvant chemotherapy (NAC), 30 day complication rates, pathological upstaging, LNP at time of RC, lymph node yield, and final pathological stage. Chi-square test of independence was used to test for associations between LVI and clinical variables. Overall survival (OS) and disease-free survival (DFS) were calculated with Kaplan-Meier method.
Results: 62 patients were found to have LVI present on TURBT and 407 patients had either no LVI or no mention of LVI on pathology report. Results are summarized in figure 1. Pathological upstaging occurred in 64.5% of the LVI group and 45.7% of the no LVI group (p=0.006) and LNP at RC was identified in 46.8% of the LVI group and 23.4% of the no LVI group (p < 0.001). Final pathologic stage was overall higher in the LVI group with 77.5% having â‰¥pT2 compared to 59.5% in the no LVI group (p < 0.001). Multivariate analysis demonstrated that LVI was independently associated with probability of upstaging (OR: 2.31, 95% CI: 1.30 â€“ 4.09, p=0.004) and LNP (OR: 1.97, 95% CI: 1.04 â€“ 3.71, p=0.037). Further, there was a significant decrease found in OS and DFS for patients with LVI present on TURBT, (p < 0.001).
Conclusions: Patients with LVI at time of TURBT had higher risk for LN positive disease and pathologic upstaging at time of RC. Further, LVI was associated with worse OS and DFS. These results suggest that patients with LVI at time of TURBT may benefit from more aggressive therapy, such as early RC, or receipt of NAC independent of stage.