Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan–Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n= 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p< 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7–23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6–2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6–3.0). The same relationship was seen across D’Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.
淋巴血管侵犯，即肿瘤细胞或细胞团在淋巴管或血管管腔内被识别，被认为是疾病播散的关键步骤。该现象已被确立为多种癌症的独立不良预后指标。因此，本研究旨在评估前列腺切除术时淋巴血管侵犯对肿瘤学结局的影响。我们对3495例因局限性前列腺癌接受根治性前列腺切除术的男性进行了多中心回顾性队列研究，仅纳入术前分期阴性的患者。通过多变量逻辑回归模型评估淋巴血管侵犯与不良病理特征之间的关系，并绘制Kaplan-Meier曲线和建立Cox比例风险模型以评估淋巴血管侵犯对肿瘤学结局的影响。在接受前列腺切除术的患者中，19%（n=653）存在淋巴血管侵犯。国际泌尿病理学会（ISUP）分级较高和非器官局限性疾病的患者中，淋巴血管侵犯阳性病变的发生率显著增加（p<0.01）。多变量逻辑回归分析显示，淋巴血管侵犯显著增加病理淋巴结阳性病变的可能性（OR 15，95%CI 9.7-23.6）。根治性前列腺切除术时存在淋巴血管侵犯显著增加生化复发的风险（HR 2.0，95%CI 1.6-2.4）。此外，在整个队列中淋巴血管侵犯显著增加转移风险（HR 2.2，95%CI 1.6-3.0），该相关性在D'Amico风险分组中呈现一致趋势。根治性前列腺切除术时存在淋巴血管侵犯与侵袭性前列腺癌特征相关，是肿瘤学预后不良的指标。
Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes
肿瘤(癌症)患者之家