Background. Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy’s overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future. Methods. Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann–Whitney and Kruskal–Wallis tests, as well as Kendall’s tau-b coefficient, yieldingp-values and odds ratios (ORs). Results. Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p< 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p= 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231–6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525–0.913). Conclusions. Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases.
背景：淋巴血管侵犯（LVI）是前列腺癌中一个重要但常被忽视的预后因素。随着对淋巴结清扫术过度治疗的争议出现，理解LVI的侧向性变得尤为重要。本研究首次针对前列腺癌（PCa）中LVI的侧向性展开探索，旨在揭示可能影响未来个体化手术策略的模式。方法：回顾性分析了96例同时存在LVI和淋巴结侵犯（LNI）的患者数据。所有患者均接受了根治性前列腺切除术（RP）及改良扩大盆腔淋巴结清扫术（mePLND）。所有标本均进行了组织病理学检查。LVI的评估分别针对前列腺的左右叶进行。采用U-Mann–Whitney检验、Kruskal–Wallis检验以及Kendall's tau-b系数评估亚组间的关联，得出p值和比值比（OR）。结果：在96例患者中，61例（63.5%）表现为仅左侧LVI，24例（25.0%）为仅右侧LVI，11例（11.5%）为双侧LVI。关于淋巴结受累情况，23例患者（24.0%）仅左侧LNI，25例（26.0%）仅右侧LNI，48例（50.0%）为双侧LNI。研究发现侧向性LVI与侧向性LNI之间存在显著相关性（p < 0.001），尤其是在仅右侧LVI的患者中。与仅右侧LVI的患者相比，伴有左侧LVI的LN阳性患者往往具有更高的pT分期（p = 0.047）和更高的双侧LNI比值比（OR = 2.795；95%置信区间[CI]：1.231–6.348），而仅右侧LVI患者的OR为0.692（95% CI：0.525–0.913）。结论：在LN阳性的PCa患者中，单侧LVI与同侧LNI相关，尤其是在仅右侧LVI的病例中。左侧LVI与更高的pT分期以及更高比例的双侧LNI病例相关。
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