Lymphovascular Invasion in Upper Tract Urothelial Carcinoma Predicts Risk

Lymphovascular invasion in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy is predictive of higher risks for recurrence and mortality, according to a recent meta-analysis.

Judith Stangl-Kremser, MD, PhD, of the Department of Urology at the University of Vienna in Austria, and colleagues conducted the study and published its results in Urologic Oncology: Seminars and Original Investigations.

“Patients with upper tract urothelial carcinoma often have a delayed diagnosis and by then, present with advanced disease, which has been shown to be associated with lymphovascular invasion,” Dr. Stangl-Kremser and colleagues wrote. “It has been suggested to be involved in the metastatic cascade of the disease.”

The researchers performed a search of PubMed/MEDLINE, Scopus, EMBASE, and Web of Science databases for all relevant articles published from 2010 to 2021 on the prognostic impact of lymphovascular invasion in patients undergoing nephroureterectomy. The researchers found 58 studies that met the criteria for inclusion in the analysis. The analysis included a total of 29,829 patients, ranging from 101 to 2492 per study. The median patient age was 69 years. Patients received adjuvant chemotherapy in 68.9% of the studies.

Lymphovascular invasion occurred in 26.2% of the patients analyzed and predicted a greater risk of disease recurrence (pooled hazard ratio [HR], 1.43; 95% CI, 1.31-1.55). Lymphovascular invasion also decreased cancer-specific survival (pooled HR, 1.53; 95% CI, 1.41-1.66) and overall survival (HR, 1.56; 95% CI, 1.45-1.69).

“It can be concluded that [lymphovascular invasion] is a common histologic pattern in surgical specimen [from] patients undergoing [radical nephroureterectomy] for [upper tract urothelial carcinoma],” Dr. Stangl-Kremser and colleagues wrote. “[Lymphovascular invasion] predicts a greater risk of recurrence and mortality. Thus, it should be carefully assessed in clinical practice to determine prognosis, and for optimal decision-making within the concept of personalized therapies.”

Stangl-Kremser J, Muto G, Grosso AA, et al. The impact of lymphovascular invasion in patients treated with radical nephroureterectomy for upper tract urothelial carcinoma: an extensive updated systematic review and meta-analysis. Urol Oncol. 2022;40(6):243-261. doi:10.1016/j.urolonc.2022.01.014