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Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder

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Abstract

Objectives

To evaluate the concordance rate of lymphovascular invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes.

Patients and methods

Two hundred and sixty-eight patients who underwent TUR and subsequent RC were reviewed. Logistic regression analyses were performed to evaluate the association of LVI and VH with NOC and lymph node metastasis at RC. Cox regression analyses were used to estimate recurrence-free survival (RFS) and cancer-specific survival (CSS).

Results

LVI and VH were detected in 13.8 and 11.2% of TUR specimens, and in 30.2 and 25.4% of RC specimens, respectively. The concordance rate between LVI and VH at TUR and subsequent RC was 69.8 and 83.6%, respectively. They were both associated with adverse pathological features such as lymph node metastasis and advanced stage. TUR LVI and VH were both independently associated with lymph node metastasis and TUR VH was independently associated with NOC. On univariable Cox regression analyses, TUR LVI was associated with RFS and CSS while TUR VH was only associated with RFS. Only TUR LVI was independently associated with RFS.

Conclusion

Detection of LVI is missed in a third of TUR specimens while VH seems more accurately identified. TUR LVI and VH are associated with more advanced disease and LVI predicts disease recurrence. Assessment and reporting of LVI and VH on TUR specimen are important for risk stratification and decision-making.

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Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

    Mohammad Abufaraj, Shahrokh F. Shariat, Beat Foerster, Carmen Pozo, Marco Moschini, David D’Andrea, Romain Mathieu & Anna K. Czech

  2. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

  3. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  4. Department of Urology, University of Texas Southwestern Medical Centre, Dallas, TX, USA

    Shahrokh F. Shariat

  5. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  6. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland

    Beat Foerster

  7. Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Carmen Pozo

  8. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Marco Moschini

  9. Department of Urology, University of Rennes, Rennes, France

    Romain Mathieu

  10. Department of Pathology, Medical University of Vienna, Vienna, Austria

    Martin Susani

  11. Department of Urology, Jagiellonian University in Krakow, Krakow, Poland

    Anna K. Czech

  12. Department of Urology, University of Montreal, Montreal, Canada

    Pierre I. Karakiewicz

  13. Department for Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria

    Veronika Seebacher

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  1. Mohammad Abufaraj
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Corresponding author

Correspondence to Shahrokh F. Shariat.

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Conflict of interest

I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript are the following: Shahrokh Shariat owns or co-owns the following patents: Methods to determine prognosis after therapy for prostate cancer. Granted 2002-09-06. Methods to determine prognosis after therapy for bladder cancer. Granted 2003-06-19. Prognostic methods for patients with prostatic disease. Granted 2004-08-05. Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma. Granted 2010-07-20. He is advisory board member for Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanofi, Urogen and Wolff. He is speaker for Astellas, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi, Wolff.

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Abufaraj, M., Shariat, S.F., Foerster, B. et al. Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder. World J Urol 36, 231–240 (2018). https://doi.org/10.1007/s00345-017-2116-3

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  • DOI: https://doi.org/10.1007/s00345-017-2116-3

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