Lymphovascular Invasion Helps Predict Post-RP Biochemical Recurrence

About 10% of patients with clinically localized prostate cancer have lymphovascular invasion on their prostatectomy specimen.
About 10% of patients with clinically localized prostate cancer have lymphovascular invasion on their prostatectomy specimen.

Prostate cancer patients with lymphovascular invasion (LVI) may be at higher risk for biochemical recurrence (BCR) following radical prostatectomy (RP), according to a new study.

Previous studies assessing the value of LVI status have shown mixed results. That prompted investigators led by Harun Fajkovic, MD, of Medical University of Vienna in Austria, to review retrospective data on 6678 patients treated with RP and bilateral lymphadenectomy between 2000 and 2011.  

The researchers found that 11.5% of patients had LVI. Previous reports have ranged from 5% to 53%. Among patients with pT3N0 disease, the rate was 12.5%.

LVI was associated with higher Gleason scores, a marker of aggressive prostate cancer. Patients with LVI had 66% greater risk of BCR over 28 months of follow-up. The 1-, 2- and 5-year BCR-free survival probabilities for LVI vs no LVI were 94% vs  97%, 91% vs 94%, and 76% vs 84%, respectively. A multivariable analysis adjusted for routine prognostic factors found that LVI was an independent predictor of BCR.

When investigators added LVI to a baseline model that included factors such as preoperative prostate-specific antigen (PSA) and Gleason score, it increased BCR discrimination, albeit slightly, from 78.9% to 79.1%. In subgroup analyses, LVI remained an independent predictor for BCR in patients with worse pathological features, including extracapsular extension, seminal invasion, and pathological Gleason score 7 and above. LVI did not aid BCR prediction for patients with organ-confined and Gleason 6 disease, however.

LVI assessment may prove useful to pT3N0 patients deciding on adjuvant therapy. “Our findings suggest that LVI may be a relevant marker to identify among these patients those who may benefit from early adjuvant therapy, and spare side effects to those who may not,” Dr Fajkovic and colleagues commented in Urologic Oncology.

Accurate determination of LVI remains crucial, according to the investigators. Retraction artefacts of surrounding stromal tissue, for example, can mimic vascular invasion.

Study limitations included lack of long-term follow-up, PSA data, and description of the extent and location of LVI. The researchers suggested future research should employ strict criteria for LVI and longer follow-up.

Sources

1. Fajkovic H, Mathieu R, Lucca I, et al. Validation of lymphovascular invasion is an independent prognostic factor for biochemical recurrence after radical prostatectomy. Urol Oncol 2016 May;34(5):233.e1-6. doi:10.1016/j.urolonc.2015.10.013.

2. Prognostic factor indicates risk of cancer recurrence following radical prostatectomy. 2016 Jun 27. Medical University of Vienna.

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