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Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

 Yong Jin Kang  ;  Hyun-Soo Kim  ;  Won Sik Jang  ;  Jong Kyou Kwon  ;  Cheol Yong Yoon  ;  Joo Yong Lee  ;  Kang Su Cho  ;  Won Sik Ham  ;  Young Deuk Choi 
 BMC CANCER, Vol.17(1) : 321, 2017 
Journal Title
Issue Date
Aged ; Disease-Free Survival ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Recurrence, Local* ; Prostate-Specific Antigen/blood ; Prostatectomy* ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery* ; Retrospective Studies
Prostate ; Prostate-specific antigen ; Radical prostatectomy
BACKGROUND: The association between lymphovascular invasion and lymphatic or hematogenous metastasis has been suspected, with conflicting evidence. We have investigated the association between the risk of biochemical recurrence and lymphovascular invasion in resection margin negative patients, as well as its association with lymph node metastasis.

METHODS: One thousand six hundred thirty four patients who underwent radical prostatectomy from 2005 to 2014 were selected. Patients with bone or distant organ metastasis at the time of operation were excluded. Survival analysis was performed to assess biochemical recurrence, metastasis and mortality risks by Kaplan-Meier analysis and multivariate Cox proportional hazard regression. Odds of lymph node metastasis were evaluated by Logistic regression.

RESULTS: LVI was detected in 118 (7.4%) patients. The median follow-up duration was 33.1 months. In the Kaplan-Meier analysis, lymphovascular invasion was associated with significantly increased 5-year and 10-year BCR rate (60.2% vs. 39.1%, 60.2% vs. 40.1%, respectively; p < 0.001), 10-year bone metastasis rate and cancer specific mortality (16.9% vs. 5.1%, p = 0.001; 6.8% vs. 2.7%, p = 0.034, respectively) compared to patients without LVI. When stratified by T stage and resection margin status, lymphovascular invasion resulted in significantly increased 10-year biochemical recurrence rate in T3 patients both with and without positive surgical margin (p = 0.008, 0.005, respectively). In the multivariate Cox regression model lymphovascular invasion resulted in 1.4-fold BCR risk and 1.7-fold metastasis risk increase (95% CI 1.045-1.749, 1.024-2.950; p = 0.022, 0.040, respectively). Lymphovascular invasion was revealed to be strongly associated with lymph node metastasis in the multivariate Logistic regression (OR 4.317, 95% CI 2.092-8.910, p < 0.001).

CONCLUSION: Lymphovascular invasion increases the risk of recurrence in T3 patients regardless of margin status, by accelerating lymph node metastasis and distant organ metastasis.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Yong Jin(강용진)
Kim, Hyun-Soo(김현수)
Yoon, Cheol Yong(윤철용)
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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