Prognostic value of lymphovascular invasion in patients with muscle-invasive bladder cancer

Abstract

Background. Bladder cancer ranks 9 in prevalence among malignancies and 2 among malignant tumors of the human urogenital tract. Removal of the bladder together with a tumor significantly reduces the quality of patients’ life and contributes to the emergence of postoperative complications that can lead to the patient’s death during the first year after the surgery. Along with radical methods of removing muscleinvasive bladder cancer (MIBC), organ-sparing operations can be performed, which can be an effective alternative to radical cystectomy. Purpose of study was to compare the results of treatment of MIBC with presence of lymphovascular invasion (LVI) in the primary tumor in two groups: after radical cystectomy with ileocystoneoplasty and partial cystectomy (PC) with adjuvant chemotherapy. Materials and methods. Depending on the method of treatment, patients were divided into 2 groups. The 1st group included 46 (42,4%) patients who underwent PC with adjuvant chemotherapy; 2nd group – 63 (57,6%) patients after radical cystectomy with ileocystoneoplasty or ureterocutaneostomy. Patient selection criteria for bladder preservation were generally recommended. Overall survival, cancer-specific and recurrencefree survival rates were evaluated according to the method of Kaplan–Meier. The median age of patients in the 1st group was 55 (48–65 years), in the 2nd – 60 (55–71 years). Results. The obtained data show that during 5-year follow-up period, the oncological results of the treatment of 2 groups have no significant difference, but taking into account significantly better quality of life of patients who underwent organ-preserving treatment, it is possible to claim that the use of bimodal therapy of MIBC in selectively chosen patients is justified. LVI was an independent predictor of both disease recurrence and cancer-specific survival rates. Patients who received complex therapy in presented studies demonstrated satisfactory cancer-specific and overall survival rates. Conclusions. The use of organ-preserving treatment with adjuvant chemotherapy in patients with MIBC and positive LVI allows the oncological results, which are comparable to radical cystectomy, to be achieved. Taking into consideration significant advantages of organ-preserving treatment compared with radical cystectomy with various methods of urine derivation, the proposed treatment strategy is an appropriate alternative to radical cystectomy.