Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder: Data from the prospective p53-MVAC trial

Friedrich Carl Von Rundstedt; Douglas A. Mata; Susan Groshen; John P. Stein; Donald G. Skinner; Walter M. Stadler; Richard J. Cote; Oleksandr N. Kryvenko; Guilherme Godoy; Seth P. Lerner

doi:10.1111/bju.12997

Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder: Data from the prospective p53-MVAC trial

Friedrich Carl Von Rundstedt, Douglas A. Mata, Susan Groshen, John P. Stein, Donald G. Skinner, Walter M. Stadler, Richard J. Cote, Oleksandr N. Kryvenko, Guilherme Godoy, Seth P. Lerner

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14 Scopus citations

Abstract

Objectives To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ-confined, node-negative urothelial cancer of the bladder (UCB) in a post hoc analysis of a prospective clinical trial. To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumours exhibited LVI. Patients and Methods Surgical and tumour factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1-T2 N0 UCB in the p53-MVAC trial (Southwest Oncology Group 4B951/NCT00005047). The presence or absence of LVI was determined by pathological examination of transurethral resection or RC specimens. Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results Among 499 patients with a median follow-up of 4.9 years, a subset of 102 (20%) had LVI-positive tumours. Of these, 34 patients had pT1 and 68 had pT2 disease. LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 [95% confidence interval (CI) 1.15-2.77; number of events (EV) 95; P = 0.01) and with OS with a HR of 2.02 (95% CI 1.31-3.11; EV 98; P = 0.001) after adjustment for pathological stage. Among 27 patients with LVI-positive tumours who were randomised to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70, 95% CI 0.16-3.17; EV 7; P = 0.65) or with OS (HR 0.45, 95% CI 0.11-1.83; EV 9; P = 0.26). Conclusions Our post hoc analysis of the p53-MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1-T2N0 disease. The analysis did not show a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not excluded.

Original language	English
Pages (from-to)	44-49
Number of pages	6
Journal	BJU international
Volume	116
Issue number	1
DOIs	https://doi.org/10.1111/bju.12997
State	Published - Jul 1 2015

Keywords

SWOG
adjuvant chemotherapy
lymphovascular invasion
urothelial cancer

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10.1111/bju.12997

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Von Rundstedt, F. C., Mata, D. A., Groshen, S., Stein, J. P., Skinner, D. G., Stadler, W. M., Cote, R. J., Kryvenko, O. N., Godoy, G., & Lerner, S. P. (2015). Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder: Data from the prospective p53-MVAC trial. BJU international, 116(1), 44-49. https://doi.org/10.1111/bju.12997

@article{14869a21f90944a698c8572af2b24aad,

title = "Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder: Data from the prospective p53-MVAC trial",

abstract = "Objectives To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ-confined, node-negative urothelial cancer of the bladder (UCB) in a post hoc analysis of a prospective clinical trial. To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumours exhibited LVI. Patients and Methods Surgical and tumour factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1-T2 N0 UCB in the p53-MVAC trial (Southwest Oncology Group 4B951/NCT00005047). The presence or absence of LVI was determined by pathological examination of transurethral resection or RC specimens. Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results Among 499 patients with a median follow-up of 4.9 years, a subset of 102 (20%) had LVI-positive tumours. Of these, 34 patients had pT1 and 68 had pT2 disease. LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 [95% confidence interval (CI) 1.15-2.77; number of events (EV) 95; P = 0.01) and with OS with a HR of 2.02 (95% CI 1.31-3.11; EV 98; P = 0.001) after adjustment for pathological stage. Among 27 patients with LVI-positive tumours who were randomised to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70, 95% CI 0.16-3.17; EV 7; P = 0.65) or with OS (HR 0.45, 95% CI 0.11-1.83; EV 9; P = 0.26). Conclusions Our post hoc analysis of the p53-MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1-T2N0 disease. The analysis did not show a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not excluded.",

keywords = "SWOG, adjuvant chemotherapy, lymphovascular invasion, urothelial cancer",

author = "{Von Rundstedt}, {Friedrich Carl} and Mata, {Douglas A.} and Susan Groshen and Stein, {John P.} and Skinner, {Donald G.} and Stadler, {Walter M.} and Cote, {Richard J.} and Kryvenko, {Oleksandr N.} and Guilherme Godoy and Lerner, {Seth P.}",

note = "Publisher Copyright: {\textcopyright} 2014 The Authors BJU International {\textcopyright} 2014 BJU International Published by John Wiley & Sons Ltd.",

year = "2015",

month = jul,

day = "1",

doi = "10.1111/bju.12997",

language = "English",

volume = "116",

pages = "44--49",

journal = "BJU international",

issn = "1464-4096",

number = "1",

}

TY - JOUR

T1 - Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder

T2 - Data from the prospective p53-MVAC trial

AU - Von Rundstedt, Friedrich Carl

AU - Mata, Douglas A.

AU - Groshen, Susan

AU - Stein, John P.

AU - Skinner, Donald G.

AU - Stadler, Walter M.

AU - Cote, Richard J.

AU - Kryvenko, Oleksandr N.

AU - Godoy, Guilherme

AU - Lerner, Seth P.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Objectives To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ-confined, node-negative urothelial cancer of the bladder (UCB) in a post hoc analysis of a prospective clinical trial. To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumours exhibited LVI. Patients and Methods Surgical and tumour factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1-T2 N0 UCB in the p53-MVAC trial (Southwest Oncology Group 4B951/NCT00005047). The presence or absence of LVI was determined by pathological examination of transurethral resection or RC specimens. Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results Among 499 patients with a median follow-up of 4.9 years, a subset of 102 (20%) had LVI-positive tumours. Of these, 34 patients had pT1 and 68 had pT2 disease. LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 [95% confidence interval (CI) 1.15-2.77; number of events (EV) 95; P = 0.01) and with OS with a HR of 2.02 (95% CI 1.31-3.11; EV 98; P = 0.001) after adjustment for pathological stage. Among 27 patients with LVI-positive tumours who were randomised to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70, 95% CI 0.16-3.17; EV 7; P = 0.65) or with OS (HR 0.45, 95% CI 0.11-1.83; EV 9; P = 0.26). Conclusions Our post hoc analysis of the p53-MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1-T2N0 disease. The analysis did not show a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not excluded.

AB - Objectives To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ-confined, node-negative urothelial cancer of the bladder (UCB) in a post hoc analysis of a prospective clinical trial. To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumours exhibited LVI. Patients and Methods Surgical and tumour factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1-T2 N0 UCB in the p53-MVAC trial (Southwest Oncology Group 4B951/NCT00005047). The presence or absence of LVI was determined by pathological examination of transurethral resection or RC specimens. Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results Among 499 patients with a median follow-up of 4.9 years, a subset of 102 (20%) had LVI-positive tumours. Of these, 34 patients had pT1 and 68 had pT2 disease. LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 [95% confidence interval (CI) 1.15-2.77; number of events (EV) 95; P = 0.01) and with OS with a HR of 2.02 (95% CI 1.31-3.11; EV 98; P = 0.001) after adjustment for pathological stage. Among 27 patients with LVI-positive tumours who were randomised to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70, 95% CI 0.16-3.17; EV 7; P = 0.65) or with OS (HR 0.45, 95% CI 0.11-1.83; EV 9; P = 0.26). Conclusions Our post hoc analysis of the p53-MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1-T2N0 disease. The analysis did not show a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not excluded.

KW - SWOG

KW - adjuvant chemotherapy

KW - lymphovascular invasion

KW - urothelial cancer

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U2 - 10.1111/bju.12997

DO - 10.1111/bju.12997

M3 - Article

C2 - 25413313

AN - SCOPUS:84933557893

SN - 1464-4096

VL - 116

SP - 44

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JO - BJU international

JF - BJU international

IS - 1

ER -

Significance of lymphovascular invasion in organ-confined, node-negative urothelial cancer of the bladder: Data from the prospective p53-MVAC trial

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