Analysis Of Prognostic Factors Of T1 High Grade Urothelial Carcinoma Of The Bladder With Lymphovascular Invasion

Objective: This study analyzed long term results of management of stage 1 high grade(T1HG)urothelial carcinoma of the bladder(UCB)with lymphovascular invasion(LVI)patients by transurethral resection of bladder tumor(TURBT)or radical cystectomy(RC)to to identify prognostic factors of T1 HG UCB with LVI patients,hoping to Provide some data reference for the choice of clinical treatment of such patients in the future.Methods: We retrospectively analyzed the clinical treatment and postoperative survival data of 249 patients with T1 high-grade bladder urothelial carcinoma who underwent TURBT or RC surgery from January 2000 to January 2016 in our hospital.Kaplan-Meier method and Log-rank test were used to verify whether lymphatic vascular invasion has adverse effects on the prognosis of patients with high-grade bladder urothelial carcinoma of T1 stage.Then,the effects of clinical and pathological characteristics of LVI-positive patients(such as patient age,number of tumors,previous history of bladder cancer,etc.)on their prognosis were analyzed by chi-square test and establishment of Cox risk model,etc.,to determine the prediction factors of relapse and survival in T1 HG UCB with LVI patients.Results: In the entire cohort,the 5-year OS of LVI positive and negative patients were 54% and 72%,.For T1 HG UCB patients treated with TURBT,OS(P = 0.031)and RFS(P = 0.0017)were poor in patients with LVI;for T1 HG UCB patients treated with RC,positive LVI was associated with decreased OS(P = 0.034)and CSS(P = 0.0013).For T1 HG UCB with LVI patients,Treatment modality(tumor burden)was and independent predictor of OS(HR 2.176,CI 1.021-4.637,p = 0.044)and CSS(HR 3.675,CI 1.311-10.297,p = 0.013).A history of urothelial carcinoma of the bladder(H.UCB)was an independent predictor of RFS(HR 2.246,CI 1.102-4.579,p = 0.026)and PFS(HR 2.259,CI 1.036-4.927,p = 0.041).Tumor size was an independent predictor of RFS(HR 2.093,CI 1.054-4.159,p = 0.035).Conclusion: For T1 HG UCB patients,the presence of LVI is associated with a poor prognosis.For T1 HG UCB with LVI patients,tumor burden rather than treatment modality predicts patient survival,they should not necessarily be managed by RC without differentiation.Recurrent T1 HG UCB with LVI potentially represents a sign of progression,and RC regardless of tumor burden might be a reasonable alternative for this subgroup of patients.