Do vascular, lymphatic, and perineural invasion have prognostic implications for bladder cancer after radical cystectomy?

Objectives. To elucidate the respective prognostic implications of vascular, lymphatic, and perineural invasion noted on the pathologic analyses of radical cystectomy specimens. Controversy still exists on whether the pathologic features of vascular, lymphatic, and perineural invasion have any role as prognostic indicators for bladder cancer. Methods. A retrospective review of 125 patients with bladder cancer treated with radical cystectomy was conducted. Patients who received either preoperative or postoperative chemotherapy, those with lymph node metastasis confirmed on postoperative pathologic analysis, those who did not undergo standard bilateral pelvic lymph node dissection, and those receiving palliative treatment were excluded from the study. Results. The mean patient age was 62.5 years (range 39 to 84), and the median follow-up duration was 41.0 months (range 1 to 146). Vascular, lymphatic, and perineural invasion was present in 8.8%, 20.8%, and 8.8% of specimens, respectively, and 28% of patients had at least one of the three pathologic features in the specimen. Univariate analysis revealed that vascular invasion, lymphatic invasion, and perineural invasion were significant prognostic predictors of overall survival. However, only the tumor stage and vascular invasion proved to be independent prognostic predictors of disease-specific survival on multivariate analysis. Conclusions. The results of the present study have shown that the pathologic tumor stage and the pathologic presence of vascular invasion are independent prognostic predictors for disease-specific survival in patients who have undergone radical cystectomy for bladder cancer. Additional study should be performed on the prognostic implications of lymphatic and perineural invasion.