Significance of lymphovascular invasion and lymph node involvement: Impact on survival after adjuvant chemotherapy in locally advanced bladder cancer.

4774 Background: Lymphovascular invasion(LVI) and lymph node involvement(LNI) have been reported to be associated with poor prognosis in bladder cancer despite aggressive local treatment. Benefit of adjuvant chemotherapy for locally advanced bladder cancer has been debated. We evaluated the impact of LVI and LNI on survival after adjuvant chemotherapy (CTx).,A retrospective analysis was conducted on 157 patients who had pT3-4(N=68) or pN+(N=89) disease after radical cystectomy and pelvic lymphadenectomy between 1991 and 2004. Adjuvant chemotherapy consisted of 3-6 cycles of MVAC (N=42) or GC (N=40). Medical records and tissues were studied for LVI and LNI. Mean follow-up was 31 months.,LVI was present in 59% of the patients. Thirty-seven percent of pT3-4 and 64% of pN+ patients received CTx. There were no significant differences in the distribution of T stage, number of involved lymph nodes, lymph node density or patients' performance status between the patients who did and did not receive CTx. LNI was independently associated with survival whereas LVI, T stage or CTx had no impact. However, LVI increased the risk of recurrence (p=0.004, odds ratio 3.661). CTx significantly prolonged survival of patients with N+ disease (mean survival 62 mos. vs. 23 mos, p=0.003). Adjuvant CTx was not beneficial in patients with N- disease.,LNI was an independent prognostic factor for survival while LVI was associated with recurrence-free survival in locally advanced bladder cancer. Adjuvant CTx prolonged survival only in those with N+ disease. No significant financial relationships to disclose.