Prognostic significance of lymphovascular invasion and perineural invasion in radical prostatectomy
10.3760/cma.j.cn112330-20241203-00531
- VernacularTitle:根治性前列腺切除术后标本中淋巴血管侵犯和神经侵犯的预后意义
- Author:
Qinliang SI
1
;
Junwei WU
1
;
Yudong WU
1
Author Information
1. 郑州大学第一附属医院泌尿外科，郑州 450052
- Publication Type:Journal Article
- Keywords:
Radical prostatectomy;
Lymphovascular invasion;
Perineural invasion
- From:
Chinese Journal of Urology
2025;46(4):255-261
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of lymphovascular invasion (LVI) and perineural invasion (PNI) in pathological specimens on the prognosis of patients after radical prostatectomy (RP).Methods:A retrospective analysis was conducted on the clinical data of 766 patients who underwent RP in the First Affiliated Hospital of Zhengzhou University from June 2019 to June 2024. The median age was 68 (63, 72) years, and the median prostate specific antigen (PSA) value was 16.56 (8.35, 34.16) ng/ml. According to the biopsy Gleason score, 168 cases (21.9%) had a score of 6, 315 cases (41.1%) had a score of 7, and 283 cases (37.0%) had a score of ≥8. The relationships between LVI/PNI and clinicopathological factors such as biopsy/radical Gleason score, pathological stage, positive surgical margin, seminal vesicle invasion, and nodal involvement were analyzed. Recurrence-free survival (RFS) was compared between LVI-positive vs. LVI-negative and PNI-positive vs. PNI-negative groups using Kaplan-Meier survival curves. Univariate and multivariate Cox regression analyses were performed to identify risk factors for RFS and assess the impact of LVI and PNI on postoperative recurrence.Results:Among the 766 postoperative pathological results, radical Gleason scores were 6 in 113 cases (14.8%), 7 in 356 cases (46.5%), and ≥8 in 297 cases (38.7%). Pathological stages included T 2 in 571 cases (74.5%), T 3 in 177 cases (23.1%), and T 4 in 18 cases (2.3%). Positive surgical margins were observed in 240 cases (31.3%), seminal vesicle invasion in 147 cases (19.2%), and nodal involvement in 63 cases (8.2%). Postoperative adjuvant therapy was administered to 94 cases (12.3%). LVI was positive in 65 cases (8.5%) and negative in 701 cases (91.5%). Compared with the LVI-negative group, the LVI-positive group showed significant differences in radical Gleason scores [0 vs. 113 cases with score 6 (16.1%), 11 (16.9%) vs. 345 (49.2%) cases with score 7, 54 (83.1%) vs. 243 (34.7%) cases with score ≥8; χ2=59.782, P<0.01], positive surgical margins [42 (64.6%) vs. 198 (28.2%); χ2=36.572, P<0.01], seminal vesicle invasion [50 (76.9%) vs. 97 (13.8%); χ2=152.656, P<0.01], nodal involvement [23 (35.4%) vs. 40 (5.7%); χ2=69.414, P<0.01], pathological stages [T 2: 7 (10.8%) vs. 564 (80.5%), T 3: 51 (78.4%) vs. 126 (18.0%), T 4: 7 (10.8%) vs. 11 (1.5%); χ2=154.364, P<0.01], and adjuvant therapy [31 (47.7%) vs. 63 (9.0%); χ2=82.775, P<0.01]. PNI was positive in 339 cases (44.3%) and negative in 427 cases (55.7%). The PNI-positive group exhibited significant differences in radical Gleason scores [11 (3.2%) vs. 102 (23.9%) cases with score 6, 155 (45.7%) vs. 201 (47.1%) cases with score 7, 173 (51.1%) vs. 124 (29.0%) cases with score ≥8; χ2=78.234, P<0.01], positive surgical margins [170 (50.1%) vs. 70 (16.4%); χ2=100.072, P<0.01], seminal vesicle invasion [129 (38.1%) vs. 18 (4.2%); χ2=139.524, P<0.01], nodal involvement [44 (13.0%) vs. 19 (4.4%); χ2=18.215, P<0.01], pathological stages [T 2: 174 (51.3%) vs. 397 (93.0%), T 3: 147 (43.4%) vs. 30 (7.0%), T 4: 18 (5.3%) vs. 0; χ2=174.625, P<0.01], and adjuvant therapy [73 (21.5%) vs. 21 (4.9%); χ2=48.463, P<0.01]. During a median follow-up of 14 (6, 32) months, 140 cases (18.3%) experienced recurrence. The recurrence rates were significantly higher in LVI-positive vs. LVI-negative [27 (41.5%) vs. 113 (16.1%); χ2=25.731, P=0.006] and PNI-positive vs. PNI-negative groups [91 (26.8%) vs. 49 (11.5%); χ2=29.882, P<0.01]. Multivariate Cox regression analysis identified age ( HR=1.021, P<0.05), PSA level ( HR=1.002, P<0.05), biopsy Gleason score ( HR=2.020, P<0.05), and nodal involvement ( HR=2.625, P<0.05) as independent risk factors for recurrence, while adjuvant therapy was an independent protective factor ( HR=0.147, P<0.01). Radical Gleason score, pathological stage, positive surgical margin, seminal vesicle invasion, LVI and PNI were not independent risk factors for recurrence (all P>0.05). Conclusions:Patients with pathological LVI or PNI after RP exhibit higher radical Gleason scores, pathological stages, positive surgical margin rates, seminal vesicle invasion rates, and nodal involvement rates. LVI and PNI positivity predict shorter recurrence-free survival, but they do not serve as independent risk factors for postoperative recurrence after RP.
