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. 2024 Feb 25;16(5):925.
doi: 10.3390/cancers16050925.

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer-Lateralization Concept

Jakub Karwacki  1 , Adam Gurwin  1 , Arkadiusz Jaworski  1 , Michał Jarocki  1 , Marcel Stodolak  1 , Andrzej Dłubak  1 , Przemysław Szuba  2 , Artur Lemiński  3   4 , Krystian Kaczmarek  3 , Agnieszka Hałoń  5 , Tomasz Szydełko  6 , Bartosz Małkiewicz  1
Affiliations

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer-Lateralization Concept

Jakub Karwacki et al. Cancers (Basel). .

Abstract

Background: Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy's overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future.

Methods: Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann-Whitney and Kruskal-Wallis tests, as well as Kendall's tau-b coefficient, yielding p-values and odds ratios (ORs).

Results: Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p < 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p = 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231-6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525-0.913).

Conclusions: Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases.

Keywords: histopathological examination; lymph node invasion; lymphovascular invasion; nodal involvement lateralization; pelvic lymph node dissection; prostate cancer; radical prostatectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart illustrating the process of patient selection. pL0: negative lymphovascular invasion (LVI) in histopathological examination; pL1: positive LVI in histopathological examination; pN0: negative lymph node invasion (LNI) in histopathological examination; pN1: positive LNI in histopathological examination.
Figure 2
Figure 2
The visual illustration of patients’ distribution, categorizing them into unilateral left, unilateral right, and bilateral groups based on lymphovascular invasion (LVI) laterality. Yellow color represents the number of patients with positive lymph nodes only on the left side, red color represents patients with nodal involvement exclusively on the right side, and blue color represents patients with bilateral nodal invasion. n: number of patients; RL: LVI in the right lobe; LL: LVI in the left lobe.
Figure 3
Figure 3
The visual illustration of patients’ distribution, categorizing them into unilateral left, unilateral right, and bilateral groups based on nodal invasion laterality. Yellow color represents the number of patients with positive lymph nodes only on the left side, red color represents patients with nodal involvement exclusively on the right side, and blue color represents patients with bilateral nodal invasion. n: number of patients; RL: lymphovascular invasion (LVI) in the right lobe; LL: LVI in the left lobe.
Figure 4
Figure 4
The Marimekko chart depicting the proportional relationship between lymphovascular invasion and lymph node invasion. LVI: lateralization; LNI: lymph node invasion; n: number of patients.
See this image and copyright information in PMC

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