Objectives: This study aimed to elucidate the relationship between lymphovascular invasion (LVI) at transurethral resection of bladder tumor (TURBT) and the risk of pathologic upstaging as well as the clinical outcomes. Materials and methods: PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from the respective dates of inception until November 11, 2013. Results: A total of 16 articles met the eligibility criteria for this systematic review, which included a total of 3,905 patients. LVI was detected in 18.6% of TURBT specimens. A significant association was found between LVI at TURBT and pathologic upstaging of bladder cancer (odds ratio = 2.21, 95% CI: 1.44-3.39) without heterogeneity (I2 = 45%, P = 0.14). The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (HR = 1.47, 95% CI: 1.24-1.74), progression-free survival (HR = 2.28, 95% CI: 1.45-3.58), and disease-specific survival (HR = 1.35, 95% CI: 1.01-1.81), but not for overall survival (HR = 1.55, 95% CI: 0.90-2.67). Tests of inconsistency for disease-specific survival (I2 = 66%, P = 0.007) and overall survival (I2 = 72%, P = 0.03) could not exclude a significant heterogeneity. The results of the Begg and the Egger tests showed that there was evidence of publication bias on pathologic upstaging and progression-free survival. Conclusions: The data obtained in this meta-analysis indicate that the presence of LVI at TURBT portends the increased risk of pathologic upstaging and may provide additional prognostic information. However, a large, well-designed, prospective study is needed to investigate potential treatment options for bladder cancer with LVI.
|Number of pages||9|
|Journal||Urologic Oncology: Seminars and Original Investigations|
|State||Published - 2014|
Bibliographical noteFunding Information:
This work was funded by Grant no. 23-2013-0010 from the SNUH Research Fund . The funding source had no role in the study design; in the collection, analysis, and interpretation of data; or in writing of the report. The corresponding author had full access to all data and had final responsibility to submit the article for publication.
© 2014 Elsevier Inc.
- Bladder cancer
- Lymphovascular invasion
- Transurethral resection
- Urothelial carcinoma