The Prognostic Impact of Angiolymphatic Invasion in Bladder Urothelial Carcinoma Patients Undergoing Radical Cystectomy

Purpose: The aim of this study was to investigate the association between angiolymphatic invasion (ALI) and bladder cancer in patients who underwent radical cystectomy (RC).Materials and Methods: Multicenter retrospective data from 495 bladder cancer patients who underwent RC between 2007 and 2019 were enrolled in this study. Patients were stratified into 2 groups according to the presence of ALI. The effect of ALI was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS).Results: The median age of the 495 patients in the study was 65 years, with median and mean follow-up durations of 23.3 months and 37.1 months, respectively. ALI was present in 182 patients (36.8%). ALI was significantly associated with worse RFS as well as CSS and OS (p<0.001, p=0.012, and p=0.01, respectively). Adjusting for significant variables, a multivariate analysis showed that tumor stage (over T2) and ALI were independent predictors for CSS, whereas lymph node (LN) metastasis was not. Meanwhile, the adjusted multivariate analysis showed that tumor stage over T2, ALI, LN metastasis, and positive surgical margin were independent predictors for RFS. Otherwise, tumor grade (over grade 2) was not a significant predictor.Conclusions: The presence of ALI was an independent predictor influencing both CSS and RFS.