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Re: Prognostic Significance of Lymphatic, Vascular and Perineural Invasion for Bladder Cancer Patients Treated by Radical Cystectomy.

available at http://www.ncbi.nlm.nih.gov/pubmed/28259358 Editorial Comment: Lymphatic and vascular invasion are thought to represent higher risk disease in radical cystectomy specimens with bladder cancer. This pathological review of 1,504 cases managed by radical cystectomy at the Mayo Clinic examined all 3 types of invasion. Lymphatic invasion and vascular invasion, but not perineural invasion, individually were associated with regional lymph node involvement (p <0.0001 and p[0.004, respectively). There were various combinations of histological subtypes in which the presence and impact of lymphatic and vascular involvement were noted. In terms of outcomes lymphatic invasion remained significantly associated. Surgeons do not often ask exactly what lymphovascular invasion is, although it involves a complex and at times difficult pathological interpretation. Due to the clarity of this article, I learned that in fact “angiolymphatic invasion” and “lymphovascular invasion” are terms that combine the findings of tumor within simple endothelial lined lymphatic spaces and tumor within muscle lined blood vessels. Although perineural invasion does not seem to be associated with regional metastasis or disease outcomes, the association of lymphatic and vascular involvement with nonorgan confined disease seems real. Lymphatic invasion also seems to correlate with disease outcome. However, at this point I am not sure whether the pathology community is moving toward separating these entities. My current pathology reports use the terms “lymphovascular invasion” and “perineural invasion.” Prediction of higher risk and/or higher stage disease before pathological interpretation of cystectomy would be helpful for clinicians and patients. In any event, the clarification and impact of lymphatic, vascular and perineural invasion within cystectomy specimens may help guide adjuvant therapy and surveillance protocols. Sam S. Chang, MD 1096 BLADDER, PENIS AND URETHRAL CANCER, AND BASIC PRINCIPLES OF ONCOLOGY Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.