Association of Lymphovascular Invasion with Biochemical Recurrence and Adverse Pathological Characteristics of Prostate Cancer: A Systematic Review and Meta-analysis

Background and objective: Lymphovascular invasion (LVI) is a significant histopathological feature in prostate cancer (PCa) associated with higher risk of biochemical recurrence (BCR) and other adverse outcomes. Our aim was to assess the association of LVI found in radical prostatectomy (RP) specimens with BCR and adverse clinicopathological findings. Methods: A systematic literature search was conducted using the PubMed, Embase, and Web of Science databases in July 2023, with an additional search in May 2024. We included 94 prospective and retrospective studies reporting on LVI in RP specimens and its association with the specified outcomes. Key findings and limitations: Meta-analyses revealed that LVI is significantly associated with higher BCR risk (hazard ratio 1.96, 95% confidence interval [CI] 1.73- 2.21), higher pathological tumour stage (odds ratio [OR] 5.77; 95% CI 3.96-8.40), higher Gleason score (OR 5.19, 95% CI 4.12-6.54), lymph node metastasis (OR 11.52, 95% CI 7.65-17.34), distant metastasis (OR 9.10, 95% CI 5.46-15.17), positive surgical margins (OR 2.38, 95% CI 1.83-3.09), extraprostatic extension (OR 5.01,95% CI 3.11-8.06), seminal vesicle invasion (OR 7.50, 95% CI 3.47-16.23), and perineural invasion (OR 133.71, 95% CI 65.93-271.15). Major limitations of this study include high heterogeneity of the data and the reliance on nonrandomised studies. Conclusions and clinical implications: Our findings reveal that LVI is associated with nearly twofold higher risk of BCR, highlighting its potential role as a critical prognostic marker. Patient summary: We analysed data from multiple studies to understand the impact of the spread of prostate cancer into the lymph or blood vessels, called lymphovascular invasion (LVI). We found that LVI is linked to a higher risk of cancer recurrence after surgery and other negative outcomes. Our findings highlight the importance of considering LVI in treatment decisions for better management of prostate cancer. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).