[Prognostic impact of lymphovascular invasion and efficacy of adjuvant therapy in patients with non-metastatic clear cell renal cell carcinoma: a single-center retrospective cohort study].
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Objectives: To investigate the prognostic impact of lymphovascular invasion (LVI) on outcomes in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) and to evaluate the efficacy of adjuvant therapy in LVI-positive patients. Methods: This is a retrospective cohort study. Clinical and pathological data of 342 ccRCC patients who underwent surgical treatment at Sun Yat-sen University Cancer Center and Sun Yat-sen University Cancer Hospital Gansu Hospital between January 2018 and December 2024 were collected. There were 239 males and 103 females, with an age of (M (IQR)) of 57 (15) years (range: 13 to 91 years). Patients were classified into LVI-positive and LVI-negative groups based on the postoperative pathological evidence of tumor cell invasion into lymphatic and(or) microvascular lumens. The comparison of data between groups was conducted using Mann-Whitney U test, χ2 test or Fisher's exact probability method. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to evaluate the impact of LVI on disease-free survival (DFS) and overall survival (OS). Three separate analyses were performed: full-cohort analysis, subgroup analysis after excluding patients who received adjuvant therapy, and efficacy analysis of adjuvant therapy within LVI-positive patients. Results: Among the 342 patients, 128 (37.4%) were LVI-positive and 214 (62.6%) were LVI-negative. No statistically significant differences were observed between the two groups in age, sex, type of surgery, maximum tumor diameter, cT stage, or cN stage (all P>0.05). The proportion of minimally invasive surgery was lower in the LVI-positive group than in the LVI-negative group (66.4% (85/128)vs. 77.6% (166/214), χ²=4.556, P=0.033). Regarding pathological features, the LVI-positive group had significantly higher rates of tumor necrosis (56.3%(72/128) vs. 32.2%(69/214), χ²=18.073, P<0.01), sarcomatoid differentiation (18.8%(24/128) vs. 7.9%(17/214), χ²=7.870, P=0.005), and Fuhrman grade≥3 (63.3%(81/128) vs. 40.2%(86/214), χ²=18.256, P<0.01) than the LVI-negative group. In the full-cohort analysis, no statistically significant differences in DFS or OS were observed between the LVI-positive and LVI-negative groups (DFS: P=0.127; OS: P=0.627). Postoperative adjuvant therapy was administered to 41 LVI-positive and 44 LVI-negative patients. After excluding patients who received adjuvant therapy, LVI-positive patients demonstrated worse DFS than LVI-negative patients (HR=1.885, P=0.009). Multivariable Cox regression analysis showed that type of surgery, cN stage, Fuhrman grade, and tumor necrosis were independent prognostic factors for DFS (all P<0.05), while age, cN stage, and Fuhrman grade were independent prognostic factors for OS (all P<0.05). LVI was not an independent prognostic factor for either DFS or OS (both P>0.05). Among LVI-positive patients, the adjuvant therapy group had better OS than the untreated group (HR=0.258, P=0.045). Conclusions: LVI is associated with an increased risk of recurrence following nephrectomy in ccRCC patients, but its independent prognostic value is limited after adjusting for other pathological factors. LVI-positive patients may derive survival benefit from postoperative adjuvant therapy.