Prognostic Value of Lymphovascular Invasion in Upper Urinary Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Systematic Review and Meta-Analysis.

This study was performed to identify the prognostic impact of lymphovascular invasion (LVI) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). A systematic search in PubMed, Embase, and the Cochrane Library was performed to identify relevant studies. The outcomes of interest, including progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were extracted, and the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used for effect size estimation. Subgroup, metaregression, and sensitivity analyses were performed to explore potential origins of heterogeneity. Publication bias was estimated by Egger's linear regression and funnel plot. Our meta-analysis included a total of 27 studies involving 17,453 patients. The pooled HRs were statistically significant for PFS (HR = 1.73, 95%CI = 1.41-2.11), CSS (HR = 1.87, 95%CI = 1.54-2.27), and OS (HR = 1.56, 95%CI = 1.29-1.87), with high heterogeneity (I 2 = 77.8%, 70.3%, and 59.2%, respectively). Four studies explored the prognostic value of LVI in patients with advanced tumor stages (T3-T4). The fixed effects model (I 2 = 33.9%) showed that the pooled HR was 1.64 (95%CI = 1.35-1.99) for CSS. Egger's plots showed no significant publication bias (PFS: P = 0.443, CSS: P = 0.096, and OS: P = 0.894). Our meta-analysis demonstrated that LVI is a poor prognostic factor for UTUC and is strongly associated with disease recurrence, cancer-specific mortality, and overall mortality.