PERINEURAL INVASION IN TRANSITIONAL-CELL CARCINOMA AND THE EFFECT ON PROGNOSIS FOLLOWING RADICAL CYSTECTOMY

Objectives. The relationship between perineural invasion and prognosis has been demonstrated to be poor in a number of malignancies. This ha s not been evaluated in the bladder. We performed a study to determine the occurrence of nodal metastases, extranodal metastases, and diseas e-free survival in patients with perineural invasion (PNI) and/or angi olymphatic invasion (ALI) in transitional cell carcinoma of the bladde r (TCCB) from radical cystectomy specimens. Methods. A retrospective r eview of 27 patients treated with radical cystectomy for TCCB was cond ucted. Comparisons were performed between three groups: PNI with or wi thout ALI (PNI +/- ALI, 12 patients), ALI alone (8 patients), and a co ntrol group (no PNI or ALI) (7 patients). Results. The mean patient ag e was 70 years (range 49 to 83). The overall median follow-up period w as 11 months (range 1 to 32). PNI +/- ALI was predominantly found in S tage T3b disease (14 of 20 [70%] cases). The overall 1-year disease-fr ee survival was 48%, 67%, and 83% for the PNI +/- ALI, ALI alone, and control groups, respectively. Nodal metastases (for all stages combine d) were found in 6 of 12 (50%), 3 of 8 (38%), and 1 of 7 (14%) patient s in the PNI +/- ALI, ALI alone, and control groups, respectively. Sim ilarly, extranodal metastatic disease was found in 5 of 12 (42%), 4 of 8 (50%), and 1 of 7 (14%) patients in the PNI +/- ALI, ALI alone, and control groups, respectively. The percentage of deaths for the PNI +/ - ALI, ALI only, and control groups were 35%, 50%, and 14%, respective ly. Conclusions. In TCCB, perineural invasion with or without angiolym phatic invasion and angiolymphatic invasion alone are associated with a higher incidence of nodal and extranodal metastases and death. (C) 1 997, Elsevier Science Inc.