A multivariate analysis of blood vessel and lymph vessel invasion as predictors of ovarian and lymph node metastases in patients with cervical carcinoma.
BACKGROUND
To the authors' knowledge there are few available data regarding the influence of lymphovascular space invasion, which has been examined separately as two components (lymphatic vessel invasion [LVI] and blood vessel invasion [BVI]), in the metastasis of cervical carcinoma.


METHODS
LVI and BVI, which include capillary vessel invasion, were reviewed retrospectively based on the histopathologic slides of 239 women with cervical carcinoma who were treated with radical hysterectomy. The correlation between lymph node and/or ovarian metastases and LVI, BVI, and other histopathologic factors was investigated by multiple logistic regression analysis. The influence of LVI and BVI on survival was examined by Cox regression analysis.


RESULTS
The rate of incidence of LVI was higher than that of BVI in all stages of cervical carcinoma (P < 0.0001 for International Federation of Gynecology and Obstetrics Stage IB and Stage II disease and P < 0.05 for Stage III disease). The incidence rate of BVI increased as LVI became more prominent and there was a significant correlation between the two findings (P < 0.0001). BVI was more frequent in adenocarcinoma/adenosquamous carcinoma than in squamous cell carcinoma (P < 0.05). LVI (P < 0.0001) and parametrial invasion (P < 0.0001) were significantly related to lymph node metastasis on multivariate analysis. Conversely, BVI (P < 0.05) and parametrial invasion (P < 0.0025), as well as adenocarcinoma or adenosquamous carcinoma (P < 0.0005), were significantly related to ovarian metastasis on multivariate analysis. With regard to the prognostic significance of these components, it was found that BVI (hazards ratio [HR] = 2.0), ovarian metastasis (HR = 6.5), and lymph node metastasis (HR = 5.5) were significantly related to a poor prognosis in women with cervical carcinoma.


CONCLUSIONS
Ovarian metastasis may occur via hematogenous spread of cervical carcinoma. The results of the current study suggest that BVI, including capillary vessels, that is diagnosed separately from LVI using hematoxylin and eosin stained sections may be an important prognostic factor for patients with cervical carcinoma.
Sakuragi
N
N
Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan.
Takeda
N
N
Hareyama
H
H
Fujimoto
T
T
Todo
Y
Y
Okamoto
K
K
Takeda
M
M
Wada
S i
Si
Yamamoto
R
R
Fujimoto
S
S
D018196:Carcinoma, Adenosquamous / Q000473:pathology* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008206:Lymphatic Diseases / Q000473:pathology*; D008207:Lymphatic Metastasis; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D019043:Vascular Neoplasms / Q000473:pathology*