Selective immunohistochemical staining of blood and lymphatic vessels reveals independent prognostic influence of blood and lymphatic vessel invasion in early-stage cervical cancer.
Lymphovascular space invasion was shown to play a key role in the progression of cervical cancer. Because of the absence of a specific marker for lymphatic vessels, earlier studies could not reliably distinguish between blood and lymphatic vessel invasion. By immunostaining for podoplanin, a novel marker for lymphatic endothelium, and for factor VIII-related antigen, we determined lymphatic and blood vessel invasion in tissue samples of 98 patients with cervical cancer pT1b treated by radical hysterectomy. Eleven (11.2%) specimens showed invasion of blood vessels, 20 (20.4%) showed invasion of lymphatic vessels, and 15 (15.3%) showed invasion of blood and lymphatic vessels. There was a strong association of lymphatic vessel invasion and lymph node involvement (P < 0.001). In univariate analysis, both blood and lymphatic vessel invasion failed to reach a statistically significant influence on overall survival, but a significant influence on disease-free survival was found (P = 0.0002 and P < 0.0001, respectively). In multivariate analysis of disease-free survival, only blood vessel invasion remained statistically significant (P = 0.0457). Lymphatic vessel invasion reached significance when lymph node status was excluded from the model (P = 0.0025). Both lymphatic vessel and blood vessel invasion occur frequently in early-stage cervical cancer. Determination of the vessel status may be of clinical importance because it signifies the risk of recurrent disease.
Birner
P
P
Institute of Clinical Pathology, University of Vienna, Austria. peter.birner@akh-wien.ac.at
Obermair
A
A
Schindl
M
M
Kowalski
H
H
Breitenecker
G
G
Oberhuber
G
G
D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D001706:Biopsy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007124:Immunoenzyme Techniques; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008208:Lymphatic System / Q000378:metabolism*; D008562:Membrane Glycoproteins / Q000378:metabolism*; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic / Q000378:metabolism*; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D014841:von Willebrand Factor / Q000378:metabolism*; D000098853:Podoplanin
D015415:Biomarkers; D008562:Membrane Glycoproteins; D014841:von Willebrand Factor; C117468:PDPN protein, human; D000098853:Podoplanin