Clinical significance of immunohistochemically-identified lymphatic and/or blood vessel tumor invasion in gastric cancer.
BACKGROUND
Tumor invasion and lymph node metastasis are significant prognostic factors for gastric cancer, and lymphatic and vascular tumor invasion are also significant risk factors for gastric cancer recurrence. Recently, the immunohistochemical detection of lymphatic and blood vessel tumor invasion (LBVI) has been shown to have a higher sensitivity and specificity than hematoxylin-eosin staining methods.


METHODS
One hundred forty-nine gastric cancer patients who underwent curative resection at Korea University Hospital between November 2003 and December 2006 served as the study subjects. Lymphatic vessel invasion was evaluated by immunostaining with the new selective marker, D2-40, and blood vessel invasion was assessed with anti-CD31 antibody. Patients were divided according to the presence of LBVI, clinicopathologic factors were compared, and postoperative surgical outcomes were analyzed.


RESULTS
LBVI was present in 66 patients (44.3%). LBVI was significantly correlated with depth of tumor invasion (P < 0.001), lymph node stage (P < 0.001), and lymph node micrometastasis (P = 0.013). Cancer recurrence was more common in the LBVI group (P = 0.007), and peritoneal seeding was the most prevalent type of recurrence (P = 0.028). Univariate analysis showed tumor size, depth of tumor invasion, lymph node stage, and LBVI to have a significant impact on survival. Based on multivariate analysis, however, depth of tumor invasion and lymph node stage were correlated with survival.


CONCLUSIONS
Immunohistochemical demonstration of LBVI is an additional prognostic marker, and provides useful information for planning treatment strategies in gastric cancer patients.
Kim
Jong-Han
JH
Department of Surgery, Korea University College of Medicine, Ansan City, Gyeong gi-Do, Korea. ppongttai@medimail.co.kr
Park
Sung-Soo
SS
Park
Seong-Heum
SH
Kim
Seung-Joo
SJ
Mok
Young-Jae
YJ
Kim
Chong-Suk
CS
Lee
Ju-Han
JH
Kim
Young-Sik
YS
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001808:Blood Vessels / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008208:Lymphatic System / Q000473:pathology; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40