Intratumoral lymphatic vessel density and clinicopathologic features of patients with early-stage cervical cancer after radical hysterectomy.
BACKGROUND
Lymphangiogenesis plays a key role in tumor growth, progression, and metastasis, yet few studies have investigated lymphatic vessel density (LVD) in cases of cervical cancer. The aim of this retrospective study was to evaluate intratumoral LVD, in addition to other histologic variables, in relation to lymph node metastases and survival of patients with stage IB to IIA cervical cancer after radical hysterectomy.


METHODS
Between 2000 and 2008, 144 patients had a diagnosis of cervical uterine cancer and underwent radical hysterectomy. Tumor stages for these patients were identified according to the criteria of the International Federation of Gynecology and Obstetrics and included 84 stage IB1, 44 stage IB2, and 16 stage IIA cases. With an antibody directed against human podoplanin (D2-40), immunohistochemical staining was used to measure LVD. The correlation between LVD and clinicopathologic features of the resected tumors was analyzed.


RESULTS
Lymphatic vessel density was significantly higher in tumors less than 2 cm in diameter (P = 0.001) and in tumors with 1.0-cm-or-less depth of invasion (P = 0.007), with early stage (P = 0.001), and with negative lymph nodes (P = 0.05). After multivariate analysis, the predictive factors associated with lymph node metastases were depth of infiltration (P = 0.027), lymphovascular space invasion (P < 0.001), and parametrial involvement (P = 0.01). For patient death, the predictive factors were International Federation of Gynecology and Obstetrics stage (P = 0.017), histologic type (P = 0.010), lymph node status (P = 0.031), and histologic grade (P = 0.041). Lymphatic vessel density was not a predictive variable for lymph node metastasis or death.


CONCLUSIONS
Intratumoral LVD was greater in early cervical cancer (ie, smaller tumors, early clinical stage, and negative lymph nodes), and no relationship between LVD and lymph node metastases or survival was observed.
Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Fabricia L
FL
Zaganelli
Filomena M
FM
Carvalho
Bernardo G L
BG
Almeida
Carlos E
CE
Bacchi
Joao Carlos Sampaio
JC
Goes
Marcelo Alvarenga
MA
Calil
Edmund C
EC
Baracat
Jesus P
JP
Carvalho
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D042583:Lymphangiogenesis; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult