Abstract
BackgroundLymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival.MethodsFifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis.ResultsThe mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD.ConclusionOur results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.
Highlights
Lymph node metastasis in endometrial cancer significantly decreases survival rate
lymphatic microvessel density (LMVD) has been investigated in many tumors, those characterized by lymphatic dissemination, such as cervical carcinomas [8,9,10], but there are few studies that have evaluated LMVD in endometrial carcinomas, and results have been conflicting [11,12]
We observed that low intratumoral LMVD was associated with poor outcome
Summary
Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. The growth of lymphatic vessels largely depends on many growth factors, such as vascular endothelial growth factor-C and -D (VEGF-C and VEGF-D), platelet derived growth factor-BB (PDGF-BB) and hepatocyte growth factor[5]. In cancer, these known lymphangiogenic factors lead to simultaneous stimulation of angiogenesis and lymphangiogenesis [6]. LMVD has been investigated in many tumors, those characterized by lymphatic dissemination, such as cervical carcinomas [8,9,10], but there are few studies that have evaluated LMVD in endometrial carcinomas, and results have been conflicting [11,12]
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