Intratumoral lymphatic vascular density is an independent factor for disease-free and overall survival in advanced stage oral squamous cell carcinoma

Abstract

The presence of lymphatic and blood vessels in oral squamous cell carcinoma (OSCC) should play a key role in progression and dissemination. This study aimed to evaluate the correlation between the lymphatic and blood vessel densities with prognostic outcomes in advanced stage OSCC. Immunohistochemical reactions for D-240, CD34, and CD105 were performed in 88 advanced stage OSCC cases located at the oral tongue and the floor of the mouth. The lymphatic vascular density (LVD), blood vascular density (BVD), and neoformed vascular density (NVD) were assessed by counting positive reactions in 4 hotspot areas, both intratumoral (IT) and peritumoral (PT), at high magnification (× 40). High IT LVD was associated with extracapsular spread of lymph node metastasis (P=.03). Recurrence rates were correlated with IT LVD (P < .0001), IT BVD (P=.036), and IT NVD (P=.047), and overall survival was associated with high IT LVD (P=.0016) and IT NVD (P=.009). Yet, IT LVD was an independent factor for disease-free survival and for overall survival based on the Cox proportional hazards model. Our results suggest that high IT LVD has a strong impact on survival outcomes in advanced stage OSCC.