Tumor lymphangiogenesis in cervical squamous cell carcinoma and its clinical significance

Abstract

To investigate the clinical significance of lymphangiogenesis in cervical cancer. Monoclonal podoplanin was used to immunostain the lymphatic microvessels in the paraffin sections of cervical squamous cancer tissues at the I(b) and II(a) stages from 35 cases kept in the archives. Computer-assisted morphometric analysis was used to quantitatively analyze the lymphatic vessels in intratumor and peritumor areas. The association with clinicopathologic data was analyzed. (1) The lymphatic microvessels were larger and denser in the peritumor areas than the intratumor areas. Cancer cells were found in the intratumoral lymphatic vessels of the lymph metastatic patients. (2) The lymphatic vessel density (LVD) of the peritumor areas was (31 +/- 10) vessels/mm(2), significantly greater than that in the intratumor areas [(20 +/- 10) vessels/mm(2), P < 0.01]. The relative lymphatic vessel area (LVA) in the peritumor areas was (0.75 +/- 0.40)%, significantly larger than that of the intratumor areas [(0.19 +/- 0.11)%, P < 0.01]. (3) The intra- and peri-tumoural LVD and LVA in the patients with lymph node metastasis were (29 +/- 7) vessels/mm(2) and (40 +/- 5) vessels/mm(2), and 0.27% +/- 0.10% and 1.23% +/- 0.36% respectively, all greater than those of the patients without lymph node metastasis [(16 +/- 8) vessels/mm(2) and (28 +/- 9) vessels/mm(2), and (0.16 +/- 0.09)%, (0.56 +/- 0.20)% respectively, P < 0.01, < 0.01, < 0.05, and < 0.01]. (4) The peri-tumoral LVA and intra-tumoral LVD and LVA in the patients with histological grade I, II, and III were (0.42 +/- 0.10)%, (9 +/- 3) vessels/mm(2), and (0.06 +/- 0.04)%; (0.77 +/- 0.37)%, (21 +/- 8) vessels/mm(2), and (0.21 +/- 0.09)%; and (0.83 +/- 0.46)%, (22 +/- 11) vessels/mm(2), and (0.21 +/- 0.12)% respectively. There were significant differences among the values of the grade II patients and grade I patients (all P < 0.05) and the grade III patients and grade I patients (all P < 0.05) and there were not significant differences between the values of the grade II patients and the grade III patients (all P > 0.05), III and grade I, no statistic significances between grade II and III. Higher lymphangiogenesis in early cervical squamous cell cancer may be associated with the risk of lymph node metastasis.