Zhang Yanna, Yan Ming, He Jiehua, Sun Jinrui, Sun Xueming
South China State Key Laboratory of Oncology, Department of Gynecologic Oncology, Guangzhou, China.
J Obstet Gynaecol Res. 2010 Oct;36(5):1015-22. doi: 10.1111/j.1447-0756.2010.01271.x. Epub 2010 Sep 16.
In the past 10 years, therapeutic advances have led to improved short-term efficacy for cervical carcinoma; however, the 5-year survival rate was not significantly enhanced. To investigate the effects of blood vessel invasion (BVI) and lymph vessel invasion (LVI) on the prognosis of early-stage cervical squamous carcinoma, we carried out immunohistochemical staining to distinguish blood and lymph vessels.
Specimens from 111 IB-stage or IIA-stage cervical squamous carcinoma cases were examined for BVI and LVI by streptavidin-peroxidase immunohistochemistry using CD-34 and D2-40 monoclonal antibodies. Data were analyzed with SPSS version 13.0 (SPSS, Chicago, IL, USA) statistical software. The survival rate and survival curve were derived by using the life table method and the Kaplan-Meier method, respectively. Multivariate prognosis analysis was conducted with Cox regression model, and prognosis was evaluated by measuring overall survival (OS) and progression-free survival (PFS).
BVI/LVI double positivity was an independent prognostic factor for both OS and PFS, whereas lymph node metastasis and surgical margin positivity affected only PFS. Patients inflicted with either BVI or LVI displayed no significant difference in survival time. Lymph-vascular space invasion (LVSI), referring to blood and/or lymph vessel invasion correlated with lymph node metastasis, surgical margin positivity, depth of cervical interstitial invasion, squamous cell carcinoma antigen (SccAg) and age. LVSI was a risk factor for both recurrence (P = 0.013, relative risk 3.060) and death (P = 0.005, relative risk 4.512). Post-operation auxiliary external radiation did not improve survival for LVSI-positive cases.
BVI/LVI double positivity constitutes an independent prognostic factor for early-stage cervical squamous carcinoma.
在过去10年中，治疗进展已使宫颈癌的短期疗效有所改善；然而，5年生存率并未显著提高。为了研究血管侵犯（BVI）和淋巴管侵犯（LVI）对早期宫颈鳞状细胞癌预后的影响，我们进行了免疫组织化学染色以区分血管和淋巴管。
采用链霉亲和素-过氧化物酶免疫组织化学方法，使用CD-34和D2-40单克隆抗体，对111例IB期或IIA期宫颈鳞状细胞癌病例的标本进行BVI和LVI检测。数据用SPSS 13.0版（SPSS，美国伊利诺伊州芝加哥）统计软件进行分析。生存率和生存曲线分别采用寿命表法和Kaplan-Meier法得出。采用Cox回归模型进行多因素预后分析，并通过测量总生存期（OS）和无进展生存期（PFS）评估预后。
BVI/LVI双阳性是OS和PFS的独立预后因素，而淋巴结转移和手术切缘阳性仅影响PFS。单纯BVI或LVI患者的生存时间无显著差异。淋巴管间隙侵犯（LVSI），即指血管和/或淋巴管侵犯，与淋巴结转移、手术切缘阳性、宫颈间质浸润深度、鳞状细胞癌抗原（SccAg）及年龄相关。LVSI是复发（P = 0.013，相对危险度3.060）和死亡（P = 0.005，相对危险度4.512）的危险因素。术后辅助外照射并不能改善LVSI阳性病例的生存率。
BVI/LVI双阳性是早期宫颈鳞状细胞癌的独立预后因素。
