Department of Gynecology and Obstetrics, Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
Int J Gynecol Cancer. 2012 Oct;22(8):1442-8. doi: 10.1097/IGC.0b013e318269139b.
Lymph node involvement is a major feature in tumor spread of endometrial cancer and predicts prognosis. Therefore, evaluation of lymph vessel invasion (LVI) in tumor tissue as a predictor for lymph node metastasis is of great importance. Immunostaining of D2-40 (podoplanin), a specific marker for lymphatic endothelial cells, might be able to increase the detection rate of LVI compared with conventional hematoxylin-eosin (H-E) staining. The aim of this retrospective study was to analyze the eligibility of D2-40-based LVI evaluation for the prediction of lymph node metastases and patients' outcome.
Immunohistochemical staining with D2-40 monoclonal antibodies was performed on paraffin-embedded tissue sections of 182 patients with primary endometrioid adenocarcinoma treated in 1 gynecologic cancer center. Tumors were screened for the presence of LVI. Correlations with clinicopathological features and clinical outcome were assessed.
Immunostaining of D2-40 significantly increased the frequency LVI detection compared with conventional H-E staining. Lymph vessel invasion was identified by D2-40 in 53 (29.1%) of 182 tumors compared with 34 (18.3%) of 182 carcinomas by routine H-E staining (P = 0.001). D2-40 LVI was detectable in 81.0% (17/21) of nodal-positive tumors and significantly predicted lymph node metastasis (P = 0.001). Furthermore, D2-40 LVI was an independent prognostic factor for patients overall survival considering tumor stage, lymph node involvement, and tumor differentiation (P < 0.01). D2-40-negative tumors confined to the inner half of the myometrium showed an excellent outcome (5-year overall survival, 97.8%).
D2-40-based LVI assessment improves the histopathological detection of lymphovascular invasion in endometrial cancer. Furthermore, LVI is of prognostic value and predicts lymph node metastasis. D2-40 LVI detection might help to select endometrial cancer patients who will benefit from a lymphadenectomy.
淋巴结浸润是子宫内膜癌肿瘤扩散的主要特征，并可预测预后。因此，评估肿瘤组织中的淋巴管侵犯（LVI）作为淋巴结转移的预测因子具有重要意义。D2-40（足细胞蛋白）作为淋巴管内皮细胞的特异性标志物的免疫组化染色可能能够提高与常规苏木精-伊红（H-E）染色相比 LVI 的检出率。本回顾性研究旨在分析基于 D2-40 的 LVI 评估对预测淋巴结转移和患者预后的适用性。
对 182 例在 1 个妇科癌症中心治疗的原发性子宫内膜样腺癌患者的石蜡包埋组织切片进行 D2-40 单克隆抗体免疫组织化学染色。筛选肿瘤中是否存在 LVI。评估与临床病理特征和临床结果的相关性。
与常规 H-E 染色相比，D2-40 免疫染色显著增加了 LVI 的检出频率。与常规 H-E 染色的 182 例癌中的 34 例（18.3%）相比，D2-40 识别出 182 例肿瘤中的 53 例（29.1%）存在 LVI（P=0.001）。D2-40 LVI 可检测到 21 例淋巴结阳性肿瘤中的 81.0%（17/21），并显著预测淋巴结转移（P=0.001）。此外，考虑到肿瘤分期、淋巴结受累和肿瘤分化，D2-40 LVI 是患者总生存的独立预后因素（P<0.01）。局限于子宫肌内层的 D2-40 阴性肿瘤具有极好的预后（5 年总生存率为 97.8%）。
基于 D2-40 的 LVI 评估可提高子宫内膜癌中淋巴管侵犯的组织病理学检测。此外，LVI 具有预后价值并可预测淋巴结转移。D2-40 LVI 检测可能有助于选择受益于淋巴结切除术的子宫内膜癌患者。
