Schiefer Ana-Iris, Schoppmann Sebastian F, Birner Peter
Department of Pathology, Medical University of Vienna, Vienna, Austria.
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Surgery. 2016 Aug;160(2):331-40. doi: 10.1016/j.surg.2016.02.034. Epub 2016 Apr 14.
Lymph node metastases constitute a strong prognostic factor in esophageal cancer. Nevertheless, the mechanisms and relevance of further spread of tumor cells from these already established metastatic sites have not been studied in this disease. The aim of this study was to investigate lymphatic vessel invasion (LVI) of tumor cells and lymphatic microvessel density in lymph node metastases in a large cohort of patients with node-positive esophageal cancer.
A total of 120 patients with node-positive esophageal cancer (67 adenocarcinomas, 53 squamous cell carcinomas) and radical esophagectomy were analyzed for LVI and lymphatic microvessel density in primary tumors and lymph node metastases using D2-40 immunostaining. In 18 patients, additional tissue from distant metastases was available.
LVI was present in 52.1% (62/119) of primary tumors, 52.5% (63/120) of lymph nodes, and 22.2% (4/18) of distant metastases. LVI in primary tumors strongly correlated with LVI in lymph node metastases (P < .05), regardless of histologic subtype. In univariate analysis, LVI in lymph node metastases was associated with shorter disease-free survival and overall survival in all tumors and in adenocarcinomas, and with shorter disease-free survival in squamous cell carcinomas (P < .05, log-rank test). Multivariable analysis revealed LVI in lymph node metastases as an independent prognostic factor for disease-free survival in the whole cohort and for disease-free and overall survival in patients with adenocarcinomas (P < .05, Cox regression).
LVI in lymph node metastasis is a significant prognostic factor in metastatic esophageal carcinoma and seems to play a relevant role in disease progression.
淋巴结转移是食管癌的一个重要预后因素。然而，肿瘤细胞从这些已建立的转移部位进一步扩散的机制及相关性在该疾病中尚未得到研究。本研究的目的是在一大群淋巴结阳性食管癌患者中，调查肿瘤细胞的淋巴管浸润（LVI）及淋巴结转移中的淋巴管微血管密度。
采用D2-40免疫染色，对120例接受根治性食管切除术的淋巴结阳性食管癌患者（67例腺癌，53例鳞状细胞癌）的原发肿瘤和淋巴结转移灶中的LVI及淋巴管微血管密度进行分析。18例患者有远处转移的额外组织。
原发肿瘤中LVI发生率为52.1%（62/119），淋巴结中为52.5%（63/120），远处转移中为22.2%（4/18）。无论组织学亚型如何，原发肿瘤中的LVI与淋巴结转移中的LVI密切相关（P<0.05）。单因素分析显示，淋巴结转移中的LVI与所有肿瘤及腺癌患者的无病生存期和总生存期缩短相关，与鳞状细胞癌患者的无病生存期缩短相关（P<0.05，对数秩检验）。多变量分析显示，淋巴结转移中的LVI是整个队列无病生存期以及腺癌患者无病生存期和总生存期的独立预后因素（P<0.05，Cox回归）。
淋巴结转移中的LVI是转移性食管癌的一个重要预后因素，似乎在疾病进展中起相关作用。
