*Department of Anatomic Pathology, University of California San Diego, San Diego ¶Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA †Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ‡Department of Internal Medicine, Yale University School of Medicine, New Haven, CT §Brown and Associates Medical Laboratories, L.L.P. #Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX ∥Department of Pathology, Mexican Oncology Hospital, Mexico City, Mexico.
Am J Surg Pathol. 2017 Sep;41(9):1205-1211. doi: 10.1097/PAS.0000000000000822.
Lymphovascular invasion (LVI) has been reported as an independent predictor of patient outcome in cervical carcinoma. However, not all studies support independent significance, especially in multivariable analyses. A risk stratification system recently introduced for endocervical adenocarcinoma was reported to better predict risk of lymph node (LN) metastasis. A subset of patients with tumors with pattern C features had LN metastasis and died of disease. In this study, we determined whether LVI had any additional significance in this subset of tumors. A total of 127 patients with pattern C tumors and at least 12-month follow-up were included. Tumors were separated into 3 subgroups. Those with no LVI and negative LNs represented 41 cases; most patients (36, 88%) were alive with no evidence of disease at last follow-up, whereas 4 (10%) died of disease, all after tumor recurrence/metastasis. Tumors with LVI, but negative LNs, represented 55 cases; recurrences were seen in 10 (18%) patients, of which 5 (50%) of them died of disease; remaining 5 patients are alive with persistent disease. Tumors with both LVI and positive LNs represented 31 cases; recurrences were seen in 13 (42%) patients; 11 (85%) patients died of disease and 2 are alive with persistent disease. One additional patient who presented with advanced stage also died of disease. Tumor size, horizontal spread, and LN status were significantly associated with outcome in univariate, but not in multivariable analysis; depth of invasion was not a predictor of outcome. Tumors with no LVI and negative LNs behaved significantly less aggressively than tumors with both LVI and positive LNs (P<0.01). LVI status (independent of LN status) was not significantly associated with patient outcome, although approached significance (P=0.06). In conclusion, LVI is a prerequisite for LN metastasis; however, by itself is not sufficient to predict tumor aggressiveness, whereas over 50% of patients with positive LNs died of disease. Stratifying pattern C tumors into subgroups based on LVI and LN status could further determine treatment in patients with pattern C tumors.
脉管侵犯（LVI）已被报道为宫颈癌患者预后的独立预测因素。然而，并非所有研究都支持其具有独立意义，特别是在多变量分析中。最近引入的一种用于宫颈内膜腺癌的风险分层系统据报道可以更好地预测淋巴结（LN）转移的风险。具有 C 型特征的肿瘤的一部分患者发生 LN 转移并死于疾病。在这项研究中，我们确定 LVI 在这组肿瘤中是否具有其他意义。共纳入 127 例 C 型肿瘤且随访至少 12 个月的患者。将肿瘤分为 3 个亚组。无 LVI 且无 LN 阴性的肿瘤代表 41 例；大多数患者（36 例，88%）在最后一次随访时无疾病证据，仍存活，而 4 例（10%）死于疾病，均在肿瘤复发/转移后。LVI 阳性但 LN 阴性的肿瘤代表 55 例；10 例（18%）患者出现复发，其中 5 例（50%）死于疾病；其余 5 例患者仍患有持续性疾病。LVI 阳性且 LN 阳性的肿瘤代表 31 例；13 例（42%）患者出现复发；11 例（85%）患者死于疾病，2 例患者仍患有持续性疾病。另外 1 例晚期患者也死于疾病。肿瘤大小、水平扩散和 LN 状态在单变量分析中与结局显著相关，但在多变量分析中无相关性；浸润深度不是结局的预测因素。无 LVI 且 LN 阴性的肿瘤的侵袭性明显低于 LVI 阳性且 LN 阳性的肿瘤（P<0.01）。LVI 状态（与 LN 状态无关）与患者结局无显著相关性，尽管接近显著（P=0.06）。总之，LVI 是 LN 转移的先决条件；然而，它本身不足以预测肿瘤侵袭性，而超过 50%的 LN 阳性患者死于疾病。根据 LVI 和 LN 状态将 C 型肿瘤分为亚组，可能会进一步确定 C 型肿瘤患者的治疗方案。
