He Ke-Wen, Sun Ju-Jie, Liu Zai-Bo, Zhuo Pei-Ying, Ma Qing-Hua, Liu Zhao-Yun, Yu Zhi-Yong
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan Department of Surgery, Haiyang People's Hospital, Yantai, Shandong, China.
Medicine (Baltimore). 2017 Nov;96(44):e8490. doi: 10.1097/MD.0000000000008490.
Lymphatic vessel invasion (LVI) is promising in determining prognosis and treatment strategies, but the application of LVI as a histopathological criterion in breast cancer patients especially those of different subgroups is controversial. This research aims to evaluate the prognostic value of LVI assessed by D2-40 not only in patients with early invasive breast cancer but also in lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative subgroups.The study cohort included 255 patients with a median follow-up of 101 months. Immunohistochemical staining for D2-40 was performed to identify LVI.LVI was present in 64 (25.1%), 15 (12.1%), 49 (37.4%), 19 (20.9%), 23 (27.7%), 13 (31.7%), and 9 (22.5%), respectively, in the whole cohort, lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative patients. LVI was associated with large tumor size (P = .04), high histological grade (P = .004), involved lymph node (P < .001), and high expression of Ki-67 (P = .003). No significant difference was found among patients with different subtypes and LVI status. The presence of LVI was significantly associated with adverse disease-free survival in the whole cohort (P < .001), lymph node-negative (P < .001), lymph node-positive (P < .001), luminal A-like (P < .001), and luminal B-like patients (P < .001) in both of the univariate and multivariate survival analysis.This study indicated that the presence of LVI stained by D2-40 provided independent prognostic information not only in the whole cohort but also in the subgroup of patients with lymph node-negative, lymph node-positive, luminal A-like, and luminal B-like diseases, which may make a case for routine clinical assessment of LVI using D2-40.
淋巴管浸润(LVI)在确定预后和治疗策略方面具有重要意义,但将LVI作为组织病理学标准应用于乳腺癌患者尤其是不同亚组患者时存在争议。本研究旨在评估通过D2-40评估的LVI不仅在早期浸润性乳腺癌患者中,而且在淋巴结阴性、淋巴结阳性、腔面A型、腔面B型、HER2富集型和三阴性亚组中的预后价值。研究队列包括255例患者,中位随访时间为101个月。进行D2-40免疫组化染色以识别LVI。在整个队列、淋巴结阴性、淋巴结阳性、腔面A型、腔面B型、HER2富集型和三阴性患者中,LVI的出现率分别为64例(25.1%)、15例(12.1%)、49例(37.4%)、19例(20.9%)、23例(27.7%)、13例(31.7%)和9例(22.5%)。LVI与肿瘤体积大(P = 0.04)、组织学分级高(P = 0.004)、淋巴结受累(P < 0.001)和Ki-67高表达(P = 0.003)相关。不同亚型和LVI状态的患者之间未发现显著差异。在单因素和多因素生存分析中,LVI的出现与整个队列(P < 0.001)、淋巴结阴性(P < 0.001)、淋巴结阳性(P < 0.001)、腔面A型(P < 0.001)和腔面B型患者(P < 0.001)的无病生存不良显著相关。本研究表明,通过D2-40染色的LVI的出现不仅在整个队列中,而且在淋巴结阴性、淋巴结阳性、腔面A型和腔面B型疾病患者亚组中提供了独立的预后信息,这可能为使用D2-40对LVI进行常规临床评估提供依据。