Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Surg Oncol. 2021 May;123(8):1736-1741. doi: 10.1002/jso.26468. Epub 2021 Mar 26.
The diagnosis of lymphovascular invasion (LVI) is often inaccurate with routine histology. This study aimed to evaluate the use of immunohistochemistry (IHC) in detecting LVI and reevaluate the clinical implications of LVI in gastric cancer.
This prospective unrandomized cohort study analyzed the rates of LVI positivity and its relevance with other clinicopathologic features.
Between November 2017 and April 2018, 558 patients undergoing curative gastrectomy were enrolled and assigned to the IHC group (n = 285) and hematoxylin-eosin group (n = 273). The use of IHC increased the rates of LVI positivity (60.8% vs. 43.3%, p < .001) and decreased the rates of undetermined LVI subtype (7.7% vs. 27.1%, p < .001). The LVI-negative patients identified by IHC had fewer lymph node metastases (16.8% vs. 34.6%, p = .002) and earlier pathological stage (p = .004) than those identified by routine histology. The LVI-positive patients identified by IHC had a higher percentage of perineural invasion (p = .019).
The use of endothelial markers significantly enhanced the detection of LVI. The LVI detected by IHC could be a better predictor of lymph node metastasis and biological aggressiveness in gastric cancer.
常规组织学检查对淋巴管浸润（LVI）的诊断常常不够准确。本研究旨在评估免疫组织化学（IHC）在检测 LVI 中的应用，并重新评估 LVI 在胃癌中的临床意义。
本前瞻性非随机队列研究分析了 LVI 阳性率及其与其他临床病理特征的相关性。
2017 年 11 月至 2018 年 4 月，共有 558 例接受根治性胃切除术的患者入组并被分配至 IHC 组（n=285）和苏木精-伊红组（n=273）。IHC 的应用增加了 LVI 阳性率（60.8%比 43.3%，p<0.001），降低了未确定 LVI 亚型的比例（7.7%比 27.1%，p<0.001）。IHC 鉴定的 LVI 阴性患者淋巴结转移率（16.8%比 34.6%，p=0.002）和病理分期更早（p=0.004），而常规组织学鉴定的 LVI 阴性患者则相反。IHC 鉴定的 LVI 阳性患者神经周围浸润的比例更高（p=0.019）。
内皮标志物的使用显著提高了 LVI 的检出率。IHC 检测到的 LVI 可能是胃癌淋巴结转移和生物学侵袭性的更好预测因子。
