Obermair A, Wanner C, Bilgi S, Speiser P, Reisenberger K, Kaider A, Kainz C, Leodolter S, Breitenecker G, Gitsch G
Department of Gynecology and Obstetrics, University Hospital of Vienna, Austria.
Cancer. 1998 Feb 15;82(4):689-96.
There is controversy over the question of whether the involvement of vascular spaces influences the prognosis of patients with carcinoma of the uterine cervix. The aim of the current study was to compare patterns of vascular space involvement determined by hematoxylin and eosin (H & E) staining with those patterns determined by immunostaining for factor VIII-related antigen (F8-RA) with regard to their prognostic impact on the disease free survival (DFS) and overall survival (OS) of patients with clinical Stage IB cervical carcinoma. Staining for F8-RA is known to highlight blood vessels predominantly, whereas the presence of tumor cell emboli in vascular spaces of H & E-stained sections mainly indicates lymphatic vessel invasion.
The authors analyzed data on 163 patients for whom vascular space involvement (VSI) was determined by H & E (VSI/H & E) and F8-RA (VSI/F8) staining from the same block in two separate runs.
The median follow-up period was 85 months (range, 5-170 months). The 25% quantile for OS was 109 months (median not reached; range, 5-170 months). The overall rates of VSI/H & E and VSI/F8 were 29.4% and 24.5%, respectively. The findings obtained by H & E and F8-RA staining were concurrent in 60.7% of cases. Lymph node involvement and VSI/F8 remained independent prognostic factors for DFS and OS. Due to a highly significant correlation of pelvic lymph node status with both VSI/H & E and tumor size, the last two parameters failed to retain a significant value. For lymph node negative patients, the estimated OS probability was 92% for those without VSI/F8 and 62% for those with VSI/F8.
VSI/F8 may provide additional information on the outcome of clinical Stage IB cervical carcinoma. Lymph node negative patients with VSI/F8 positive tumors may benefit from more intense postsurgical treatment. Further trials involving larger series of patients are necessary to confirm these findings.
血管间隙受累是否会影响子宫颈癌患者的预后存在争议。本研究的目的是比较苏木精和伊红（H&E）染色确定的血管间隙受累模式与因子VIII相关抗原（F8-RA）免疫染色确定的模式，以评估它们对临床I B期宫颈癌患者无病生存期（DFS）和总生存期（OS）的预后影响。已知F8-RA染色主要突出血管，而H&E染色切片血管间隙中肿瘤细胞栓子的存在主要表明淋巴管侵犯。
作者分析了163例患者的数据，这些患者的血管间隙受累（VSI）在两次独立检测中通过同一组织块的H&E（VSI/H&E）和F8-RA（VSI/F8）染色来确定。
中位随访期为85个月（范围5 - 170个月）。OS的25%分位数为109个月（未达到中位值；范围5 - 170个月）。VSI/H&E和VSI/F8的总体发生率分别为29.4%和24.5%。H&E和F8-RA染色结果在60.7%的病例中一致。淋巴结受累和VSI/F8仍然是DFS和OS的独立预后因素。由于盆腔淋巴结状态与VSI/H&E和肿瘤大小高度相关，后两个参数未能保持显著意义。对于淋巴结阴性的患者，无VSI/F8者的估计OS概率为92%，有VSI/F8者为62%。
VSI/F8可能为临床I B期宫颈癌的预后提供额外信息。VSI/F8阳性肿瘤的淋巴结阴性患者可能从更积极的术后治疗中获益。需要进一步纳入更多患者的试验来证实这些发现。
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