Association between intratumoral lymphatic microvessel density (LMVD) and clinicopathologic features in endometrial cancer: a retrospective cohort study

Abstract

BackgroundLymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival.MethodsFifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis.ResultsThe mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD.ConclusionOur results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.

Prognostic significance of tumor-associated macrophages in endometrial adenocarcinoma

“…Therefore, lymph vessels were counted in the tumor invasive front, considered most crucial for malignant cell spread [35]. The range of lymph vessels determined in our study was in accord with previous reports [36,37]. Consistent with our results, increased LVD has been correlated with a dense infiltration of TAMs in a number of cancer entities [38].…”

Lymphatic vessel invasion detected by the endothelial lymphatic marker D2-40 (podoplanin) is predictive of regional lymph node status and an independent prognostic factor in patients with resected esophageal cancer

“…It has been shown that D2-40 is the most sensitive and specific antibody for the detection of lymphatic endothelium in different malignancies like gastric [19], colorectal [20], vulvar [21], breast [22] and endometrial cancer [23].…”

The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors

“…In our previous experience with cancers of the vulva, cervix and endometrium, we found an inverse correlation between intratumoral LVD and lymph node metastasis and prognosis 9-11. To explain our previous results, we hypothesized that the intratumoral lymphatic vessels were non-functional and therefore had the potential to disturb local drainage, including the transport of neoplastic cells outside the tumor.…”