THE PROGNOSTIC VALUE OF LYMPHATIC AND BLOOD-VESSEL INVASION IN OPERABLE BREAST-CANCER

Background. This study assessed the prognostic effect of lymphatic and blood vessel invasion (LVI and BVI) on survival in a retrospective sa mple of 1408 patients with breast cancer. Methods. Survival analysis w as evaluated by univariate (Kaplan-Meier product limit method and log rank test) and multivariate (Cox model) analysis. Correlations among v ariables were studied by contingency tables and statistical significan ce was evaluated by chi-square test. Results. Lymphatic vessel invasio n was present in 34.2% of cases, and BVI in 4.2%, Lymphatic vessel ini vasion correlated with BVI (P < 0.0001), and both were correlated with metastatic axillary lymph nodes and increasing tumor size and grade; BVI was sporadic (only 10 cases) among lymph node negative patients. A lthough LVI was more frequent among premenopausal patients and those w ith ductal carcinomas, BVI was unrelated to menopausal status and tumo r type. Lymphatic vessel invasion and BVI were associated with poor su rvival by univariate analysis (P < 0.0001). By multivariate analysis, relative risk of death was significantly increased when LVI was presen t both in the whole series as well as in the lymph node negative and l ymph node positive subgroups; the prognostic role of LVI was independe nt of menopausal and lymph node status, tumor size, tumor grade, or ad juvant treatment, In the lymph node negative sample, LVI had strong pr ognostic power, In the lymph node positive sample, the prognostic role of LVI was also independent of the number of lymph nodes with metasta ses, Blood vessel invasion had no prognostic role in any subgroup. Con clusion. The prevalence of BVI was particularly low in this study, and the question of its possible prognostic role for patients with breast cancer should be assessed with methods that amplify its detection. LV I is a strong prognostic factor for operable patients with breast canc er. In lymph node negative patients, LVI is a predictor of poor progno sis for those who are consequently candidates for adjuvant therapy. Si milarly, in lymph node positive patients, LVI is a predictor for a hig h risk of death for those who are candidates for highly intensive adju vant strategies.