A multivariate analysis of blood vessel and lymph vessel invasion as predictors of ovarian and lymph node metastases in patients with cervical carcinoma

BACKGROUND, To the authors' knowledge there are few available data regardin g the influence of lpmphovascular space invasion, which has been examined s eparately as two components (lymphatic vessel invasion [LVI] and blood vess el invasion [BVI]), in the metastasis of cervical carcinoma. METHODS. LVI and BVI, which include capillary vessel invasion, were reviewe d retrospectively based on the histopathologic slides of 239 women with cer vical carcinoma who were treated with radical hysterectomy The correlation between lymph node and/or ovarian metastases and LVI, BVI, and other histop athologic factors was investigated by multiple logistic regression analysis . The influence of LVI and BVI on survival was examined by Cox regression a nalysis. RESULTS, The rate of incidence of LVI was higher than that of BVI in all st ages of cervical carcinoma (P < 0.0001 for International Federation of Gyne cology and Obstetrics Stage IB and Stage II disease and P < 0.05 for Stage III disease). The incidence rate of BVI increased as LVI became more promin ent and there was a significant correlation between the two findings (P < 0 .0001). BVI was more frequent in adenocarcinoma/adenosquamous carcinoma tha n in squamous cell carcinoma (P < 0.05), LVI (P < 0.0001) and parametrial i nvasion (P < 0.0001) were significantly related to lymph node metastasis on multivariate analysis. Conversely, BVI (P < 0.05) and parametrial invasion (P < 0.0025), as well as adenocarcinoma or adenosquamous carcinoma (P < 0. 0005), were significantly related to ovarian metastasis on multivariate ana lysis. With regard to the prognostic significance of these components, it w as found that BVI (hazards ratio [IIR] = 2.0), ovarian metastasis (HR = 6.5 ), and lymph node metastasis (IIR = 5.5) were significantly related to a po or prognosis in women with cervical carcinoma. CONCLUSIONS. Ovarian metastasis may occur via hematogenous spread of cervic al carcinoma. The results of the current study suggest that BVI, including capillary vessels, that is diagnosed separately from LVI using hematoxylin and eosin stained sections may be an important prognostic factor for patien ts with cervical carcinoma. (C) 2000 American Cancer Society.