Selective immunohistochemical staining of blood and lymphatic vessels reveals independent prognostic influence of blood and lymphatic vessel invasionin early-stage cervical cancer

Lymphovascular space invasion was shown to play a key role in the progressi on of cervical cancer. Because of the absence of a specific marker for lymp hatic vessels, earlier studies could not reliably distinguish between blood and lymphatic vessel invasion. By immunostaining for popoplanin, a novel m arker for lymphatic endothelium, and for factor VIII-related antigen, we de termined lymphatic and blood vessel invasion in tissue samples of 98 patien ts with cervical cancer pT1b treated by radical hysterectomy. Eleven (11.2% ) specimens showed invasion of blood vessels, 20 (20.4%) showed invasion of lymphatic vessels, and 15 (15.3%) showed invasion of blood and lymphatic v essels. There was a strong association of lymphatic vessel invasion and lym ph node involvement (P < 0.001), In univariate analysis, both blood and lym phatic vessel invasion failed to reach a statistically significant influenc e on overall survival, but a significant influence on disease-free survival was found (P = 0.0002 and P < 0.0001, respectively). In multivariate analy sis of disease-free survival, only blood vessel invasion remained statistic ally significant (P = 0.0457), Lymphatic vessel invasion reached significan ce when lymph node status was excluded from the model (P = 0.0025), Both ly mphatic vessel and blood vessel invasion occur frequently in early-stage ce rvical cancer. Determination of the vessel status may be of clinical import ance because it signifies the risk of recurrent disease.