International Journal of Clinical Oncology

, Volume 23, Issue 3, pp 532–538 | Cite as

Lymphatic vessel involvement is predictive for lymph node metastasis and an important prognostic factor in endometrial cancer

  • Akihiko Wakayama
  • Wataru Kudaka
  • Hirofumi Matsumoto
  • Hajime Aoyama
  • Takuma Ooyama
  • Yusuke Taira
  • Yoshihisa Arakaki
  • Yuko Shimoji
  • Tadaharu Nakasone
  • Kumiko Nishihira
  • Itomi Kaneshima
  • Tomoko Tamaki
  • Naoki Yoshimi
  • Yoichi Aoki
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Lymphovascular space involvement is reported to be an important risk factor in endometrial cancer. This study was conducted to evaluate the separate prognostic effects of lymphatic invasion and venous invasion on the outcomes of patients with endometrial cancer.

Methods

From 2006 to 2013, 189 histologically confirmed endometrial cancer patients were examined. To study the venous invasion (v) of the endometrial cancer, Victoria blue–H&E staining—which positively stains the elastic fibers of vessels—was performed. Immunohistochemical staining with D2-40 was used to study the lymphatic invasion (ly) of the endometrial cancer.

Results

The median age of the patients was 57 (range 25–84) years. ly(+) and/or v(+) patients were significantly more likely to present an advanced cancer stage, G3 tumor, and deep myometrial invasion than ly(−)/v(−) patients. The incidence of lymph node metastasis was high in ly(+) patients, and that of ovarian metastasis was high in v(+) patients. Lymphatic vessel invasion was significantly correlated with regional lymph node metastasis. We found a significantly higher incidence of distant metastasis in ly(+) patients. Most recurrences in ly(+)/v(−) patients occurred in lymph nodes, while those in ly(+)/v(+) patients occurred mainly at distant organs. Finally, the prognosis was significantly poorer for ly(+) patients, in whom lymphatic invasion was an independent prognostic factor along with distant metastasis.

Conclusions

Our study suggests that by separately evaluating lymphatic invasion and blood vessel invasion in endometrial cancer cases, useful information for predicting lymph node metastasis and recurrence sites as well as prognostic information can be obtained.

Keywords

Endometrial cancer D2-40 Victoria blue Lymph node metastasis Lymphatic vessel Prognosis 
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Notes

Acknowledgements

The authors would like to thank Enago (http://www.enago.jp) for the English language review.

Funding

There was no funding for this article.

Compliance with ethical standards

Conflict of interest

The authors declare that there was no conflict of interest regarding this study.

Ethical approval

This retrospective study was conducted according to the principles stated in the 1964 Declaration of Helsinki and its subsequent revisions, and was approved by the Institutional Review Board of our university on March 8, 2017 (#1075).

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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Akihiko Wakayama
    • 1
  • Wataru Kudaka
    • 1
  • Hirofumi Matsumoto
    • 2
  • Hajime Aoyama
    • 2
  • Takuma Ooyama
    • 1
  • Yusuke Taira
    • 1
  • Yoshihisa Arakaki
    • 1
  • Yuko Shimoji
    • 1
  • Tadaharu Nakasone
    • 1
  • Kumiko Nishihira
    • 1
  • Itomi Kaneshima
    • 1
  • Tomoko Tamaki
    • 2
  • Naoki Yoshimi
    • 2
  • Yoichi Aoki
    • 1
  1. 1.Department of Obstetrics and Gynecology, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
  2. 2.Department of PathologyRyukyu University HospitalOkinawaJapan

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