Relationship Between Lymph-vascular Space Invasion And Lymph Node Metastasis And Prognosis In Early Cervical Cancer

Objective studying the relationship of Lymph-vascular space invasion(LVSI)and lymph node metastasis and prognosis to further guide the treatment and to judge the prognosis in early cervical cancer.Methods The clinical and pathological data of 273 cases of early cervical cancer(IA2-IIA)patients were retrospectively collected.All patients were treated initially for surgical treatment at Dalian Maternal and Child Health Care Hospital between January2009 and June 2012.The surgery was extensive hysterectomy + pelvic lymphadenectomy ± para abdominal lymph node dissection.According to the risk factors,adjuvant radiotherapy or combined chemoradiotherapy was performed.A total of273 patients were in cluded in this study,All patients were 27-72 years old and the median age was 48 years.All patients were categorized according to the 2009 FIGO(International Federation of Gynecology and Obstetrics international society of Obstetrics and Gynecology).5 patients were stage IA2,130 patients were stage IB1,56 patients were stage IB2,82 patients were stage IIA;Histological types: 225 cases with squamous cell carcinoma,25 cases cases with adenocarcinoma,17 cases with adenosquamous carcinoma and 6 cases with other pathological types.Differentiation degree: 32 patients with high differentiation,70 patients with moderate differentiation and 171 patients with low differentiation;9 patients with parauterine involvement and264 patients without paracervical involvement;Depth of cervical interstitial infiltration:114 cases with less than 1/2,159 cases with greater than or equal to 1/2;The size of the lesions: 73 patients with lesions larger than or equal to 4cm,200 patients with lesions less than 4cm;Lymph node status: 121 patients with negative lymph nodes and 91patients with positive lymph nodes;137 patients were LVSI positive,136 patients were LVSI negative.The lymph node metastasis rate of LVSI positive patients was 33.6%(46/137),The lymph node metastasis rate of LVSI negative was 11.0%(15/136).Postoperative pathology confirmed by experienced gynecological tumor pathology experts.The clinical and pathological data of the 273 patients were summarized and analyzed.Univariate analysis(X 2)to study the correlation between the clinicopathological factors and LVSI,Multivariate analysis to study the correlation between the significant clinicopathological factors and LVSI.Multivariate analysis was analyzed by Binary Logistic Regression.Using Kaplan-Miere Method to draw survival curve and determine the effect of LVSI on the 5-year disease free survival(DFS)and the overall survival(OS)of all patients and lymph node negative patients.Furthermore,the influence of LVSI positive on the prognosis of early cervical squamous cell carcinoma and non-squamous cell carcinoma was analyzed respectively.The postoperative patients with followed-up by the tumor diagnosis with outpatient follow-up records,telephone forms and so on.the postoperative follow up deadline is June 2017.Results(1)Univariate analysis showed that histological type(P=0.001),histological differentiation(P=0.000),lymph node metastasis(P=0.000),cervical stromal invasion depth(P=0.000)were significantly correlated with the LVSI.The age,parametrial involvement,tumor size,FIGO stage were no significantly correlated with the LVSI(P > 0.05);Multivariate analysis showed that differentiation,lymph node metastasis and cervical stromal invasion depth were significantly correlated with the LVSI(P < 0.05).(2)The 5-year disease free survival(DFS)of LVSI positive patients was 72%,and the overall survival(OS)was 76%;The 5-year DFS of LVSI negative patients was 82%.The5-year OS of LVSI negative patients was 93%.The study showed that LVSI positive could significantly reduce the 5-year DFS and OS of patients with early cervical cancer.The 5-year DFS and OS of LVSI-positive patients without lymph node metastasis also decreased significantly.The patients were divided into squamous cell carcinoma group and non-squamous cell carcinoma group by histological type.Further analysis showed that LVSI positive could significantly reduce the 5-year DFS and OS of patients with cervical squamous cell carcinoma,and the 5-year OS of patients with cervical non-squamous cell carcinoma.Conclusion LVSI is the independent risk factors of lymph node metastasis and whitch can significantly reduce the 5-year survival rate in patients with early cervical cancer.Patients with LVSI positive may have deeper the cervical stromal invasion and poorer differentitaton,But more studies are needed to confirm them.