Relationship Between Lymphovascual Space Invasion And Other Clinical Pathological Factors In Early-stage Cervical Cancer And Its Effect On Prognosis

Background and ObjectiveIn China,the annual incidence of Cervical cancer is about 100,000,and the incidence rate is the highest in female reproductive system malignancies.Early-stage cervical cancer is mainly treated with surgery.Surgery can remove the lesion.The procedure is sub-wide or extensive hysterectomy(type B or C)+ pelvic lymphadenectomy ± para-aortic lymph node biopsy or resection,postoperative basis Supplementary treatment for related clinical pathological risk factors,The NCCN Clinical Practice Guidelines for Cervical Cancer have clear and detailed regulations.The NCCN Clinical Practice Guidelines for Cervical Cancer,published in 2015,clearly state that Lymphovascual Space Invasion(LVSI)is one of the risk factors.LVSI is a pathological phenomenon that is prevalent in many malignancies,including cervical cancer.Postoperative pathological sections were stained with HE and observed under a light microscope.If at least one cluster of tumor cells was observed in the gap formed by the flattened endothelial cells outside the lymphatic vessels or the vessel wall,and these tumor cells were attached to the wall,It is called lymphatic vascular infiltration.Clinically,LVSI is also known as vascular thrombosis or vascular invasion.Most scholars believe that lymph node metastasis,cervical interstitial infiltration and tumor size are independent risk factors for the prognosis of cervical cancer.The impact of LVSI on prognosis is currently controversial.This study retrospectively analyzed the clinical and pathological data of 470 patients with IA2~IIA2 cervical cancer treated by gynecology in the Second Affiliated Hospital of Zhengzhou University from January 1,2009 to December 31,2015.To compare the relationship between LVSI and other clinicopathological factors,to explore whether LVSI can be used as an independent prognostic factor for early cervical cancer,and provide reference for postoperative complementary treatment of cervical cancer patients.Materials and methodsMaterialsTo review the clinical and pathological data and follow-up data of 470 patients with IA2~IIA2 cervical cancer who underwent gynecological surgery in the Second Affiliated Hospital of Zhengzhou University from January 1,2009 to December 31,2015.MethodsClinical pathological data were collected.Inclusion criteria were: complete medical records,surgical treatment,subtotal or extensive hysterectomy(type B or C)+ pelvic lymphadenectomy ± para-aortic lymph node biopsy / resection,postoperative pathology Confirmed as cervical cancer.Statistical items: name,age,maternal parity,clinical stage,tumor size,pathological type,preoperative treatment,histological grade,cervical interstitial infiltration,parametrial infiltration,lymphatic vascular infiltration,lymph node metastasis,postoperative treatment.Regular follow-up of each patient's survival was followed.Follow-up: gynecological outpatient review or telephone follow-up.The survival time of each patient was calculated,including: 5-year tumor-free survival time(DFS)and overall survival time(OS).Tumor-free survival time(DFS)was defined as the date from the date of surgery to the last follow-up date or clinical,pathological recurrence,and the overall survival time(OS)was defined as the date from the surgery to the last follow-up date or death date,calculated monthly,follow-up date As of August 31,2017.470 patients were divided into LVSI-positive group and LVSI-negative group.The clinical and pathological factors were compared between the two groups.The prognosis of cervical cancer was analyzed in patients with complete follow-up data(5-year tumor-free survival time and 5-year total survival time).Clinical pathological factors.Statistical methodsStatistical analysis was performed using SPSS 22.0 statistical software.When the clinicopathological factors between the LVSI positive group and the negative group were compared,the chi-square test was used for single factor analysis and logistic regression analysis was used for multivariate analysis.Survival analysis was performed using the Kaplan-Meier method,Log-rank test was used for single factor analysis,and COX proportional hazard model was used for multivariate analysis.The difference was statistically significant at ?<0.05.Results470 patients,aged 24.0 to 77.0 years,mean age 46.98 years,mean pregnancy 3.7 times,mean number of times 2.2 times.Preoperatively,clinical stage was defined according to FIGO2009.There were 60 patients in IA2,195 in IB1,58 in IB2,104 in IIA1,and 53 in IIA2.138 patients received preoperative treatment and 332 patients underwent direct surgery.324 cases were treated after surgery,195 cases were chemotherapy alone,39 cases were treated with radiotherapy alone,90 cases were treated with radiotherapy and chemotherapy,and 146 cases were untreated after surgery.The median follow-up time was 53 months(1 to 101 months).Of the 470 patients,22 were lost to follow-up because of no regular follow-up or telephone number change,and 448 patients had complete follow-up data.The follow-up rate was 95.32%.1.The relationship between LVSI and other clinicopathological factors470 patients were divided into positive group and negative group according to the presence or absence of LVSI,84 cases in LVSI positive group and 386 cases in LVSI negative group.The positive rate of LVSI was 17.87%.Univariate analysis showed statistically significant differences in cervical interstitial infiltration depth,histological grade,parametrial infiltration,lymph node metastasis,and postoperative treatment between the two groups(?<0.05),but in age,pathological type,tumor size,There was no significant difference in clinical stage and preoperative treatment(?>0.05).The statistically significant factors in the above univariate analysis were further analyzed by logistic regression for multivariate analysis.The results showed that LVSI was associated with depth of cervical myometrial invasion,histological differentiation,lymph node metastasis,parametrial metastasis,and postoperative treatment(?< 0.05).2.Effect of LVSI on recurrence and deathOf the 470 patients,448 patients had complete follow-up data.Survival analysis was performed.The 5-year disease-free survival rate was 86.8%,and the 5-year overall survival rate was 87.9%.There were 55 cases of recurrence,50 cases of death,47 cases of death due to cervical cancer recurrence,and 3 cases of death due to other causes.Of the 55 relapsed cases,LVSI was positive in 21(38.2%),and in 393 non-recurring cases,LVSI was positive in 63(16.0%),and LVSI positive was a risk factor for recurrence(?=0.000);Of the 50 deaths,17 were LVSI-positive(34.0%),and 398 were LVSI-positive(67.8%).LVSI-positive was a risk factor for death(?=0.000).3.The effect of LVSI on the prognosis of early cervical carcinomaSurvival analysis was performed on 448 patients with complete follow-up data.Univariate analysis showed that clinical stage,histological grade,cervical interstitial infiltration,lymph node metastasis,LVSI,parametrial infiltration,LVSI & LN and postoperative treatment were risk factors affecting 5-year disease-free survival time and overall survival(?<0.05),age,pathological type,tumor size,preoperative treatment and 5-year tumor-free survival time and 5-year total survival time(?>0.05).Multivariate analysis showed that histological grade,cervical interstitial infiltration,LVSI,and lymph node metastasis were independent prognostic factors for 5-year disease-free survival(?<0.05).Histological grade,cervical interstitial infiltration,and lymph node metastasis were 5-year overall survival.Independent prognostic factors(?<0.05).The survival time of the LVSI positive group was significantly lower than that of the LVSI negative group(?<0.05).4.Survival of LVSI-positive and LVSI-negative groups in different lymph nodesThe combination of LVSI and lymph node(LN)metastasis was discussed: The survival rate was highest in patients with negative lymph node metastasis and LVSI(OS 93.8%;DFS 92.9%),and the survival rate was higher in simple LVSI positive group(OS 90.7%;DFS 82.2%).The lymph node metastasis group(OS 78.6%;DFS 78.9%);the lymph node metastasis and LVSI positive all had the lowest survival rate(OS 41.7%;DFS 37.9%),ie LVSI(-)& LN(-)> LVSI(+)& LN(-)> LVSI(-)& LN(+)> LVSI(-)& LN(+)> LVSI(+)& LN(+).5.Postoperative treatment of early-stage cervical cancer with LVSIUnivariate analysis showed that 79 cases(94.0%)of the LVSI-positive group were treated with postoperative treatment,and 386(63.5%)of the 386 patients with LVSI-negative group had significant differences(? = 0.000).Univariate survival analysis that affected prognosis showed that postoperative treatment had an effect on 5-year overall survival(? = 0.012)and disease-free survival(? = 0.002).Conclusions1.In early-stage cervical cancer,histologically poor differentiation,parametrial infiltration,deep interstitial invasion of the cervix,and lymph node metastasis are independent risk factors for LVSI.2.LVSI affects recurrence and death in patients with early-stage cervical cancer.3.In early-stage cervical cancer,LVSI is an independent risk factor for tumor-free survival and is not an independent risk factor for overall survival.4.When LVSI is present in postoperative pathology,postoperative supplemental therapy is recommended.