Study On The Relationship Between Surgical Treatment And Pseudo Vascular Invasion In Early Cervical Cancer

Objective:Pseudovascular invasion(PVI)refers to the tumor cells entering the vascular space through mechanical metastasis rather than biological metastasis.It is a man-made false image of Lymphovascular space invasion(LVSI),which is easily confused with LVSI,so as to give wrong treatment guidance。To analyze the incidence of pseudo vascular invasion in open and laparoscopic surgery for early cervical cancer and the incidence of inaccurate pathological reading of LVSI,and investigate the effect of PVI on the treatment and prognosis of early cervical cancer.Methods:To do the retrospective analysis of the 2009 FIGO stage ⅠA2-IⅠA2cervical cancer patients with complete clinical and pathological materials who received operation treatment from January 2012 to December 2013 in Dalian Gynecology and Obstetrics Hospital Affiliated to Dalian University,183 cases were reviewed,80cases(43.7%)underwent laparoscopic surgery and 103 cases(56.3%)underwent abdominal surgery.The general clinicopathologic data including body mass index,age,grade,FIGO stage,histological type,LVSI,lymph node status and postoperative adjuvant treatment were collected.There was no significant difference between the two groups(P>0.05).Postoperative pathological section were re-read by an experienced pathologist and to compare the incidence of PVI between the two surgical methods and analyze the related clinicopathologcial factors of PVI.Postoperative follow-up was carried out through outpatient follow-up or telephone follow-up.The follow-up date was up to September 2020,and median follow-up time was 93 months(81-104months).Overall survival(OS)refers to the period from the date of operation to the date of death or the last follow-up.Progression-free survival(PFS)refers to the period from the date of surgery to the date of clinicopathological recurrence or the last follow-up.The postoperative adjuvant treatment and survival of patients with PVI were analysed.SPSS 19.0 software was used for data processing.The measurement data of normal distribution were expressed as mean±standard deviation,and independent sample t test was used.The counting data were expressed by rate,and X~2test or Fisher’s exact test was used.Logistic regression analysis was used for multivariate analysis.Kaplan merier plotted the survival curve.Log rank test was used for univariate comparison of survival.P<0.05 with statistical significance.Results:(1)Of the 183 patients with ⅠA2-IⅠA2 stage cervical cancer,106 cases(57.9%)had LVSI and 33 cases(18.0%)had PVI.The incidence of LVSI in laparoscopic and open groups(61.3%and 55.3%)was no significant difference(P>0.05).(2)The incidence of PVI in laparoscopic group[26.3%(21/80)]was significantly higher than that in open group[11.7%(12/103)],and the difference was statistically significant(P=0.011).(3)Univariate analysis showed that PVI was not correlated with histological type,FIGO stage,tumor size,lymph node metastasis,degree of differentiation,parametrial invasion,stromal invasion and surgical margin(P>0.05),but correlated with LVSI(P=0.00)and surgical method(P=0.011).Multivariate analysis showed that LVSI(P=0.000)and laparoscopic surgery(P=0.005)increased the risk of PVI.(4)Of the33 patients with PVI,30 cases had no recurrence,3 cases recurred respectively at 8,16and 26 months after operation,and 2 cases died respectively at 20 and 30 months after operation.All the 3 patients were in the open group。The 5-year PFS(90.9%)and OS(93.9%)of PVI positive patients were higher than those of PVI negative patients(84.0%,87.3%),but there was no significant difference between them(P>0.05).(5)After re-reading,11 cases with LVSI were confirmed to have PVI,including5 cases with LVSI and PVI,6 cases with PVI alone were misdiagnosed as LVSI,and the rate of incorrect reading was 3.3%(6/183).Among the 6 patients with PVI misjudged as LVSI,4 patients received postoperative adjuvant therapy.Among them,2 patients received adjuvant therapy because of high-risk factors,and the other 2 patients received adjuvant therapy because of more than two medium risk factors(deep interstitial infiltration,tumor>4cm,LVSI).Conclusion:The incidence of PVI in laparoscopic surgery is higher than that in open surgery for early cervical cancer.The misdiagnosis of PVI as LVSI may increase unnecessary adjuvant therapy,However,there is no evidence that PVI has an effect on prognosis at present.