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Intratumoral Lymphatic Vessel Density and Clinicopathologic Features of Patients With Early-Stage Cervical Cancer After Radical Hysterectomy
  1. Fabricia L. Zaganelli, MD*,
  2. Filomena M. Carvalho, MD,
  3. Bernardo G.L. Almeida, MD,
  4. Carlos E. Bacchi, MD, PhD,
  5. Joao Carlos Sampaio Goes, MD, PhD§,
  6. Marcelo Alvarenga Calil, MD, PhD§,
  7. Edmund C. Baracat, MD, PhD* and
  8. Jesus P. Carvalho, MD, PhD*
  1. *Departments of Obstetrics and Gynecology, and
  2. Departments of Pathology, Faculdade de Medicina da Universidade de SãDepartments of o Paulo;
  3. Departments of Consultoria em Patologia, Botucatu; and
  4. §Departments of Instituto Brasileiro de Controle do Cancer, SãDepartments of o Paulo (SP), Brazil.
  1. Address correspondence and reprint requests to Jesus P. Carvalho, MD, PhD, Rua Barata Ribeiro 414 cj.93, São Paulo (SP) 01380-000, Brazil. E-mail: carvalhojp{at}


Introduction: Lymphangiogenesis plays a key role in tumor growth, progression, and metastasis, yet few studies have investigated lymphatic vessel density (LVD) in cases of cervical cancer. The aim of this retrospective study was to evaluate intratumoral LVD, in addition to other histologic variables, in relation to lymph node metastases and survival of patients with stage IB to IIA cervical cancer after radical hysterectomy.

Methods: Between 2000 and 2008, 144 patients had a diagnosis of cervical uterine cancer and underwent radical hysterectomy. Tumor stages for these patients were identified according to the criteria of the International Federation of Gynecology and Obstetrics and included 84 stage IB1, 44 stage IB2, and 16 stage IIA cases. With an antibody directed against human podoplanin (D2-40), immunohistochemical staining was used to measure LVD. The correlation between LVD and clinicopathologic features of the resected tumors was analyzed.

Results: Lymphatic vessel density was significantly higher in tumors less than 2 cm in diameter (P = 0.001) and in tumors with 1.0-cm-or-less depth of invasion (P = 0.007), with early stage (P = 0.001), and with negative lymph nodes (P = 0.05). After multivariate analysis, the predictive factors associated with lymph node metastases were depth of infiltration (P = 0.027), lymphovascular space invasion (P < 0.001), and parametrial involvement (P = 0.01). For patient death, the predictive factors were International Federation of Gynecology and Obstetrics stage (P = 0.017), histologic type (P = 0.010), lymph node status (P = 0.031), and histologic grade (P = 0.041). Lymphatic vessel density was not a predictive variable for lymph node metastasis or death.

Conclusions: Intratumoral LVD was greater in early cervical cancer (ie, smaller tumors, early clinical stage, and negative lymph nodes), and no relationship between LVD and lymph node metastases or survival was observed.

  • Uterine cervical cancer
  • Radical hysterectomy
  • Lymphatic vessel density
  • Podoplanin
  • Lymph node metastases

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  • This work was supported by grants from the Centro de Estudos do Instituto Brasileiro de Controle do Cancer, São Paulo, Brazil.