Increased Intratumoral Lymphatic Vessel Density Correlates with Lymph Node Metastasis in Early Gastric Carcinoma

Abstract

Prediction of lymph node metastasis in early gastric carcinoma (EGC) is important for management and follow-up of EGC patients. Increased lymphangiogenesis has been suggested to correlate with lymphatic invasion and lymph node metastasis in various tumors. Lymphatic vessel density (LVD) and microvessel density (MVD) of 141 EGCs were determined by double immunohistochemical staining for D2-40 and CD31. The mean values of three to five hotspots were calculated in intratumoral and peritumoral areas in digital images. The mean value of intratumoral LVD in a lymph-node-positive EGC group was 28.24/field, which was significantly higher than in a lymph-node-negative EGC group (19.43/field, P = 0.005). Peritumoral LVD, intratumoral MVD, and peritumoral MVD did not correlate with lymph node metastasis in EGCs (P > 0.05). Intratumoral LVD did not show significant differences according to lymphatic invasion and differentiation, which were positive predictors for lymph node metastasis in EGC. Using multivariate logistic regression, intratumoral LVD was an independent factor, with the above two factors and depth of invasion, for the prediction of lymph node metastasis in EGC with a relative risk of 3.570 in high-intratumoral-LVD group compared with low-intratumoral-LVD group (P = 0.022). Intratumoral LVD may be a useful, independent predictor for lymph node metastasis, especially in combination with previously established predictors in EGC.