PURPOSE: To separately evaluate the lymphatic and blood vascular system in order to assess the diagnostic accuracy of microvascular invasion (MVI) and to identify predictive markers for occult metastasis in testicular non seminomatous germ cell tumors (NSGCT).
MATERIALS AND METHODS: Tissue samples of 86 patients treated for NSGCT (stage1: n=48; stage>1: n=38) were stained using the lymphatic endothelial cell (LEC) specific marker LYVE-1 and the blood vessel endothelial cell marker Von Willebrand factor (vWF). Lymphatic (LVD-LYVE-1) and blood vessel density (BVD-vWF) were assessed. The presence of lymphatic (LVI-LYVE-1) and blood vascular invasion (BVI-vWF) was documented. The parameters were correlated with standard clinicopathological data.
RESULTS: BVD-vWF was significantly higher than LVD-LYVE-1 (p< 0.001). Peri- and nontumoral LVD-LYVE-1 were associated with the presence of metastasis at the time of diagnosis (p=0.020,OR:1.277 per unit;p=0.095,OR:1.113 per unit). LVI-LYVE-1 was significantly associated with the presence of metastasis (p=0.002;OR=4.517), whereas BVI-vWF was only slightly significant (p=0.071,OR:2.261). Only LVI-LYVE-1 was significantly associated with the presence of metastasis in a multiple logistic regression model. MVI-HE was not associated with metastasis, whereas MVI evaluated in LYVE-1 and vWF stained sections (MVI-IHC) was (p=0.016; OR:3.506).
CONCLUSIONS: LVI-LYVE-1 was the most important predictive parameter for the presence of metastasis at the time of diagnosis, suggesting a higher relevance of the lymphatic system in the metastatic dissemination of NSGCT. The use of vascular endothelial cell (VEC) specific markers provides higher diagnostic accuracy in terms of MVI. Our results may impact the current concept of MVI used for risk stratification of clinical stage 1 NSGCT.
Written by:
Heinzelbecker J, Gross-Weege M, Weiss C, Hörner C, Trunk MJ, Erben P, Haecker A, Bolenz C. Are you the author?
Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Institute of Medical Statistics and Biometry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Institute of Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Reference: J Urol. 2014 Mar 11. pii: S0022-5347(14)02913-9.
doi: 10.1016/j.juro.2014.02.2569
PubMed Abstract
PMID: 24631105
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