Prognostic Significance of Lymphatic and Venous Invasions in pT3 Colorectal Carcinoma, Quantified with a Double Staining Combining CD34 Immunostaining and Elastica Staining

Taichi Sato, Eiji Shinto, Yojiro Hashiguchi, Hideki Ueno and Hidetaka Mochizuki

Department of Surgery I, National Defense Medical College

Purpose: We clarified the prognostic significance of lymphatic and venous invasion judged by slides with double staining combining CD34 immunostaining and elastica staining. Methods: Subjects were 125 patients with pT3 colorectal carcinoma who underwent curative surgery between 1989 and 1993. Each representative pathological section including the deepest area of tumor penetration was stained with elastica staining after immunostaining for CD34. Cancer was classified based on the number of lymphatic invasions per section (ly (-), 0; ly (+), 1 or more) and on venous invasions (v (-), 0; v (+), 1 or more). We then looked at the relationship between invasion grade and patient prognosis. Results: Microscopically, we clearly identified lymph vessels with immunostained endothelium and venous vessels with round elastic fibers on slides with double staining. V (+) was strongly associated with lymph node metastasis (p=0.01). Univariate analysis showed that the ly (-) group (5-year survival of 88.9%) and v (-) group (90.0%) showed more favorable survival than the ly (+) group (75.6%, p=0.06) and v (+) group (78.9%, p=0.09). Lymph node metastasis (HR 3.6, p=0.008) was found by multivariate analysis to be independent prognostic factors, but not ly (+) and v (+). Conclusions: To diagnose the grade of vessel invasion objectively, additional staining was useful. Lymphatic and venous invasion were not found to be independent prognostic factors in patients with pT3 colorectal carcinoma.

Key words
colorectal carcinoma, lymphatic invasion, venous invasion, CD34 immunostaining, elastica staining

Reprint requests
Taichi Sato Department of Surgery I, National Defense Medical College
3-2 Namiki, Tokorozawa, 359-0042 JAPAN

Accepted
March 22, 2006

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