We studied 115 cases of EEC diagnosed on hysterectomy specimens. Double immunohistochemical staining (D2-40/CD31) was performed in all 115 cases to show LVI and BVI on the same slide. MELF pattern invasion was present in 24/115 (21%) cases. MELF-positive tumors had a higher frequency of LVI than MELF-negative tumors (58% and 23%, respectively); the frequency of BVI was twice as high in MELF-positive tumors in comparison to MELF-negative tumors (25% and 12%, respectively). These differences were significant (p˂ 0.0001). All tumors with positive BVI also had a concomitant LVI. The presence of MELF invasion had no impact on overall survival, confirming previous studies. 5-year survival rates were almost equal in cases with negative LVSI and cases with positive isolated LVI (98% vs. 97%). However, in cases where BVI was also present, the 5-year survival rate was significantly lower, 63% (p˂ 0.0001). Furthermore, BVI proved to be an independent prognostic factor for overall survival, disease-free survival, and recurrence in the multivariate analysis. In conclusion, MELF pattern invasion is a good predictor of lymphatic and blood vessel invasion but has no prognostic value. Our results suggest that BVI in EEC has greater clinical value than isolated LVI or myometrial invasion patterns, and the therapeutic approach should be guided by BVI presence. Therefore, we hope this study will promote the routine evaluation of BVI in the context of EEC diagnostic procedures.
本研究对115例子宫切除标本确诊的子宫内膜样腺癌（EEC）病例进行分析。所有病例均采用双重免疫组化染色（D2-40/CD31）技术，在同一张切片上同步显示淋巴管侵犯（LVI）和血管侵犯（BVI）。其中24例（21%）存在微囊性、拉长及碎片化（MELF）型浸润模式。MELF阳性肿瘤的LVI发生率（58%）显著高于MELF阴性肿瘤（23%）；BVI发生率在MELF阳性肿瘤中（25%）是阴性组（12%）的两倍。这些差异具有统计学意义（p˂0.0001）。所有存在BVI的肿瘤均同时伴有LVI。MELF浸润模式对总生存期无影响，此结果与既往研究一致。无淋巴血管间隙浸润（LVSI）病例与单纯LVI阳性病例的5年生存率基本持平（98% vs. 97%）。但当存在BVI时，5年生存率显著降低至63%（p˂0.0001）。多变量分析进一步证实，BVI是总生存期、无病生存期及复发率的独立预后因素。结论表明：MELF浸润模式能有效预测淋巴管和血管侵犯，但无独立预后价值。本研究提示在EEC中，BVI比单纯LVI或肌层浸润模式具有更重要的临床意义，治疗决策应以BVI存在与否为指导。因此，我们建议将BVI评估纳入EEC常规诊断流程。
肿瘤(癌症)患者之家