Background: There is controversy over the question of whether the involvement of vascular spaces influences the prognosis of patients with carcinoma of the uterine cervix. The aim of the current study was to compare patterns of vascular space involvement determined by hematoxylin and eosin (H & E) staining with those patterns determined by immunostaining for factor VIII-related antigen (F8-RA) with regard to their prognostic impact on the disease free survival (DFS) and overall survival (OS) of patients with clinical Stage IB cervical carcinoma. Staining for F8-RA is known to highlight blood vessels predominantly, whereas the presence of tumor cell emboli in vascular spaces of H & E-stained sections mainly indicates lymphatic vessel invasion.
Methods: The authors analyzed data on 163 patients for whom vascular space involvement (VSI) was determined by H & E (VSI/H & E) and F8-RA (VSI/F8) staining from the same block in two separate runs.
Results: The median follow-up period was 85 months (range, 5-170 months). The 25% quantile for OS was 109 months (median not reached; range, 5-170 months). The overall rates of VSI/H & E and VSI/F8 were 29.4% and 24.5%, respectively. The findings obtained by H & E and F8-RA staining were concurrent in 60.7% of cases. Lymph node involvement and VSI/F8 remained independent prognostic factors for DFS and OS. Due to a highly significant correlation of pelvic lymph node status with both VSI/H & E and tumor size, the last two parameters failed to retain a significant value. For lymph node negative patients, the estimated OS probability was 92% for those without VSI/F8 and 62% for those with VSI/F8.
Conclusions: VSI/F8 may provide additional information on the outcome of clinical Stage IB cervical carcinoma. Lymph node negative patients with VSI/F8 positive tumors may benefit from more intense postsurgical treatment. Further trials involving larger series of patients are necessary to confirm these findings.