Skip to main content
Top
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

High lymphatic vessel density and presence of lymphovascular invasion both predict poor prognosis in breast cancer

Authors: Song Zhang, Dong Zhang, Mingfu Gong, Li Wen, Cuiwei Liao, Liguang Zou

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

Lymphatic vessel density and lymphovascular invasion are commonly assessed to identify the clinicopathological outcomes in breast cancer. However, the prognostic values of them on patients’ survival are still uncertain.

Methods

Databases of PubMed, Embase, and Web of Science were searched from inception up to 30 June 2016. The hazard ratio with its 95% confidence interval was used to determine the prognostic effects of lymphatic vessel density and lymphovascular invasion on disease-free survival and overall survival in breast cancer.

Results

Nineteen studies, involving 4215 participants, were included in this study. With the combination of the results of lymphatic vessel density, the pooled hazard ratios and 95% confidence intervals were 2.02 (1.69–2.40) for disease-free survival and 2.88 (2.07–4.01) for overall survival, respectively. For lymphovascular invasion study, the pooled hazard ratios and 95% confidence intervals were 1.81 (1.57–2.08) for disease-free survival and 1.64 (1.43–1.87) for overall survival, respectively. In addition, 29.56% (827/2798) of participants presented with lymphovascular invasion in total.

Conclusions

Our study demonstrates that lymphatic vessel density and lymphovascular invasion can predict poor prognosis in breast cancer. Standardized assessments of lymphatic vessel density and lymphovascular invasion are needed.
Appendix
Available only for authorised users
Literature
1.
go back to reference Saurel CA, Patel TA, Perez EA. Changes to adjuvant systemic therapy in breast cancer: a decade in review. Clin Breast Cancer. 2010;10(3):196–208.CrossRefPubMed Saurel CA, Patel TA, Perez EA. Changes to adjuvant systemic therapy in breast cancer: a decade in review. Clin Breast Cancer. 2010;10(3):196–208.CrossRefPubMed
2.
go back to reference Colozza M, Azambuja E, Cardoso F, Sotiriou C, Larsimont D, Piccart MJ. Proliferative markers as prognostic and predictive tools in early breast cancer: where are we now? Ann Oncol. 2005;16(11):1723–39.CrossRefPubMed Colozza M, Azambuja E, Cardoso F, Sotiriou C, Larsimont D, Piccart MJ. Proliferative markers as prognostic and predictive tools in early breast cancer: where are we now? Ann Oncol. 2005;16(11):1723–39.CrossRefPubMed
5.
go back to reference Mylona E, Nomikos A, Alexandrou P, Giannopoulou I, Keramopoulos A, Nakopoulou L. Lymphatic and blood vessel morphometry in invasive breast carcinomas: relation with proliferation and VEGF-C and -D proteins expression. Histol Histopathol. 2007;22(8):825–35.PubMed Mylona E, Nomikos A, Alexandrou P, Giannopoulou I, Keramopoulos A, Nakopoulou L. Lymphatic and blood vessel morphometry in invasive breast carcinomas: relation with proliferation and VEGF-C and -D proteins expression. Histol Histopathol. 2007;22(8):825–35.PubMed
6.
go back to reference Nakamura Y, Yasuoka H, Tsujimoto M, Imabun S, Nakahara M, Nakao K, Nakamura M, Mori I, Kakudo K. Lymph vessel density correlates with nodal status, VEGF-C expression, and prognosis in breast cancer. Breast Cancer Res Treat. 2005;91(2):125–32.CrossRefPubMed Nakamura Y, Yasuoka H, Tsujimoto M, Imabun S, Nakahara M, Nakao K, Nakamura M, Mori I, Kakudo K. Lymph vessel density correlates with nodal status, VEGF-C expression, and prognosis in breast cancer. Breast Cancer Res Treat. 2005;91(2):125–32.CrossRefPubMed
7.
go back to reference Zhang Z-Q, Han Y-Z, Nian Q, Chen G, Cui S-Q, Wang X-Y. Tumor invasiveness, not Lymphangiogenesis, is correlated with lymph node metastasis and unfavorable prognosis in young breast cancer patients (<= 35 years). PLoS One. 2015;10(12):e0144376.CrossRefPubMedPubMedCentral Zhang Z-Q, Han Y-Z, Nian Q, Chen G, Cui S-Q, Wang X-Y. Tumor invasiveness, not Lymphangiogenesis, is correlated with lymph node metastasis and unfavorable prognosis in young breast cancer patients (<= 35 years). PLoS One. 2015;10(12):e0144376.CrossRefPubMedPubMedCentral
8.
go back to reference El-Gendi S, Abdel-Hadi M. Lymphatic vessel density as prognostic factor in breast carcinoma: relation to clinicopathologic parameters. J Egypt Natl Canc Inst. 2009;21(2):139–49.PubMed El-Gendi S, Abdel-Hadi M. Lymphatic vessel density as prognostic factor in breast carcinoma: relation to clinicopathologic parameters. J Egypt Natl Canc Inst. 2009;21(2):139–49.PubMed
9.
go back to reference Uzzan B, Nicolas P, Cucherat M, Perret GY. Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis. Cancer Res. 2004;64(9):2941–55.CrossRefPubMed Uzzan B, Nicolas P, Cucherat M, Perret GY. Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis. Cancer Res. 2004;64(9):2941–55.CrossRefPubMed
10.
go back to reference Ji RC. Lymphatic endothelial cells, tumor lymphangiogenesis and metastasis: new insights into intratumoral and peritumoral lymphatics. Cancer Metastasis Rev. 2006;25(4):677–94.CrossRefPubMed Ji RC. Lymphatic endothelial cells, tumor lymphangiogenesis and metastasis: new insights into intratumoral and peritumoral lymphatics. Cancer Metastasis Rev. 2006;25(4):677–94.CrossRefPubMed
11.
go back to reference Jinno H, Sakata M, Asaga S, Wada M, Shimada T, Kitagawa Y, Suzuki T, Nakahara T, Kitamura N, Kubo A, et al. Predictors to assess non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis. Breast J. 2008;14(6):551–5.CrossRefPubMed Jinno H, Sakata M, Asaga S, Wada M, Shimada T, Kitagawa Y, Suzuki T, Nakahara T, Kitamura N, Kubo A, et al. Predictors to assess non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis. Breast J. 2008;14(6):551–5.CrossRefPubMed
12.
go back to reference Nathanson SD, Kwon D, Kapke A, Alford SH, Chitale D. The role of lymph node metastasis in the systemic dissemination of breast cancer. Ann Surg Oncol. 2009;16(12):3396–405.CrossRefPubMed Nathanson SD, Kwon D, Kapke A, Alford SH, Chitale D. The role of lymph node metastasis in the systemic dissemination of breast cancer. Ann Surg Oncol. 2009;16(12):3396–405.CrossRefPubMed
13.
go back to reference Gudlaugsson E, Skaland I, Undersrud E, Janssen EA, Soiland H, Baak JP. D2-40/p63 defined lymph vessel invasion has additional prognostic value in highly proliferating operable node negative breast cancer patients. Mod Pathol. 2011;24(4):502–11.CrossRefPubMed Gudlaugsson E, Skaland I, Undersrud E, Janssen EA, Soiland H, Baak JP. D2-40/p63 defined lymph vessel invasion has additional prognostic value in highly proliferating operable node negative breast cancer patients. Mod Pathol. 2011;24(4):502–11.CrossRefPubMed
14.
go back to reference Mohammed RAA, Menon S, Martin SG, Green AR, Paish EC, Ellis IO. Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker. Mod Pathol. 2014;27(12):1568–77.CrossRefPubMed Mohammed RAA, Menon S, Martin SG, Green AR, Paish EC, Ellis IO. Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker. Mod Pathol. 2014;27(12):1568–77.CrossRefPubMed
15.
go back to reference Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
16.
go back to reference Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.CrossRefPubMedPubMedCentral Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.CrossRefPubMedPubMedCentral
17.
go back to reference Bono P, Wasenius VM, Heikkila P, Lundin J, Jackson DG, Joensuu H. High LYVE-1-positive lymphatic vessel numbers are associated with poor outcome in breast cancer. Clin Cancer Res. 2004;10(21):7144–9.CrossRefPubMed Bono P, Wasenius VM, Heikkila P, Lundin J, Jackson DG, Joensuu H. High LYVE-1-positive lymphatic vessel numbers are associated with poor outcome in breast cancer. Clin Cancer Res. 2004;10(21):7144–9.CrossRefPubMed
18.
go back to reference van der Schaft DW, Pauwels P, Hulsmans S, Zimmermann M, van de Poll-Franse LV, Griffioen AW. Absence of lymphangiogenesis in ductal breast cancer at the primary tumor site. Cancer Lett. 2007;254(1):128–36.CrossRefPubMed van der Schaft DW, Pauwels P, Hulsmans S, Zimmermann M, van de Poll-Franse LV, Griffioen AW. Absence of lymphangiogenesis in ductal breast cancer at the primary tumor site. Cancer Lett. 2007;254(1):128–36.CrossRefPubMed
19.
go back to reference Gu Y, Qi X, Guo S. Lymphangiogenesis induced by VEGF-C and VEGF-D promotes metastasis and a poor outcome in breast carcinoma: a retrospective study of 61 cases. Clin Exp Metastasis. 2008;25(7):717–25.CrossRefPubMed Gu Y, Qi X, Guo S. Lymphangiogenesis induced by VEGF-C and VEGF-D promotes metastasis and a poor outcome in breast carcinoma: a retrospective study of 61 cases. Clin Exp Metastasis. 2008;25(7):717–25.CrossRefPubMed
20.
go back to reference Zhang X-H, Huang D-P, Guo G-L, Chen G-R, Zhang H-X, Wan L, Chen S-Y. Coexpression of VEGF-C and COX-2 and its association with lymphangiogenesis in human breast cancer. BMC Cancer. 2008;8:4.CrossRefPubMedPubMedCentral Zhang X-H, Huang D-P, Guo G-L, Chen G-R, Zhang H-X, Wan L, Chen S-Y. Coexpression of VEGF-C and COX-2 and its association with lymphangiogenesis in human breast cancer. BMC Cancer. 2008;8:4.CrossRefPubMedPubMedCentral
21.
go back to reference Mohammed RA, Ellis IO, Elsheikh S, Paish EC, Martin SG. Lymphatic and angiogenic characteristics in breast cancer: morphometric analysis and prognostic implications. Breast Cancer Res Treat. 2009;113(2):261–73.CrossRefPubMed Mohammed RA, Ellis IO, Elsheikh S, Paish EC, Martin SG. Lymphatic and angiogenic characteristics in breast cancer: morphometric analysis and prognostic implications. Breast Cancer Res Treat. 2009;113(2):261–73.CrossRefPubMed
22.
go back to reference Tsutsui S, Matsuyama A, Yamamoto M, Takeuchi H, Oshiro Y, Ishida T, Maehara Y. The Akt expression correlates with the VEGF-A and -C expression as well as the microvessel and lymphatic vessel density in breast cancer. Oncol Rep. 2010;23(3):621–30.CrossRefPubMed Tsutsui S, Matsuyama A, Yamamoto M, Takeuchi H, Oshiro Y, Ishida T, Maehara Y. The Akt expression correlates with the VEGF-A and -C expression as well as the microvessel and lymphatic vessel density in breast cancer. Oncol Rep. 2010;23(3):621–30.CrossRefPubMed
23.
go back to reference Zhao YC, Ni XJ, Li Y, Dai M, Yuan ZX, Zhu YY, Luo CY. Peritumoral lymphangiogenesis induced by vascular endothelial growth factor C and D promotes lymph node metastasis in breast cancer patients. World J Surg Oncol. 2012;10:165.CrossRefPubMedPubMedCentral Zhao YC, Ni XJ, Li Y, Dai M, Yuan ZX, Zhu YY, Luo CY. Peritumoral lymphangiogenesis induced by vascular endothelial growth factor C and D promotes lymph node metastasis in breast cancer patients. World J Surg Oncol. 2012;10:165.CrossRefPubMedPubMedCentral
24.
go back to reference Abe N, Ohtake T, Saito K, Kumamoto K, Sugino T, Takenoshita S. Clinicopathological significance of lymphangiogenesis detected byimmunohistochemistry using D2-40 monoclonalantibody in breast cancer. Fukushima J Med Sci. 2016;62(1):1–7.CrossRef Abe N, Ohtake T, Saito K, Kumamoto K, Sugino T, Takenoshita S. Clinicopathological significance of lymphangiogenesis detected byimmunohistochemistry using D2-40 monoclonalantibody in breast cancer. Fukushima J Med Sci. 2016;62(1):1–7.CrossRef
25.
go back to reference Schoppmann SF, Bayer G, Aumayr K, Taucher S, Geleff S, Rudas M, Kubista E, Hausmaninger H, Samonigg H, Gnant M, et al. Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg. 2004;240(2):306–12.CrossRefPubMedPubMedCentral Schoppmann SF, Bayer G, Aumayr K, Taucher S, Geleff S, Rudas M, Kubista E, Hausmaninger H, Samonigg H, Gnant M, et al. Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg. 2004;240(2):306–12.CrossRefPubMedPubMedCentral
26.
go back to reference Arnaout-Alkarain A, Kahn HJ, Narod SA, Sun PA, Marks AN. Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer. Mod Pathol. 2007;20(2):183–91.CrossRefPubMed Arnaout-Alkarain A, Kahn HJ, Narod SA, Sun PA, Marks AN. Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer. Mod Pathol. 2007;20(2):183–91.CrossRefPubMed
27.
go back to reference Ito M, Moriya T, Ishida T, Usami S, Kasajima A, Sasano H, Ohuchi N. Significance of pathological evaluation for lymphatic vessel invasion in invasive breast cancer. Breast Cancer (Tokyo, Japan). 2007;14(4):381–7.CrossRef Ito M, Moriya T, Ishida T, Usami S, Kasajima A, Sasano H, Ohuchi N. Significance of pathological evaluation for lymphatic vessel invasion in invasive breast cancer. Breast Cancer (Tokyo, Japan). 2007;14(4):381–7.CrossRef
28.
go back to reference Tezuka K, Onoda N, Takashima T, Takagaki K, Ishikawa T, Wakasa T, Wakasa K, Hirakawa K. Prognostic significance of lymphovascular invasion diagnosed by lymphatic endothelium immunostaining in breast cancer patients. Oncol Rep. 2007;17(5):997–1003.PubMed Tezuka K, Onoda N, Takashima T, Takagaki K, Ishikawa T, Wakasa T, Wakasa K, Hirakawa K. Prognostic significance of lymphovascular invasion diagnosed by lymphatic endothelium immunostaining in breast cancer patients. Oncol Rep. 2007;17(5):997–1003.PubMed
29.
go back to reference Yamauchi C, Hasebe T, Iwasaki M, Imoto S, Wada N, Fukayama M, Ochiai A. Accurate assessment of lymph vessel tumor emboli in invasive ductal carcinoma of the breast according to tumor areas, and their prognostic significance. Hum Pathol. 2007;38(2):247–59.CrossRefPubMed Yamauchi C, Hasebe T, Iwasaki M, Imoto S, Wada N, Fukayama M, Ochiai A. Accurate assessment of lymph vessel tumor emboli in invasive ductal carcinoma of the breast according to tumor areas, and their prognostic significance. Hum Pathol. 2007;38(2):247–59.CrossRefPubMed
30.
go back to reference El-Gohary YM, Metwally G, Saad RS, Robinson MJ, Mesko T, Poppiti RJ. Prognostic significance of intratumoral and peritumoral lymphatic density and blood vessel density in invasive breast carcinomas. Am J Clin Pathol. 2008;129(4):578–86.CrossRefPubMed El-Gohary YM, Metwally G, Saad RS, Robinson MJ, Mesko T, Poppiti RJ. Prognostic significance of intratumoral and peritumoral lymphatic density and blood vessel density in invasive breast carcinomas. Am J Clin Pathol. 2008;129(4):578–86.CrossRefPubMed
31.
go back to reference Mohammed RAA, Martin SG, Mahmmod AM, Macmillan RD, Green AR, Paish EC, Ellis IO. Objective assessment of lymphatic and blood vascular invasion in lymph node-negative breast carcinoma: findings from a large case series with long-term follow-up. J Pathol. 2011;223(3):358–65.CrossRefPubMed Mohammed RAA, Martin SG, Mahmmod AM, Macmillan RD, Green AR, Paish EC, Ellis IO. Objective assessment of lymphatic and blood vascular invasion in lymph node-negative breast carcinoma: findings from a large case series with long-term follow-up. J Pathol. 2011;223(3):358–65.CrossRefPubMed
32.
go back to reference Kato T, Kameoka S, Kimura T, Nishikawa T, Kobayashi M. The combination of angiogenesis and blood vessel invasion as a prognostic indicator in primary breast cancer. Br J Cancer. 2003;88(12):1900–8.CrossRefPubMedPubMedCentral Kato T, Kameoka S, Kimura T, Nishikawa T, Kobayashi M. The combination of angiogenesis and blood vessel invasion as a prognostic indicator in primary breast cancer. Br J Cancer. 2003;88(12):1900–8.CrossRefPubMedPubMedCentral
33.
go back to reference Vermeulen PB, van Golen KL, Dirix LY. Angiogenesis, lymphangiogenesis, growth pattern, and tumor emboli in inflammatory breast cancer: a review of the current knowledge. Cancer. 2010;116(11 Suppl):2748–54.CrossRefPubMed Vermeulen PB, van Golen KL, Dirix LY. Angiogenesis, lymphangiogenesis, growth pattern, and tumor emboli in inflammatory breast cancer: a review of the current knowledge. Cancer. 2010;116(11 Suppl):2748–54.CrossRefPubMed
34.
go back to reference Tammela T, Alitalo K. Lymphangiogenesis: molecular mechanisms and future promise. Cell. 2010;140(4):460–76.CrossRefPubMed Tammela T, Alitalo K. Lymphangiogenesis: molecular mechanisms and future promise. Cell. 2010;140(4):460–76.CrossRefPubMed
35.
go back to reference Kojima M, Shimazaki H, Iwaya K, Kage M, Akiba J, Ohkura Y, Horiguchi S, Shomori K, Kushima R, Ajioka Y. Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer: a framework for developing an objective pathological diagnostic system using the Delphi method, from the pathology working Group of the Japanese Society for cancer of the Colon and Rectum. J Clin Pathol. 2013;66(7):551–8.CrossRefPubMedPubMedCentral Kojima M, Shimazaki H, Iwaya K, Kage M, Akiba J, Ohkura Y, Horiguchi S, Shomori K, Kushima R, Ajioka Y. Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer: a framework for developing an objective pathological diagnostic system using the Delphi method, from the pathology working Group of the Japanese Society for cancer of the Colon and Rectum. J Clin Pathol. 2013;66(7):551–8.CrossRefPubMedPubMedCentral
36.
go back to reference Gujam FJ, Going JJ, Edwards J, Mohammed ZM, McMillan DC. The role of lymphatic and blood vessel invasion in predicting survival and methods of detection in patients with primary operable breast cancer. Crit Rev Oncol Hematol. 2014;89(2):231–41.CrossRefPubMed Gujam FJ, Going JJ, Edwards J, Mohammed ZM, McMillan DC. The role of lymphatic and blood vessel invasion in predicting survival and methods of detection in patients with primary operable breast cancer. Crit Rev Oncol Hematol. 2014;89(2):231–41.CrossRefPubMed
Metadata
Title
High lymphatic vessel density and presence of lymphovascular invasion both predict poor prognosis in breast cancer
Authors
Song Zhang
Dong Zhang
Mingfu Gong
Li Wen
Cuiwei Liao
Liguang Zou
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3338-x

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine