Peritumoral Lymphatic Microvessel Density Associated with Tumor Progression and Poor Prognosis in Gastric Carcinoma

Background. Lymphangiogenesis and angiogenesis are critical processes for tumor growth, invasion, and metastasis, and are crucial for therapeutic strategies. The aim of the present study was to evaluate the clinical significance of lymphangiogenesis and its regulation in gastric carcinomas. Methods. The lymphatic vessel density (LVD) in 65 gastric carcinoma cases was investigated by immunohistochemistry using D2-40 antibody, and evaluated with prognostic parameters. The intratumoral micro-vessel density (MVD), using CD31 antibody, was assessed and correlated with LVD. Results. D2-40 identified peritumoral lymphatics in all cases, and lymphatic vessel density (LVD) ranged from 3 to 19 (median, 5; mean +/- SD, 7.69 +/- 4.67). The peritumoral L'VD significantly correlated with large tumor size (P = 0.0001), lymph node metastasis (P = 0.004), visceral organ metastasis (P = 0.0001), and TNM stage (P = 0.001). Survival was also significantly lower in patients with high LVD tumors than in patients with low LVD tumors (P = 0.04). Among various clinicopathologic characteristics, CD31 expression was associated only with lymph node metastasis (P = 0.001). However, there was no significant correlation between CD31 and D2-40. Conclusion. Our study showed that lymphangiogenesis plays an important role in the progression of gastric carcinoma. Therefore, D2-40, as an indicator for tumor lymphangiogenesis, may serve as a prognostic marker in gastric carcinoma. (C) 2010 Elsevier Inc. All rights reserved.