THE CLINICAL RELEVANCE OF LYMPHATIC AND BLOOD-VESSEL INVASION IN BREAST-CANCER PATIENTS

We reviewed 795 patients treated between 1978 and 1988 at the Department of Radiation Oncology of the University of Wuerzburg to study the influence of lymphatic vessel (LVI), blood vessel (BVI) invasion within the primary tumor on distant recurrence and survival following mastectomy or conservative treatment. Among them there were 140 patients with LVI and 18 patients with BVI. In the LVI positive group 75% of patients had axillary lymph nodes involved. In the BVI positive group 94% were nodal positive. The mean number of involved axillary nodes was higher in the group with LVI (4.6) as well as in the group with BVI (9.6) in comparison to the groups with absence of LVI (1.2) or BVI (1.7). LVI and BVI have a distinct impact on survival (P<0.001, P<0.01 respectively) and metastatic-free interval (P<0.001, P<0.01 respectively). The 2- and 5-year survival rates were 78% and 42% for the LVI group compared to 89% and 71% respectively for the LVI negative group. The corresponding 2- and 4.5-year survival rates for the BVI positive group were 68% and 40% compared to 87% and 70% respectively for the BVI negative group. The 5-year metastatic-free rate was 50% in the LVI group compared to 68% in the group without LVI. In the BVI group 53% were free of distant disease at 5 years compared to 66% in the group without BVI. This study suggests that from the biological point of view, LVI and BVI is a sign of agressive disease with poor prognosis. Patients with intra- or peritumoral LVI or BVI represent high risk groups for distant recurrence.