Significance of Lymphangiogenesis in Primary Tumor and Draining Lymph Nodes During Lymphatic Metastasis of Pancreatic Head Cancer

Background and Objectives: The aim of this study was to investigate the significance of lymphangiogenesis in primary pancreatic tumors and in draining lymph nodes during lymphatic metastasis of pancreatic head cancers. Methods: Specimens were obtained from 70 patients. To evaluate lymphangiogenesis, we measured lymphatic vessel density (LVD) using D2-40 antibody in the primary tumors and in the draining lymph nodes. AE1/AE3 antibody was used to detect tiny, histologically negative metastases in lymph nodes. Results: Patients with high LVD of primary tumors had significantly higher incidence of node metastasis (P = 0.0006) and lower postoperative survival rate (P = 0.0066) than those with low LVD. Intranodal LVDs increased with increasing size of the intranodal metastases. The LVDs of non-metastatic nodes in patients with node metastasis were also significantly higher than those of non-metastatic nodes in patients without node metastasis (P < 0.0001). The LVDs of peripancreatic nodes in patients with paraaortic node metastases were significantly higher than those in patients without paraaortic metastasis (P < 0.0001). Conclusions: Lymphangiogenesis in primary tumors and draining lymph nodes is essential for efficient spread of tumor cells through the lymphatic system. Thus, inhibition of lymphangiogenesis could limit lymphatic dissemination of tumor cells. J. Surg. Oncol. 2010;102:809-815. (C) 2010 Wiley-Liss, Inc.