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PubMed2003

Sclerosing hemangioma with lymph node metastasis.

Sclerosing hemangioma (SH) of the lung is an uncommon type of tumor, which is composed of polygonal and cuboidal cells. This disease is generally regarded as benign but extremely rare cases with lymph node metastasis have been reported. We report a case of SH with a metastasis to the regional lymph nodes. A 19-year-old girl presented with a 2-year history of coughing. A chest X-ray and a CT scan indicated a large mass in the lower lobe. As a result, a left lower lobectomy with a dissection of the hilar and interlobar lymph nodes was performed. The tumor was a well-defined huge mass with partial adhesion to the mediastinal and parietal pleura. The dissected hilar, interlobar, and intrapulmonary lymph nodes demonstrated metastasis. Histologically, the primary and metastatic tumor consisted of polygonal and cuboidal cells. Both types of tumor cells were uniformly immunoreactive to the epithelial membrane antigen (EMA) and the thyroid transcription factor-1 (TTF-1). However, the cuboidal cells tested positive for pancytokeratin, whereas the polygonal cells tested consistently negative. Postoperatively, the patient received chemotherapy and no recurrence or metastasis 2 years after surgery was noted. Although a pulmonary SH is considered to be benign, this case highlights the need for the evaluation of lymph node metastasis.

Adult↗

PubMed2003

Correlation between vascular endothelial growth factor C expression and lymph node metastasis in T1 carcinoma of the colon and rectum.

PURPOSE: Vascular endothelial growth factor C (VEGF-C) is known to be associated with the development of the lymphatic vessel system. Recently, VEGF-C is thought to be correlated with lymph node metastasis in some malignant tumors. In this study, we investigated the correlation between VEGF-C expression and lymph node metastasis in early carcinoma of the colon and rectum. METHODS: Two hundred and twenty-one endoscopically biopsied specimens from patients with T1 colorectal carcinoma prior to operation were investigated by an immunohistochemical study. RESULTS: VEGF-C expression was more frequently observed in the tumors with nodal metastasis than in those without metastasis. Moreover, a multivariate analysis indicated that VEGF-C expression is an independent predictor of lymph node metastasis. CONCLUSION: VEGF-C staining using endoscopically biopsied specimens prior to operation could be of use in the prediction of lymph node metastasis and in preoperative selection of treatment in patients with T1 colorectal carcinoma.

Adult↗

PubMed2006

Axillary lymph node metastasis in recurrence of papillary thyroid carcinoma: a case report.

Papillary thyroid cancer usually metastasizes to regional lymph nodes and to distant sites such as lungs and bones. We report a case of axillary lymph node metastasis as a result of recurrence of papillary carcinoma in a 62-year-old woman with papillary thyroid cancer extending locally beyond the thyroid capsule. Six years after initial surgical treatment, a lymph node metastasis in the left axillary region was diagnosed with positron tomography. To our knowledge, only one previous case of confirmed axillary metastasis of thyroid cancer has ever been reported. These two cases provide some evidence that thyroid carcinoma may exceptionally spread to axillary lymph nodes. Hypotheses that may account for such unusual localization include hematogenous dissemination or retrograde dissemination to regional lymphatic channels. Thus, when recurrence of thyroid carcinoma is considered, careful clinical examination of the axilla is recommended. Furthermore, thyroid carcinoma must be considered in the differential diagnosis of an axillary mass, especially when breast cancer is ruled out.

Axilla↗

PubMed1998

[Cervical lymph node metastasis: CT, ultrasound versus physical palpation].

OBJECTIVE: To evaluate the accuracy of CT, ultrasonography and manual palpation in the diagnosis of cervical lymph node metastasis and to identify the value of CT and ultrasound in the diagnosis of occult cervical lymph node metastasis. METHODS: Sixty patients (74 sides) were studied double-blindedly by CT and ultrasonography prior to cervical lymphadenectomy, and the results were correlated with histo-pathologic findings. RESULTS: According to histologic examination of the dissected specimens, in 56 of 74 sides there were cervical lymph node metastases, 46 of the 56 sides with metastatic nodes were diagnosed by manual palpation(sensitivity, 82.1%; specificity, 83.3%; accuracy, 82.4%). However, lymphnode metastases in 53 sides were revealed by CT(sensitivity, 94.6%; specificity, 94.4%; accuracy, 94.6%), i.e., CT discovered 70% of the occult metastatic nodes in this series. Lymph node metastases were diagnosed accurately in 51 sides by ultrasonography (sensitivity, 91.1%; specificity, 94.4%; accuracy, 91.9%), and 50% of the occult metastatic nodes were found by ultrasound. CONCLUSION: CT, ultrasound examinations are superior to physical palpation in ascertaining cervical lymph node metastasis, as 50%-70% of the occult cervical metastatic nodes can be diagnosed.

Adolescent↗

PubMedDate not supplied

Clinicopathological features of lymph node metastasis in early gastric cancer.

From 1979 through 1992, 482 cases with solitary early gastric cancer were resected in the Department of Surgery of the National Kyushu Medical Center Hospital. Among the 482 cases, the incidence of lymph node metastasis was 10.0% (48/482). The features of lymph node metastasis were studied while taking into account the combination of clinicopathological findings of the gastric cancer. Lymph node metastasis was rare in both the differentiated type mucosal cancers and submucosal cancers measuring 20 mm or smaller in size without depression. From these results, for early gastric cancer with the above-mentioned characteristics, either endoscopic therapy or local resection without lymph node dissection is considered to be sufficient treatment to obtain a favorable outcome.

Adult↗

PubMed2003

Comparison of fuzzy inference, logistic regression, and classification trees (CART). Prediction of cervical lymph node metastasis in carcinoma of the tongue.

OBJECTIVES: In this paper three statistical methods [logistic regression, classification and regression tree (CART), and fuzzy inference] for the prediction of lymph node metastasis in carcinoma of the tongue are compared. METHODS: A retrospective collection of data in 75 patients treated for tongue cancer was carried out at the Clinic and Policlinic for Oral and Maxillo-facial Surgery at the University Hospital of Freiburg in Germany between January 1990 and December 1999; biopsy material was used for laboratory evaluations. Statistical methods for the prediction of lymph node metastasis were compared using ROC curves and accuracy rates. RESULTS: All three methods show similar results for the prediction of lymph node metastasis with slightly superior results for fuzzy inference and CART. A great overlap is apparent in the ROC curves. The best result observed for fuzzy inference and CART was a sensitivity of 79.2% [95% confidence interval: (57.8%; 92.9%)] and a specificity of 86.3% (73.7%; 94.3%); the best result for predictions based on the logistic regression was a sensitivity of 66.7% (44.7%; 84.4%) and a specificity of 80.4% (66.9%; 90.2%). Accuracy rates of fuzzy method and CART were higher [accuracy rate for fuzzy method and CART: 84% (73.7%; 91.4%), for logistic regression method: 73.3%, 95%-CI: (61.9%; 82.9%)]. CONCLUSIONS: From a clinical point of view, the predictive ability of the three methods is not sufficiently large to justify use of these methods in daily practice. Other factors probably on the molecular level are needed for the prediction of lymph node metastasis.

Decision Support Techniques↗

PubMedDate not supplied

Topographical distribution of lymph node metastasis in adenocarcinoma of the gastroesophageal junction.

BACKGROUND/AIMS: The current discussion concerning the extent of resection in patients with adenocarcinoma of the gastroesophageal junction is focused beside the luminal extent of resection primarily on the value of lymphadenectomy. METHODOLOGY: In order to clarify whether spread of lymph node metastasis shows different pathways in adenocarcinomas of the gastroesophageal junction, a prospective, morphological study of the topographical distribution of lymph node metastasis was performed. Transthoracic en bloc esophagectomy with two-field lymphadenectomy (n = 13) or transhiatal esophagectomy with lymphadenectomy of the lower mediastinum and compartment I (lymph node No. 1-3) as well as II (n = 4) was performed in type I carcinoma and transhiatally extended gastrectomy with D2-lymphadenectomy and lymphadenectomy of the lower mediastinum in type II and III carcinoma (n = 33). RESULTS: In 50 specimens, 1730 lymph nodes were evaluated with regard to metastatic infiltration. We found metastases in the lymph nodes of the lower mediastinum in 24% of type I carcinoma, in 11% of type II carcinoma and in 13% of type III carcinoma, whereas the lymph nodes of the upper mediastinum were tumor free in all patients with transthoracic en bloc resection and 2-field lymphadenectomy (n = 13). In all cases with lymph node metastasis abdominal lymph nodes were affected independently from the localization of the primary tumor. CONCLUSIONS: The main direction of lymph node spread in adenocarcinoma of the gastroesophageal junction is towards the abdomen and the lower mediastinum. For precise tumor staging standardized lymphadenectomy of the lower mediastinum and the abdominal compartments I and II is essential.

Adenocarcinoma↗

PubMed2006

Prediction of lymph node metastasis in patients with endometrioid endometrial cancer using expression microarray.

PURPOSE: To characterize the gene expression profiles of endometrioid endometrial cancers associated with lymph node metastasis in an effort to identify genes associated with metastatic spread. EXPERIMENTAL DESIGN: Tumors from 41 patients with endometrioid endometrial cancer grossly confined to the uterine cavity were evaluated. Positive lymph nodes were noted in 12 of 41 patients. RNA was analyzed for gene expression using the Affymetrix HG133A and HG133B GeneChip set, representing 45,000 array features covering >28,000 UniGene clusters. Data analysis was done using multidimensional scaling, binary comparison, and hierarchical clustering. Gene expression for several differentially expressed genes was examined using quantitative PCR. RESULTS: Gene expression data was obtained from 30,964 genes that were detected in at least 5% of the cases. Supervised analysis of node-positive versus node-negative cases indicated that 450 genes were significantly differentially expressed between the two classes at P < 0.005, 81 of which were differentially expressed by at least 2-fold at P < 0.005. Overexpressed genes included two cell cycle checkpoint genes, CDC2 and MAD2L1, which have previously been described in association with lymph node metastasis in other cancer types. The ZIC2 zinc finger gene was overexpressed in endometrial cancers with positive nodes versus those with negative nodes. CONCLUSION: Gene expression profiling of the primary tumors in patients with endometrioid endometrial cancers seems promising for identifying genes associated with lymph node metastasis. Future studies should address whether the status of nodal metastasis can be determined from the expression profiles of preoperative tissue specimens.

Carcinoma, Endometrioid↗

PubMed2003

[Clinical efficacy analysis of chemotherapy to lymph node metastasis in epithelial ovarian cancer].

BACKGROUND & OBJECTIVE: Epithelial ovarian cancer is moderate sensitivity to chemotherapy; the survival has been improved by aggressive cytoreductive surgery followed by combination chemotherapy with cisplatin-based regimen.However,there is a controversy about chemotherapeutic sensitivity of its lymph node metastasis. This study was designed to evaluate chemotherapeutic sensitivity and prognosis of lymph node metastases in epithelial ovarian cancer. METHODS: The authors retrospectively analyzed 50 cases of epithelial ovarian cancer with lymph node metastases in Cancer Hospital,Chinese Academy of Medical Sciences, Peking Union Medical College from June 1986 to February 2001, which included 32 cases with stage III-IV, and 18 with recurrent disease. All the 50 patients were with valuable metastatic lymph nodes,and among these patients 38 were also with valuable abdominal-pelvic tumor. Forty-six patients received 1-3 courses of neoadjuvant chemotherapy,cytoreductive surgery, and postoperative chemotherapy. The response rate was evaluated by the response criteria for solid tumor. The chemotherapy included neoadjuvant chemotherapy, and chemotherapy for patients with residual tumor after operation or recurrence. Forty-five patients received platinum-based chemotherapy regimens [including CP (cyclophosphamide+cisplatin), CAP (cyclophosphamide+epirubicin+cisplatin), TC (paclitaxel+carboplatin), TP (paclitaxel+cisplatin), cisplatin+mitomycin+vincristine+etoposide+carboplatin, gemcitabine+carboplatin,IEP(ifosphamide+etoposide+cisplatin regimens) and 1 patient received melphalan, 1 patient with CF(cyclophosphamide+5-fluorouracil)regimen, 3 patients with ifosphamide+etoposide. RESULTS: The overall response rates of lymph node metastasis and abdominal-pelvic tumor were 68.0% and 71.1%, respectively (P >0.05). The response rates of lymph node metastasis and abdominal-pelvic tumor for stage III-IV were 78.1% and 76.7%, respectively (P >0.05); both were 50% for recurrent patients with epithelial ovarian cancer. CONCLUSION: Either in stage III-IV or in recurrent patients with epithelial ovarian cancer, chemotherapeutic sensitivity of lymph node metastasis was similar to that of abdominal and pelvic tumor. The prognosis was related to the optimality of cytoreductive surgery, and the intensity of chemotherapy.

Adult↗

PubMedDate not supplied

First drainage lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patients with pN-1 stage tumors.

BACKGROUND: We attempted to identify the first lymph node(s) involved in metastasis of gastric cancer by studying the topographical pattern of metastasis to regional lymph nodes in patients with pN-1 stage tumors. MATERIALS AND METHODS: A total of 190 patients (108 males and 82 females; age range, 27 to 83 years; mean, 59.7 years), who had undergone curative resection combined with lymphadenectomy for solitary carcinoma of the stomach and were histologically diagnosed as having pN-1 stage tumors, were enrolled in the present study. The topographical patterns of metastasis to regional lymph nodes were reviewed from the pathology records of these patients. RESULTS: A total of 7561 lymph nodes (mean, 39.8/patient; range 15-99/patient) were dissected and metastasis was histologically observed in 523 nodes (6.9%, mean, 2.7/patient). Although perigastric lymph nodes were a common site of metastasis, the distribution of positive nodes depended on tumor location. As the number of positive nodes increased, a more diffuse pattern of regional involvement was noted. Skip metastasis was identified in 10 (5%) out of 190 patients. This unusual pattern of metastasis was found in 9 (14%) out of 63 patients with single positive nodes, while only one (1%) out of 127 patients with 2-6 positive nodes exhibited this pattern of metastasis. The difference between the two groups was statistically significant (p < 0.0001). CONCLUSION: Although perigastric lymph nodes are important first sites of drainage from pN-1 stage gastric tumors, the pattern of lymph node metastasis varies widely within a regional area even in pN-1 stage patients.

Adult↗

PubMed2006

Contralateral cervical and mediastinal lymph node metastasis in medullary thyroid cancer: systemic disease?

BACKGROUND: The current American Joint Committee on Cancer/International Union Against Cancer classification designates cervical and mediastinal lymph nodes as regional lymph nodes. In a unilateral thyroid neoplasm, however, involvement of the contralateral cervical lymph node compartment or the mediastinal lymph node compartment, both of which have been designated "distant" lymph nodes, may serve as a surrogate parameter of distant metastases. METHODS: This institutional series consisted of 105 consecutive patients with medullary thyroid cancer who underwent systematic dissections of both distant lymph node compartments. RESULTS: Thirty-eight patients had no distant lymph node metastasis, 36 patients had involvement of only 1, and 31 patients of both distant lymph node compartments. Significant associations (P < .001) were seen on univariate analysis between the number of involved "distant" lymph node compartments (none, one, or both) and extrathyroidal extension (3%, 33%, and 58%), the number of positive lymph nodes (means of 3, 13, and 33), and distant metastasis (8%, 36%, and 61%). In a multivariate logistic regression model, only involvement of one or both "distant" lymph node compartments (versus no distant lymph node metastasis) remained significantly related to distant metastasis in a dose-dependent fashion. CONCLUSIONS: "Distant" lymph nodes in medullary thyroid cancer should be regarded as nonregional lymph nodes because their involvement is indicative of distant metastasis.

Female↗

PubMed1999

99mTc-MIBI single-photon emission-computed tomography in diagnosis of lung cancer and mediastinal metastasis lymph nodes.

AIM: To evaluate the value of technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) single-photon emission-computed tomography (SPECT) in diagnosis of lung cancer and in preoperative prediction of mediastinal metastasis lymph nodes. METHODS: After the chest image of 99mTc-MIBI SPECT, fifty patients (40M, 10F; age 56 a +/- 11 a) diagnosed "lung field shadow" underwent the lung focus and mediastinal lymph nodes resection. As the golden standard, pathologic diagnosis was used to evaluate the role of preoperative 99mTc-MIBI SPECT. RESULTS: The sensitivity, specificity, and accuracy of 99mTc-MIBI SPECT were 93%, 50%, and 86%, respectively in lung cancer and 81%, 95%, and 88%, respectively in mediastinal metastasis lymph node. The results were also better than those of chest scan with CT. CONCLUSION: The 99mTc-MIBI SPECT is a useful and noninvasive method for diagnosing lung cancer and predicting mediastinal metastasis lymph nodes, which will guide the surgeon to resect the mediastinal metastasis lymph nodes.

Adult↗

PubMed2000

Location of tumor and distribution of lymph node metastasis in gastric cancer: lesser curve or greater curve.

BACKGROUND: The aim of this study was to clarify the relationship between the location of tumor and distribution of lymph node metastasis in node-positive gastric cancer. Pathologic findings of tumors in which location of tumors or positive nodes was confined within the lesser or greater curve were evaluated, and candidates of limited resection were assessed. METHODS: A total of 211 patients with node-positive gastric cancer treated by D2 or D3 gastrectomy was studied. Location, size, gross type, and histologic type of tumors, presence or absence of serosal, lymphatic, and vascular invasions, and status of lymph node metastasis were investigated. Tumors were divided into lesser curve tumors, greater curve tumors, and others; and lymph node metastases were classified as lesser curve metastasis, greater curve metastasis, and both curves metastasis. RESULTS: Lesser or greater curve tumors were featured by small size, negative serosal invasion, negative vascular invasion, metastasis confined to the perigastric nodes, and number of positive nodes less than seven. Cases of lesser or greater curve metastasis were featured by tumor location within the lesser or greater curve, small size, grossly superficial type, negative serosal invasion, negative lymphatic invasion, and number of positive nodes less than seven. When size of lesser or greater curve tumors was less than 4 cm, lymph node metastasis was mostly restricted to the same lesser or greater curve. CONCLUSION: Among node-positive gastric cancers, tumors located within the lesser or greater curve were characterized by small size, negative serosal invasion, and a few metastases confined to the perigastric lymph nodes. When tumor size was less than 4 cm and tumor invasion was not into serosa, lesser or greater curve tumors rarely extend into lymph nodes along the other curve. Limited resection or less invasive treatment is acceptable for such small gastric cancers along the lesser or greater curve.

Gastrectomy↗

PubMedDate not supplied

The inhibitory effect of matrix metalloproteinase inhibitor ONO-4817 on lymph node metastasis in tongue carcinoma.

BACKGROUND: ONO-4817 is a novel matrix metalloproteinase (MMP) inhibitor which has a broad inhibitory spectrum for MMPs. We investigated the inhibitory effect of ONO-4817 on cervical lymph node metastasis of tongue carcinoma. MATERIALS AND METHODS: HSC-3-M3, a cell line derived from human tongue carcinoma with high metastatic potential for lymph node, was used. The direct cytotoxicity of ONO-4817 was assessed by MTT assay and the gelatinolytic activity by gelatin zymography and film in situ zymography (FIZ). The inhibitory effect on lymph node metastasis was examined by orthotopic implantation model with nude mice. RESULTS: ONO-4817 had no direct cyototoxicity on HSC-3-M3 cells. Gelatin zymography and FIZ demonstrated a suppression of MMP-9 activation and a marked inhibition of gelatinolysis. Additionally, a suppression of cervical lymph node metastasis was shown by therapeutic experiment. CONCLUSION: The MMP inhibitor, ONO-4817, is a candidate for adjunctive therapy of cervical lymph node metastasis in tongue carcinoma.

Animals↗

PubMed2006

Vascular endothelial growth factor-C expression in bladder transitional cell cancer and its relationship to lymph node metastasis.

OBJECTIVE: To elucidate the role of vascular endothelial growth factor-C (VEGF-C) in bladder transitional cell carcinoma (TCC), examining VEGF-C expression in bladder TCC tissue and the association of VEGF-C with clinicopathological features, as the expression of VEGF-C in several carcinomas is significantly associated with angiogenesis, lymphangiogenesis and regional lymph node metastasis, but there are few reports of VEGF-C expression in bladder TCC. PATIENTS AND METHODS: The study included 45 patients with bladder TCC; VEGF-C expression was assessed by immunohistochemistry and the association between VEGF-C expression and angiogenesis, as evaluated by microvessel density (MVD), was examined. RESULTS: There was VEGF-C expression in the cytoplasm of tumour cells, but very little in the normal transitional epithelium. VEGF-C expression was significantly associated with tumour size, pathological T stage, pathological grade, lymphatic-venous involvement and pelvic lymph node metastasis (all P < 0.05). Multivariate analysis showed that VEGF-C expression was an exclusive independent factor influencing pelvic lymph node metastasis. Moreover, the patients with high VEGF-C expression had a markedly poorer prognosis than those with no or low VEGF-C expression (P = 0.014). A multivariate analysis based on the Cox proportional hazard model showed that lymph node metastasis was only an independent prognostic factor in the multivariate analysis using the Cox regression model (P = 0.010). CONCLUSION: The present study provides evidence supporting the involvement of VEGF-C expression in the promotion of lymph node metastasis in bladder TCC. Examination of VEGF-C expression in biopsy specimens might be beneficial in predicting pelvic lymph node metastasis.

Adult↗

PubMed1994

A clinicopathological analysis of early gastric cancer: retrospective study with special reference to lymph node metastasis.

We reviewed 217 cases of early gastric cancer (EGC) resected from 1978 through 1988. To determine the indications for curative resection by endoscopic mucosectomy (EM) for EGC, we paid special attention to lymph node metastasis examined after gastrectomy. The overall incidence of lymph node metastasis was 12.4%. It was 3.4% for mucosal (m-) cancer and 23.5% for submucosal (sm-) cancer. The maximum diameter of the lesion, depth of cancerous invasion, and location of the lesion showed positive correlations with lymph node involvement (p < 0.05). EGCs less than 20 mm in diameter had no lymph node metastasis. Pieces of mucosa about 20 mm in diameter on the average could be obtained with a single EM procedure. EGC with ulceration had a higher incidence of lymph node involvement than did that without ulceration. We conclude that if EM reveals an intramucosal gastric carcinoma less than 20 mm in diameter without ulceration, curative resection by EM is indicated.

Adenocarcinoma↗

PubMed2002

Expression of chemokine receptor CCR7 is associated with lymph node metastasis of gastric carcinoma.

The interactions of chemokine receptor CCR7 and its ligands are essential for migration of lymphocytes and dendritic cells to lymph nodes. In this study, we found that 4 of 6 (67%) gastric carcinoma cell lines tested expressed functional CCR7 for the chemokine CCL21/6Ckine, as demonstrated by calcium mobilization and actin polymerization assays. Moreover, we also showed that signaling through CCR7 induced chemotactic and invasive responses in CCR7-positive gastric carcinoma cells. In clinical samples, immunohistochemical assay showed that CCR7-positive carcinoma cells were detected in 42 of 64 (66%) cases and a significant difference in both lymph node metastasis (P < 0.001) and lymphatic invasion (P < 0.001) between CCR7-positive and -negative cases. Patients with CCR7-positive tumors had a significantly poorer prognosis than those with CCR7-negative tumors (P < 0.05). Stepwise regression analysis revealed that the most important factor related to lymph node metastasis was the expression of CCR7. These results indicated that CCR7 and its ligands interaction is associated with preferential lymph node metastasis of gastric carcinoma.

Actins↗

PubMed2004

Impact of vascular endothelial growth factor-C and -D expression in human pancreatic cancer: its relationship to lymph node metastasis.

PURPOSE: The aim of this study was to evaluate the expression of vascular endothelial growth factor (VEGF)-C and -D in pancreatic cancer and to reveal its relation to lymph node metastasis. EXPERIMENTAL DESIGN: Formalin-fixed, paraffin-embedded blocks were obtained from 58 patients with pancreatic head cancer. All of the patients underwent a curative resection. The total number of resected lymph nodes was 1,058. The expressions of VEGF-C and -D were evaluated by immunohistochemical staining. To evaluate the relation to lymph node metastasis, the expressions of VEGF-C and -D between the marginal and central portions in the tumor were compared. When >25% of the tumor cells showed distinct staining, the portion was judged as high expression. RESULTS: The two groups with high expression of VEGF-C (P = 0.015) and VEGF-D (P = 0.020) in the marginal portion had a significantly higher incidence of lymph node metastasis compared with the groups with low expression, respectively. Furthermore, the group with high expression of both VEGF-C and -D in the marginal portion had a higher incidence of lymph node metastasis compared with the group with low expression (P = 0.007). The 5-year survival rate of patients with high expression of both VEGF-C and -D in the marginal portion was significantly lower than that of patients with low expression of both VEGF-C and -D (P = 0.017). CONCLUSIONS: VEGF-C and -D expression in tumor cells in the marginal portion of the tumor significantly associated with lymphatic metastasis and prognosis in patients with pancreatic head cancer.

Adenocarcinoma↗