Extent of lymphovascular space invasion may predict lymph node metastasis in uterine serous carcinoma

Abstract

Objectives Emerging evidence suggests that extent of lymphovascular space invasion (LVSI) predicts for risk of lymph node metastasis in endometrioid uterine cancers. However, this correlation remains unknown in the setting of uterine serous carcinoma (USC). We sought to examine the association between extent of LVSI and other histopathologic characteristics with risk of nodal metastasis for women with USC. Materials/Methods Pathological data from all cases of uterine serous carcinoma between July 1998 to July 2015 at our institution were reviewed. Descriptive, univariate, and multivariate logistic regression analysis of selected pathologic features were performed. Results 88 patients with USC underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy. Surgical staging revealed the following FIGO stage distributions: I (41%), II (8%), III (32%), IV (19%). LVSI was present in 44 (50%) patients. 36 patients (41%) had LN metastases with median number of total nodes removed of 17 (range, 1–49). On univariate analysis, depth of myometrial invasion, LVSI, tumor size, and cervical stromal involvement were significantly associated with nodal involvement. In a multivariate model, LVSI (OR 6.25, 95% CI 2.2–18.0, p < 0.01) and cervical stromal involvement (OR 3.33, 95% CI 1.10–10.0, p = 0.03) were the only factors that remained significant. Among patients with LVSI-positive disease, extensive LVSI was associated with increased risk of nodal involvement compared to focal LVSI (90% vs 29%, p = 0.04). Conclusions Presence and extent of LVSI, and cervical stromal invasion are important predictors for lymph node metastasis in uterine serous carcinoma.

Adjuvant Pelvic Radiation “Sandwiched” Between Paclitaxel/Carboplatin Chemotherapy in Women With Completely Resected Uterine Serous Carcinoma: Long-term Follow-up of a Prospective Phase 2 Trial

“…While PFS was unaffected, patients with stage I USC and LVSI had considerably worse OS, with a 2.7 times higher risk of death. This is consistent with recent literature suggesting that LVSI is an important predictor of advanced disease and LVSI an independent prognostic factor associated with worse OS[12–14]. The presence of LVSI in early stage disease may further change the management recommendations for adjuvant RT in patients who would previously have been recommended vaginal brachytherapy alone.…”

Long non-coding RNA LINC00336 as an independent prognostic indicator and an oncogenic lncRNA in bladder cancer

“…Previous studies corroborate that lymph node metastases constitute a strong prognostic factor in BCa [29,30]. Mechanistic investigations highlight that lymphovascular invasion may be an important predictor for lymph node metastasis in multiple cancer types [31][32][33]. The present study reveals a significant increase in LINC00336 expression level in BCa patients with vascular invasion.…”

Defining Substantial Lymphovascular Space Invasion in Endometrial Cancer

“…Several studies have shown that the extent of LVSI is clinically relevant and can be used to improve the stratification of patients with intermediate/high-risk and high-risk EC 9,10,19. Moreover, introducing the concept of measuring the extent of LVSI resulted in pathologists reporting the extent of LVSI using a semiquantitative approach (i.e.…”

“…high-risk EC (9,10,19). Moreover, introducing the concept of measuring the extent of LVSI resulted in pathologists reporting the extent of LVSI using a semiquantitative approach (i.e.…”

“…In addition, LVSI is often a critical factor in new risk models that incorporate molecular features (7), including the model used in the ongoing PORTEC-4a trial (8). Moreover, recent studies have shown that the extent of LVSI-and not merely the presence or absence of LVSI-is the strongest predictor of recurrent regional and metastatic disease in patients with stage I disease (9,10).…”