Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer

Abstract

ObjectiveThe purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer.MethodsA dual-institutional, retrospective department database review was performed to identify patients with ‘low-risk endometrial cancer’ (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected.ResultsWe identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival.ConclusionsAge ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.

Serous component is a recurrence predictive factor of grade 1 endometrioid carcinoma at stage IA: A multi-institutional and retrospective study

“…Several reports demonstrated that lympho-vascular invasion was a worse prognostic factor for low-risk or early-stage endometrial carcinoma [18][19][20]. Our study did not show the association between lympho-vascular invasion and recurrence or PFS.…”

Surgicopathological outcomes and survival in carcinoma body uterus: A retrospective analysis of cases managed by laparoscopic staging surgery in Indian women

“…LVSI is independently associated with lymph node metastases in women with apparent early-stage endometrial cancer and an independent predictor of survival even after adjustment for the presence of lymph node metastases. [ 22 23 ] LVSI is associated with a higher grade of tumor histology, as evident in our study, with all cases being a high grade with metastasis to pelvic lymph node in four out of the seven cases in which lymph vascular space was invaded by tumor emboli. [ 24 ]…”

Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer – a Swedish Gynecologic Cancer Group (SweGCG) study

“…Several factors have been identified as predictors of lymph node metastases, recurrence and survival in patients with early-stage endometrioid endometrial adenocarcinoma (EC). These factors include age, FIGO grade, cervical stromal invasion, depth of myometrial invasion (MI), and lymphovascular space invasion (LVSI) [1][2][3][4][5][6][7][8][9][10]. Currently, treatment for presumed early-stage EC involves surgery with or without lymphadenectomy followed by chemotherapy and/or radiation therapy based upon the estimated risk for recurrence according to above-mentioned high-risk factors [11].…”

“…LVSI has repeatedly been shown to be an independent negative prognostic factor for recurrence and survival [5,10,12,13] and, in some studies, even for patients without lymph node metastases [9,14]. In the ESMO-ESGO-ESTRO Consensus guidelines from 2016, patients with LVSI-positive endometrioid tumors (grades 1 and 2) that have not undergone lymph node staging are categorized as being in the high-intermediate risk group, and adjuvant external beam radiotherapy is recommended to decrease the risk of pelvic recurrence [11].…”