Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer

Cusano, Ellen; Myers, Victoria; Samant, Rajiv; Sudai, Talia; Keller, Allison; Le, Tien; Choan, E; Grimes, Scott; Xu, Yiqing

doi:10.1097/igc.0000000000001229

Cited by 30 publications

(42 citation statements)

References 14 publications

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“…Pulgar et al showed that the presence of LVSI was associated with reduced prognosis and a shorter survival rate [9]. Cusano et al analyzed the prognostic significance of LVSI in patients with (T1N0) node-negative surgically staged endometrial cancer, and showed that LVSI was an independent factor of risk for reduced overall survival (OS), as were age, histologic grade, and tumor stage [10]. A recent retrospective study showed that increased patient age, advanced tumor stage, increased tumor grade, and the presence of LVSI were negative prognostic factors for patient survival in= high-grade endometrial cancer [11].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Prognostic Factors and Adjuvant Radiotherapy on Survival in Patients with High-Grade Early-Stage Endometrial Cancer: A Retrospective Clinical Study

et al. 2019

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Background This retrospective clinical study aimed to investigate the effect of prognostic factors and adjuvant radiotherapy in patients with high-grade early-stage endometrial cancer on overall survival (OS) and disease-free survival (DFS). Material/Methods The medical records of patients diagnosed with high-grade, early stage (I or II) endometrial adenocarcinoma who had received adjuvant radiotherapy after surgery were reviewed. Results Seventy-nine patients included 39 patients (49.4%) with stage II endometrial cancer, 25 patients (31.6%) with histologic grade 3 tumors, and 47 patients (59.5%) with endometrial cancer showing lymphovascular space invasion (LVSI). There were 45 patients (57.0%) who received external pelvic radiotherapy with an average dose of 46.0 Gy (range, 11.2–50.4 Gy), and 34 patients (43.0%) received vaginal brachytherapy (VBT) with an average dose of 21.5 Gy (range, 10–36 Gy). Multivariate analysis showed that tumor stage (HR, 4.066; 95% CI, 1.227–13.467; p=0.022) and histologic grade (HR, 16.652; 95% CI, 4.430–62.589; p<0.001) were independent predictors for OS. Increased serum CA-125 levels (HR, 1.136; 95% CI, 0.995–1.653; p=0.047) and histologic grade (HR, 3.236; 95% CI, 1.107–15.156; p=0.015) were independent predictors for DFS. Adjuvant radiotherapy was not found to be significantly associated with improved OS (HR, 1.259; 95% CI, 0.518–3.058; p=0.612) or DFS (HR, 1.056; 95% CI, 0.994–1.123; p=0.078). Conclusions This retrospective study showed that in high-grade early-stage endometrial cancer treated with postoperative adjuvant radiotherapy, independent predictors for OS were tumor stage and grade. Adjuvant radiotherapy was not associated with improved OS or DFS.

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Section: Discussionmentioning

confidence: 99%

The Effect of Prognostic Factors and Adjuvant Radiotherapy on Survival in Patients with High-Grade Early-Stage Endometrial Cancer: A Retrospective Clinical Study

et al. 2019

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“…Recently published data dealing with the importance of lymphovascular space invasion (LVSI) in pT1N0 node‐negative patients has shown the 5‐year disease recurrence rate of 4.8% in lymph node negative and LVSI negative and 14.1% lymph node negative and LVSI‐positive patients ( P = 0.006) . The question arises whether these facts are caused by the low sensitivity of the standard tests used for the detection of metastatic involvement of SLNs or not.…”

Section: Discussionmentioning

confidence: 99%

“…Recently published data dealing with the importance of lymphovascular space invasion (LVSI) in pT1N0 node-negative patients has shown the 5-year disease recurrence rate of 4.8% in lymph node negative and LVSI negative and 14.1% lymph node negative and LVSI-positive patients (P = 0.006). 23 The question arises whether these facts are caused by the low sensitivity of the standard tests used for the detection of metastatic involvement of SLNs or not. In our group of patients, the OSNA method detected a statistically significant higher number of positive lymph nodes, which would result in the classification of a statistically significant higher number of patients into higher FIGO stages, which would better correspond to the frequency of patients in whom the recurrence of the disease occurs in the early stage.…”

Section: Detection Of a Sentinel Lymph Node In Ec Patients Is Not Amentioning

confidence: 99%

One‐step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients

Kosťun

Pešta

Sláma

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Utilisation of the one‐step nucleic acid amplification (OSNA) molecular biology method for the detection of the metastatic involvement of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients. A comparison with histopathological ultrastaging and a description of the clinical consequences. Methods Surgically treated EC patients underwent detection of SLNs. Nodes greater than 5 mm were cut into sections 2‐mm thick parallel to the short axis of the node. Odd sections were examined according to the OSNA method, while even ones according to an appropriate ultrastaging protocol. Nodes less than or equal to 5 mm were cut into halves along the longitudinal axis with one half examined according to the OSNA method and the other half by ultrastaging. Results Fifty‐eight patients were included and 135 SLNs were acquired. Both ultrastaging and OSNA agreed on 116 results. According to the OSNA method, 20.69% more patients were classified into International Federation of Gynecology and Obstetrics (FIGO) stage III. When comparing the results of the OSNA method to the conclusions of ultrastaging as a reference method, sensitivity of 90.9%, specificity of 85.5% and concordance of 85.9% were attained. Conclusions The results of the OSNA method showed a higher frequency of detection of micrometastases and included 20.69% more patients into FIGO stage III.

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“…It is well stablished [30, 31] that the presence of LVSI is a potent predictor of lymph node metastasis. Even more, it is a powerful prognostic factor, even in the patients with no lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

L1 Cell Adhesion Molecule (L1CAM) expression in endometrioid endometrial carcinomas: A possible pre-operative surrogate of lymph vascular space invasion

et al. 2018

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BackgroundRisk stratification of endometrial carcinomas is primarily based on surgical staging that requires extensive retroperitoneal lymph node dissection. One of the most powerful predictor of lymph node involvement is the lymph vascular space invasion (LVSI). The objective of this study was to determine the potential of L1 Cell Adhesion Molecule (L1CAM) to predict LVSI and its association with other risk factors in endometrioid endometrial carcinomas.Materials and methodsWe studied 47 consecutive patients aged 37–88 (61.34±10.52). Twenty-three patients (48.9%) were submitted to complete surgical staging. Nine patients (19.1%) underwent surgical staging without para-aortic dissection. Seven (14.9%) were submitted to hysterectomy with no lymph node dissection. Eight patients (17.0%) only had the biopsy material for analysis. The 32 patients submitted to lymphadenectomy were staged according to the FIGO system and classified among the risk categories of the ESMO-ESGO-ESTRO guidelines. The following histological characteristics were analyzed: tumor size (mm), depth of myometrial infiltration, presence of microcystic, elongated, and fragmented (MELF) pattern of myoinvasion, and lymph vascular space invasion (LVSI). Immunohistochemical analyses of mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2, p53, and L1CAM were performed in formalin-fixed paraffin embedded whole tumor tissue sections.ResultsLVSI was identified in 26/41 (63,4%) of the cases. L1CAM was positive in 8/47 (17%) cases, all of them positive for LVSI and within the high-risk category of ESMO-ESGO-ESTRO. L1CAM-positive cases were associated with high histological grade and p53 aberrant immunohistochemical profile. Besides, it showed a trend to larger tumors, greater depth of myometrial infiltration, and with a higher frequency of the MELF pattern of myoinvasion. LVSI was also associated with FIGO stage, tumor size, depth of myometrial infiltration, and tumor grade.ConclusionsL1CAM is highly associated with LVSI and could be used as a pre-operative predictor of lymph node involvement in endometrioid endometrial carcinomas.

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Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer

Cited by 30 publications

References 14 publications

The Effect of Prognostic Factors and Adjuvant Radiotherapy on Survival in Patients with High-Grade Early-Stage Endometrial Cancer: A Retrospective Clinical Study

The Effect of Prognostic Factors and Adjuvant Radiotherapy on Survival in Patients with High-Grade Early-Stage Endometrial Cancer: A Retrospective Clinical Study

One‐step nucleic acid amplification vs ultrastaging in the detection of sentinel lymph node metastasis in endometrial cancer patients

L1 Cell Adhesion Molecule (L1CAM) expression in endometrioid endometrial carcinomas: A possible pre-operative surrogate of lymph vascular space invasion

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