Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks

Gorostidi, Mikel; Noval, Begoña Díaz de la; Gil-Ibáñez, Blanca; Lago, Víctor; Jaunarena, Ibón; Iserte, Pablo Padilla

doi:10.1097/igc.0000000000001022

Cited by 13 publications

(5 citation statements)

References 39 publications

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“…Also, in this study, the degree of lymphovascular space invasion (LVSI) and myometrial invasion were found to adversely affect prognosis in patients diagnosed with endometrial cancer. 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].…”

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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“…Given the relative high incidence of distant recurrences for patients with lymphovascular invasion, even in the absence of lymph node metastasis, certain authors support the utilization of adjuvant chemotherapy since radiation therapy cannot eliminate microscopic metastases outside the radiation field. In a recent survey among active members of the Spanish Society of Gynecology and Obstetrics, 47% of responders recommend the addition of systemic chemotherapy for patients with early-stage endometrial cancer in the presence of lymphovascular invasion 19. Nevertheless, to date, data from randomized trials such as PORTEC-3 and GOG-249 do not support the utilization of adjuvant chemotherapy for early-stage endometrioid tumors, regardless of tumor grade and lymphovascular invasion status 18 20.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy for stage I high-intermediate risk endometrial carcinoma with lymph-vascular invasion

Nasioudis

et al. 2022

Int J Gynecol Cancer

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ObjectiveThe goal of this study was to evaluate if addition of adjuvant chemotherapy to radiation therapy improves overall survival in patients with high-intermediate risk stage I endometrial carcinoma with lymphovascular invasion.MethodsPatients diagnosed between January 2010 and December 2015 with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial carcinoma with lymphovascular invasion who underwent hysterectomy with lymphadenectomy and met the GOG-99 criteria for high-intermediate risk were identified in the National Cancer Database. Patients who received adjuvant radiotherapy with or without adjuvant chemotherapy (administered within 6 months of surgery) and had at least 1 month of follow-up were selected for further analysis. Overall survival was compared with the log-rank test following stratification by type of radiation treatment. A Cox model was constructed to control for a priori selected confounders.ResultsA total of 2881 patients who met the inclusion criteria were identified; 2417 (83.9%) patients received radiation therapy alone while 464 (16.1%) received chemoradiation. Rate of adjuvant chemotherapy administration was comparable between patients who received vaginal brachytherapy alone (16.2%), and external beam radiation therapy (with or without vaginal brachytherapy) (15.8%), p=0.78. Rate of chemoradiation was higher for patients with grade 3 (28.8%) tumors compared with those with grade 2 (9.9%) and grade 1 (8.3%) tumors, p<0.001. After controlling for confounders for patients receiving external beam radiation, addition of chemotherapy was not associated with improved overall survival (HR 0.90, 95% CI 0.56 to 1.46). For patients receiving vaginal brachytherapy addition of chemotherapy was associated with better overall survival (HR 0.644, 95% CI 0.45 to 0.92). Benefit was limited to patients with grade 3 tumors, p=0.026; 4-year overall survival rate was 81.1% versus 74.9%.ConclusionsIn patients with high-intermediate risk FIGO stage I endometrioid endometrial carcinoma and lymphovascular invasion, addition of chemotherapy to radiation therapy was associated with a survival benefit for patients with grade 3 tumors receiving vaginal brachytherapy.

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“…Interestingly, in a survey of gynecologists, only half of the practitioners knew about vascular pseudoinvasion or how it occurs (13). The mechanism of vascular pseudoinvasion has been a matter of debate, as it probably results from adapting the technique, either intraoperatively or postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Vascular Pseudoinvasion After Endometrial Ablation

Karpathiou

Corsini

Dagher

et al. 2020

International Journal of Gynecological Pathology

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Vascular pseudoinvasion or displacement of tumor or normal endometrial tissue is a potential pitfall in uterine pathology. The proposed mechanisms of this phenomenon are mostly associated with the uterine manipulator used during minimally invasive hysterectomies. The aim of this report is to describe vascular pseudoinvasion in a still unreported setting, that of a postendometrial ablation hysterectomy, and to provide a summary of studies dealing with artifactual or nonmalignant myometrial vessel involvement by normal or neoplastic endometrial tissue.

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Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks

Cited by 13 publications

References 39 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

Adjuvant chemotherapy for stage I high-intermediate risk endometrial carcinoma with lymph-vascular invasion

Vascular Pseudoinvasion After Endometrial Ablation

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