Lymphovascular Space Invasion (LVSI) Is an Isolated Poor Prognostic Factor for Recurrence and Survival Among Women With Intermediate- to High-Risk Early-Stage Endometrioid Endometrial Cancer

Objective The prognostic significance of lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer is not established. We sought to determine if LVSI status in patients with early-stage low-risk endometrial cancer correlates with recurrence and survival. Methods The records of all women who underwent hysterectomy for primary treatment of endometrial cancer from January 2006 through January 2011 at one academic institution were reviewed. Patients with grade 1 or 2 endometrioid histology, myometrial invasion less than 50%, and disease confined to the uterus (clinical FIGO stage IA) were analyzed. Fisher’s exact test and the Wilcoxon rank-sum test were applied to compare patients with and without LVSI. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Results Two hundred forty patients met the inclusion criteria. Forty (16.7%) had LVSI. Ninety-one patients (37.9%) underwent lymphadenectomy. Median tumor size was 30 mm in patients with and 26 mm in patients without LVSI (p=0.150). Thirty patients (12.5%) received adjuvant therapy. Site of recurrence did not differ between patients with and without LVSI. Patients with LVSI were more likely to have myometrial invasion (p<0.001), postoperative pathologic grade 2 disease (p<0.001), to undergo lymphadenectomy (p=0.049) and receive adjuvant therapy (p<0.001). The 5-year cumulative incidence of recurrence was 3.8% in the no-LVSI group and 14.2% in the LVSI group (p=0.053). The presence of LVSI was significantly associated with worse RFS (p=0.002) and OS (p=0.013). Conclusion Patients with low-risk endometrial cancer and LVSI have worse RFS and OS despite being more likely to undergo lymphadenectomy and adjuvant therapy.

Section: Discussionmentioning

confidence: 99%

Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer

Reis

Burzawa

Tsunoda

et al. 2015

“…Tumors that are LVSI positive are classified as intermediate risk, and adjuvant treatment is recommended for these patients. 5,6 However, recent studies have shown that positivity for LVSI is the strongest prognostic factor for recurrence or cancer-related death 7,8 ; hence, LVSI has been the focus of increased investigation.…”

mentioning

confidence: 99%

Blood Vessel Invasion Is a Strong Predictor of Postoperative Recurrence in Endometrial Cancer

Sato¹,

Taguchi

Fukui³

et al. 2018

“…22 Given the high recurrence rate in low-risk patients, this suggests a potential role for adjuvancy in positive LVSI, even without other high-risk features. 20,31,35 In Aristizabal et al 36 study, the survival difference and 5-year OS between stage I patients with positive LVSI and those with negative LVSI were highly significant (81% and 97%, P = 0.009), instead of differentiating by MI. According to these data, a stratification of the FIGO stage I based on the LVSI status would predict mortality better.…”

Section: Discussionmentioning

confidence: 92%

Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks

Gorostidi¹,

Noval

Gil-Ibáñez

et al. 2017

Results suggest that LVSI remains a controversial issue in the management of patients with endometrial cancer. Acquiring a deeper knowledge and uniform criteria could avoid the risk of undertreatment and overtreatment in this group of patients with early-stage endometrial cancer. The identification of vascular pseudoinvasion is recommended, although the clinical and prognostic implications still need to be determined.