Prognostic significance of several histological features in intermediate and high‐risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy

Abstract

SummaryThe purpose of the present study was to explore the prognostic significance of several histological features with respect to lymph node metastasis, failure-free survival (FFS), and overall survival (OS) in intermediate and high-risk endometrial cancer patients treated with curative intent. One hundred and eighty patients with endometrial cancer were treated with hysterectomy with or without lymphadenectomy and received external beam radiotherapy (EBRT). The mean follow-up period was 4.25 years (range 0.44-10.45 years). In multifactor analysis, fractional myometrial invasion (MI) (P = 0.047), histology (P < 0.001) and lymph-vascular space invasion (LVSI) (P = 0.025) were significant predictors for FFS when nodal status was not included. When lymph node status was known, histology (P = 0.007) and LVSI (P = 0.014) remained significant factors for FFS. For OS, histology (P < 0.001) and fractional MI (P = 0.004) were the significant factors. Lymph node status could be predicted by tumour grading (P = 0.016) and absolute MI (P = 0.002). Histology type and the presence of LVSI were the most important prognostic factors in high-risk endometrial cancer patients treated by surgery and postoperative radiotherapy. Absolute MI and tumour grading were useful predictors of nodal spread.

Prognostic Significance of Lymphovascular Space Invasion and Nodal Involvement in Intermediate- and High-Risk Endometrial Cancer Patients Treated With Curative Intent Using Surgery and Adjuvant Radiotherapy

“…Briet et al 15 found that endometrial cancer patients with LVSI were 5 times more likely to have pelvic LN metastases in comparison with LVSI-negative patients. Similarly, Narayan et al 10 showed that the incidence of nodal metastases in endometrial cancer was 33% when LVSI was present, but only 1% when LVSI was absent.…”

“…Similarly, Kondalsamy-Chennakesavan et al 17 had shown that LVSI predicts nodal metastases, independently, after adjusting for cervical involvement, serosal/ adnexal involvement, grade, and depth of MI. Hanson et al, 18 Narayan et al, 10 and Watanabe et al 19 have also reported that LVSI significantly predicts lymph node metastases. Briet et al 15 found that endometrial cancer patients with LVSI were 5 times more likely to have pelvic LN metastases in comparison with LVSI-negative patients.…”

“…The details of radiotherapy techniques have been described previously. 10 Definitions Used in Assessing Outcomes Failure Failure was defined as recurrence of disease following radiotherapy. Because the primary tumor was removed at surgery, there was no residual or persistent disease at the primary site.…”

“…Recently, it has been shown that MI is closely related to LVSI. 10,11 Honore and Hanson 11 note that there is a significant increase in the risk of LVSI as the depth of MI increases, with the relative risk being highest with full-thickness MI (relative risk, 11.642). In the present series consisting of intermediate-and high-risk patients, more than 50% of patients had LVSI, with absolute MI ranging from 0 to 42 mm.…”

“…9 Recently, Narayan et al 10 examined the prognostic significance of several histological factors, including LVSI, in intermediateand high-risk endometrial cancer patients treated with surgery and adjuvant pelvic radiotherapy. Lymphovascular space invasion was related to fractional MI (P G 0.001), 10,11 whereas only tumor grade and absolute MI related to nodal involvement.…”