Substantial lymphovascular space invasion predicts worse outcomes in early-stage endometrioid endometrial cancer

Barnes, Elizabeth; Martell, Kevin; Parra‐Herran, Carlos; Taggar, Amandeep; Donovan, Elysia; Leung, Eric

doi:10.1016/j.brachy.2020.12.006

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…[55][56][57] Low-grade EECs are associated with a good prognosis when they are limited to the uterine corpus and there is no LVSI or focal LVSI. 2,22,[58][59][60][61][62] There is a subset of patients with low-grade endometrioid carcinomas involving the endometrium and the ovaries, which are associated with a good prognosis. [63][64][65] They were previously described as synchronous independent tumors, but molecular analysis has established a common clonal origin.…”

Section: Stage Imentioning

confidence: 99%

“…It is very important to distinguish "substantial" or "extensive" LVSI from "focal" or "no" LVSI. [20][21][22] Although determination of the precise number of involved vessels to discriminate between focal and extensive/substantial requires additional scientific evidence, for staging purposes the recommendation by WHO 2020 (≥5 vessels) is adopted. 1…”

Section: Lymphovascular Space Invasion (Lvsi)mentioning

confidence: 99%

See 1 more Smart Citation

FIGO staging of endometrial cancer: 2023

Berek

Matías‐Guiu

Creutzberg

et al. 2023

Intl J Gynecology & Obste

187

112

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Introduction: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. Methods: The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. Results: Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous,

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Section: Stage Imentioning

confidence: 99%

Section: Lymphovascular Space Invasion (Lvsi)mentioning

confidence: 99%

FIGO staging of endometrial cancer: 2023

Berek

Matías‐Guiu

Creutzberg

et al. 2023

Intl J Gynecology & Obste

187

112

View full text Add to dashboard Cite

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“…Recent data indicate that "substantial" or "extensive" LVI is associated with adverse outcomes when compared with carcinomas with "focal" or "no" LVI (117)(118)(119). Although there have been different proposals for what constitutes extensive LVI, it is a good rule of thumb to diagnose extensive LVI when it is easily recognisable at scanning magnification (and artifact is excluded) and when present in 3 or more vessels on closer inspection.…”

Section: LVImentioning

confidence: 99%

Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR)

Matías‐Guiu

Selinger

Anderson

et al. 2022

International Journal of Gynecological Pathology

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Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.

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“…One caveat to the qualitative nature in which LVSI assessment was performed in our study is that this to some extent limits clinical implementation due to interobserver variability. This interobserver variability may partly explain the differences in the reported prevalence of substantial LVSI (12,25,26), although some of these differences can also be explained by study cohort composition. However, we acknowledge that borderline cases exist in which the qualitative nature of this approach will result in variability in the interpretation of focal versus substantial LVSI.…”

Section: Lvsi In High-risk Endometrial Cancermentioning

confidence: 99%

“…Furthermore, correct interpretation of true LVSI versus artifactual displacement remains another challenge and may also impact reported prevalence. Intriguingly, despite all of this, the prognostic power of substantial LVSI is generally found across many independent cohorts (12,18,20,25). We foresee that the increased attention on this topic will eventually result into international consensus, which through training will lead to improved agreement among pathologists.…”

Section: Lvsi In High-risk Endometrial Cancermentioning

confidence: 99%

Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-Risk Endometrial Cancer

Peters

León‐Castillo

Høgdall

et al. 2021

International Journal of Gynecological Pathology

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Approximately 15% of patients with endometrial cancer present with high-risk disease (HREC). Moreover, assessing the extent of lymphovascular space invasion (LVSI) may provide prognostic insight among patients with HREC. The aim of this study was to determine whether the extent of LVSI can serve as a prognostic factor in HREC. All cases of ESMO-ESGO-ESTRO 2016 classified HREC in the Danish Gynecological Cancer Database (DGCD) diagnosed from 2005 to 2012 were reviewed for the presence and extent of LVSI (categorized using a 3-tiered definition). We used the Kaplan-Meier analysis to calculate actuarial survival rates, both adjusted and unadjusted Cox regression analyses were used to calculate the proportional hazard ratio (HR). A total of 376 patients were included in our analysis. Among 305 patients with stage I/II HREC, 8.2% and 6.2% had focal or substantial LVSI, respectively, compared with 12.7% and 38.0% of 71 patients with stage III/IV HREC, respectively. Moreover, the estimated 5-yr recurrence-free survival rate was significantly lower among patients with substantial LVSI compared with patients with no LVSI for both stage I/II (HR: 2.8; P=0.011) and stage III/IV (HR: 2.9; P=0.003) patients. Similarly, overall survival was significantly lower among patients with substantial LVSI for both stage I/II (HR: 3.1; P<0.001) and stage III/IV (HR: 3.2; P=0.020) patients. In patients with HREC, substantial LVSI is an independent adverse prognostic factor for lymph node and distant metastases, leading to reduced survival. Thus, the extent of LVSI should be incorporated into routine pathology reports in order to guide the appropriate choice of adjuvant treatment.

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Substantial lymphovascular space invasion predicts worse outcomes in early-stage endometrioid endometrial cancer

Cited by 14 publications

References 30 publications

FIGO staging of endometrial cancer: 2023

FIGO staging of endometrial cancer: 2023

Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR)

Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-Risk Endometrial Cancer

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