The impact of lymphovascular space invasion on survival in early stage low-grade endometrioid endometrial cancer

Abstract

Background The lymphovascular space invasion (LVSI) is suggested as a prognostic factor for endometrial cancer in many studies, but it has not yet been employed in FIGO staging system. The present study was aimed to evaluate the impact of LVSI on survival in patients with early stage endometrioid endometrial cancer. Methods This retrospective cohort was conducted on early stage endometrial cancer patients who underwent surgical staging [total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)] and omental biopsy at Referral Teaching Hospitals of Tehran from 2005 to 2021. Patient’s age, menopause status, tumor grade, tumor size, depth of myometrial invasion, LVSI and lower segment involvement were recorded. Data were analyzed with SPSS 22. Results 415 patients with stage I and grade 1–2, endometrioid endometrial cancer were analyzed. 100 patients (24.1%) were LVSI-positive. 3-year and 5-year survival rates were 97.1% and 88.9%, respectively. Recurrence occurred in 53 patients (12.8%). 3-year overall survival rates in LVSI-negative and LVSI-positive were 98.7% and 92%. These rates for 5-year survival were 92.1% and 79%, respectively. Recurrence rates in LVSI-negative were 8.9% while it was 25% in LVSI-positive cases. Multivariate analysis showed that LVSI has significant correlation with 3-year and 5-year overall survival rates. Conclusions LVSI in early stage endometrial cancer significantly and independently influences 3-year and 5-year survival rates and acts as a strong prognostic factor in these patients. LVSI should be implemented in endometrial cancer staging systems due to its significant correlation with cancer recurrence rates and 5-year survival rates.

Evaluation of prognostic significance of lymphovascular space invasion in early stage endometrial cancer: a systematic review and meta-analysis

“…Furthermore, our meta-analysis demonstrated that patients with LVSI have worse OS in both stage I EC (HR=5.19, 95%CI 3.33-8.07) and stage IA grade 1 or 2 endometrioid carcinoma patients (HR=5.52, 95%CI 2.16-14.09) compared to patients without LVSI. Our research findings are in concordance with previous studies reporting a significant association between LVSI and decreased OS ( 3 , 6 , 7 ). However, it is important to note that there have been conflicting reports regarding the impact of LVSI on prognosis.…”

“…Nine studies ( 3 , 6 – 9 , 11 , 12 , 14 , 21 ) involving 3,337 patients evaluated the relationship between LVSI and recurrence. The recurrence rate for patients with LVSI was 18.10% (72/398), compared to 6.16% (181/2939) for patients without LVSI in stage I EC.…”

“…Nevertheless, conflicting results have been reported regarding the impact of LVSI on survival outcomes in early-stage EC. Many studies have shown that LVSI-positive is associated with lower overall survival (OS), higher recurrence, and increased risks of lymph node and distant metastasis, and is a poor prognostic factor for EC (6)(7)(8). LVSI has been reported as a risk factor, even in cases of stage I EC without lymph node metastasis (9)(10)(11).…”

Endometrial Carcinoma: A Comprehensive Analysis of Clinical Parameters, Treatment Modalities, and Prognostic Outcomes at a Tertiary Oncology Center in the UAE

“…Among these, lymphovascular space invasion (LVSI) has emerged as a significant predictor of both lymph node metastasis and overall survival. A study conducted in early-stage endometrial cancer patients found that LVSI significantly and independently influenced the three-year and five-year survival rates [12]. Another study echoed these findings, emphasizing that patients with lower International Federation of Obstetrics and Gynecology (FIGO) stages but with confirmed LVSI presence may be at an increased risk of recurrence and poor overall survival [13].…”

Is HOXA5 a Novel Prognostic Biomarker for Uterine Corpus Endometrioid Adenocarcinoma?

“…However, even with early diagnosis, certain clinicopathological factors indicate high recurrence rates and poor treatment outcomes [9,10]. The serous adenocarcinoma histologic subtype of EC (SAEC) and high histological grade are common independent risk factors for EC recurrence and are associated with poor survival rates [11,12]. Traditionally, these morphological features have been key factors in assessing the risk of EC recurrence [13].…”