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Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer
  1. Ricardo dos Reis, MD*,
  2. Jennifer K. Burzawa, MD,
  3. Audrey T. Tsunoda, MD*,
  4. Masayoshi Hosaka, MD,
  5. Michael Frumovitz, MD,
  6. Shannon N. Westin, MD, MPH,
  7. Mark F. Munsell, MS and
  8. Pedro T. Ramirez, MD
  1. *Gynecologic Oncology Department, Barretos Cancer Hospital, São Paulo, Brazil; and Departments of
  2. Gynecologic Oncology and Reproductive Medicine and
  3. Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Pedro T. Ramirez, MD, Department of Gynecologic Oncology, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: peramire{at}


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 1 academic institution were reviewed. Patients with grade 1 or 2 endometrioid histology, myometrial invasion less than 50%, and disease confined to the uterus (clinical International Federation of Obstetrics and Gynecology stage IA) were analyzed. Fisher 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).

Conclusions Patients with low-risk endometrial cancer and LVSI have worse RFS and OS despite being more likely to undergo lymphadenectomy and adjuvant therapy.

  • Lymphovascular Invasion
  • Risks
  • Uterine cancer

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  • This research is supported in part by the National Institutes of Health through MD Anderson Cancer Center’s support grant CA016672 and an NIH K12CA088084 K12 Calabresi Scholar Award to S.N.W.

  • The authors declare no conflicts of interest.