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Blood Vessel Invasion Is a Strong Predictor of Postoperative Recurrence in Endometrial Cancer
  1. Marie Sato, MD*,
  2. Ayumi Taguchi, MD, PhD*,
  3. Yamato Fukui, MD*,
  4. Akira Kawata, MD*,
  5. Satoru Taguchi, MD,
  6. Tomoko Kashiyama, MD, PhD*,
  7. Satoko Eguchi, MD, PhD*,
  8. Tomoko Inoue, MD, PhD*,
  9. Kensuke Tomio, MD, PhD*,
  10. Michihiro Tanikawa, MD, PhD*,
  11. Kenbun Sone, MD, PhD*,
  12. Mayuyo Mori, MD, PhD*,
  13. Kazunori Nagasaka, MD, PhD*,
  14. Katsuyuki Adachi, MD, PhD*,
  15. Masako Ikemura, MD, PhD,
  16. Yukako Domoto, MD, PhD,
  17. Takahide Arimoto, MD, PhD*,
  18. Katsutoshi Oda, MD, PhD*,
  19. Masashi Fukayama, MD, PhD,
  20. Yutaka Osuga, MD, PhD* and
  21. Tomoyuki Fujii, MD, PhD*
  1. * Departments of Obstetrics and Gynecology,
  2. Urology, and
  3. Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  1. Address correspondence and reprint requests to: Ayumi Taguchi, MD, PhD, Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–8655, Japan. E-mail: aytaguchi-tky{at}


Objectives Although lymphovascular space invasion is a prognostic factor for the recurrence of resectable endometrial cancer, the differential impacts of lymphatic vessel invasion (LVI) and blood vessel invasion (BVI) on the recurrence of endometrial cancer are poorly described. We investigated the prognostic significance of LVI and BVI on the recurrence of endometrial cancer and their association with patterns of recurrence.

Methods We retrospectively reviewed 376 patients with stage I to III endometrial cancer who underwent surgery with curative intent at our institution between 2007 and 2015. The associations of the presence of lymphovascular space invasion or LVI and BVI with recurrence-free survival and patterns of recurrence were evaluated.

Results Lymphovascular space invasion positivity was an independent prognostic factor for recurrence-free survival (hazards ratio [HR], 3.070; 95% confidence interval [CI], 1.404–6.824; P = 0.0048). However, when categorized by LVI versus BVI, the latter was a strong independent prognostic factor (HR, 2.697; CI, 1.288–5.798; P = 0.0081), whereas the former was not (HR, 1.740; CI, 0.795–3.721; P = 0.1637). Hematogenous metastasis was the most prevalent form of recurrence in endometrial cancer (24 [50%] of all 48 recurrent cases). Notably, 17 (19.5%) of 87 patients with BVI developed hematogenous metastases, compared with 7 (2.4%) of 289 without BVI (χ2 test, P < 0.0001).

Conclusions Blood vessel invasion rather than LVI was a strong predictor of postoperative recurrence in stage I to III endometrial cancer, probably due to its predisposition to hematogenous metastases.

  • Blood vessel invasion
  • Endometrial cancer
  • Hematogenous metastasis
  • Lymphatic vessel invasion
  • Lymphovascular space invasion

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  • This study was not supported by any external sources of funding.

  • The authors declare no conflicts of interest.