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Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer
  1. Ali Ayhan1,
  2. Hanifi Şahin2,3,
  3. Mustafa Erkan Sari2,3,
  4. Ibrahim Yalçin2,3,
  5. Ali Haberal1 and
  6. Mehmet Mutlu Meydanli2,3
  1. 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
  2. 2 Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
  3. 3 Faculty of Medicine, University of Health Sciences, Ankara, Turkey
  1. Correspondence to Mustafa Erkan Sari, Zekai Tahir Burak Kadın Saglıgı Egitim ve Arastırma Hastanesi, Ankara 06230, Turkey; drerkansari{at}gmail.com

Abstract

Objective The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer.

Methods A dual-institutional, retrospective department database review was performed to identify patients with ‘low-risk endometrial cancer’ (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected.

Results We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival.

Conclusions Age ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.

  • endometrial neoplasms
  • lymphovascular space invasion
  • survival analysis
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned, externally peer reviewed.

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