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351 Substantial lymph-vascular space invasion (LVSI) as predictor of distant relapse and poor prognosis in low-risk early stage endometrial cancer
  1. L Tortorella1,
  2. S Restaino1,
  3. G Zannoni2,
  4. G Vizzielli1,
  5. V Chiantera3,
  6. S Cappuccio1,
  7. A Gioè1,
  8. E La Fera1,
  9. G Dinoi1,
  10. G Angelico2,
  11. G Scambia1 and
  12. F Fanfani1
  1. 1Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy
  2. 2Bambino e di Sanità Pubblica, Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
  3. 3Dipartimento di Ginecologia Oncologica, Università di Palermo, Italy


Objective To evaluate the prognostic role of LVSI, evaluated in a semi-quantitative fashion on prognosis of early stage, low risk endometrial cancer (EC).

Methods We enrolled patients who underwent surgery for EC between 2003 and 2018 in two referral cancer center. All patients had endometrioid EC, G1-G2, with myometrial invasion <50%, and no lymph-node involvement. LVSI was analyzed in a semi-quantitative way, according to a three-tiered scoring system in absent, focal and substantial.

Results Among 524 patients, any positive LVSI was found in 57 patients (10.9%) with 6.7% (n=35) focal LVSI and 4.2% (n=22) substantial LVSI. Substantial LVSI was associated to higher rate of G2 (p<0.001), myometrial infiltration (p=0.002) and greater tumor dimensions (p=0.014). Patients with substantial LVSI were more likely to receive adjuvant treatment (6.6% vs 52.6%p<0.001). The 5-year OS was 99.5% in patients with absent LVSI and 70.6% in those with substantial LVSI (p<0.001). The 5-year recurrence free survival was 93.6% in patients with absent LVSI and 56.5% in those with substantial LVSI (p<0.001). The rate of distant failures increased from 1.8% for absent LVSI to 22.7% for substantial LVSI (p=0.002). In univariate analysis substantial LVSI was the strongest predictor of poor overall survival (HR= 11.9, p=0.001). Multivariate analysis showed that substantial LVSI was an independent predictive factor of both recurrence (HR=5.88, p=0.001) and distant failure (HR=10.6, p=0.006).

Abstract 351 Figure 1

Overall survival and disease free survival according to lymph-vascular space invasion status

Abstract 351 Table 1

Univariable and multivariable logistic regression analysis of risk factors for distant recurrence among patients at low risk

Conclusions Substantial LVSI represents the strongest independent risk factor for decreased survival and distant relapse, indicating a role for potential hematogenous dissemination.

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