Objectives To identify the clinical, therapeutic and survival impact of lymphovascular space invasion (LVSI) in epithelial ovarian cancer.
Methods Retrospective study of 151 patients staged surgically in Salah Azaiez Tunisian cancer center, between 2000 and 2010.
Results We performed primary debulking surgery in 128 patients (84.8%) and 23 patients (15.2%) underwent and interval debulking surgery. Maximal cytoreduction (R0) was achieved in 67 of patients (44.4%),39 patients had a residual disease ≤1 cm (25.8%) and 45 patients had a residual disease >1 cm (28.8%). LVSI were recorded in 51 patients (33.8%).LVSI was were associated to higher serum level of CA 125 >1000UI/ml (52.9% vs 33%,p=0.01),higher quantity of ascites >1litre (49% vs 28%,p=0.01) with more frequent cacinomatosis in the upper abdomen (60.8% vs 31%, p<0.0001) and more residual disease R1/R2 (72.5% vs 47%,p<0.0001),bilateral tumors (82.4% vs 58%,p=0.003),advanced FIGO stage III-IV (96.1% vs 68%, p<0.0001) and high tumor grade (88.3% vs 59%, p<0.0001). Among the 84 patients who underwent lymphadenectomy, LVSI positive tumors were correlated to higher risk of lymph node metastasis (LNM) (57.1% vs 30.4%, p=0.018) with higher LN ratio (13.95±21.69 vs 7.25±17.90, p=0.17) and more frequent associated pelvic and para aortic LNM (33.3% vs 10.2%, p=0.015). LVSI positive tumors were correlated to a decreased 5-years overall survival (25.2%vs 44%, p=0.004) and recurrence free survival (26.8% vs 47%,p=0.019).
Conclusion LVSI is an independent predictor of extended lymph node metastasis, progression and survival in patients with primary epithelial ovarian cancer.
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