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Abstract
Introduction/Background The 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system groups focal lymphovascular space invasion (F-LVSI) and no LVSI (NEG) into one risk category, sparking debate over the prognostic impact of substantial LVSI (S-LVSI). We sought to clarify the prognostic significance of LVSI in patients with stage I node-negative endometrioid endometrial cancer (EEC).
Methodology This retrospective cohort study examined patients with FIGO 2009 stage I EEC treated surgically with total hysterectomy and lymph node assessment at 2 tertiary care centers between 01/01/2012–12/31/2019. LVSI was categorized as F-LVSI (<5 spaces) or S-LVSI (≥5 spaces) using World Health Organization (WHO)/FIGO2023 criteria.
Results Of 1555 patients included, 65(4.2%) had S-LVSI, 119(7.7%) F-LVSI, and 1371(88.1%) NEG. Median age was 64 years (range, 24–90) for S-LVSI, 67 years (range, 35–87) for F-LVSI, and 60 years (range, 27–92) for NEG (P<.001). Thirty-five patients (54%) with S-LVSI, 44 (37%) with F-LVSI, and 115(8.4%) with NEG (P<.001) had stage IB disease. Twenty-one patients (32%) with S-LVSI, 24(20%) with F-LVSI, and 91(6.6%) with NEG (P<.001) had grade 3 disease. Thirty-six patients (55%) with S-LVSI, 80(67%) with F-LVSI, and 207(15%) with NEG (P<.001) received adjuvant treatment. Median follow-up was 61 months (range, 0.8–134). Five-year progression-free survival rates were 68.7% (S-LVSI), 70.5% (F-LVSI), and 90.7% (NEG; P<.001). Five-year overall survival rates were 76.5% (S-LVSI), 82.2% (F-LVSI), and 95.4% (NEG; P<.001). On multivariate analysis, compared to NEG, F-LVSI and S-LVSI demonstrated increased risk of progression/death (aHR, 1.84 [95% CI: 1.73–1.96]) and aHR, 2.17 [95% CI: 1.96–2.39], respectively). Compared to F-LVSI, S-LVSI had an aHR for recurrence/death of 1.18 (95% CI: 1.0–1.4).
Conclusion S-LVSI and F-LVSI were independently associated with disease progression/death. However, S-LVSI as defined by WHO/FIGO2023 was not associated with different oncologic outcomes compared to F-LVSI. Grouping F-LVSI and NEG into one risk category requires further investigation.
Disclosures Vicky Makker reports providing unpaid consultion for: ArQule, AstraZeneca, Clovis Oncology, Cullinan, Duality, Eisai, Faeth Therapeutics, GlaxoSmithKline, Jazz, Immunocore, ITeos Therapeutics, Kartos Therapeutics, Karyopharm Therapeutics, Lilly, Merck, Moreo, Morphosys, Prelude, Novartis, Takeda, Zymeworks. Research Funding for: AstraZeneca (Inst), Bayer (Inst), Bristol-Myers Squibb (Inst), Clovis Oncology (Inst), Duality (Inst), Eisai (Inst), Faeth Therapeutics (Inst), Karyopharm Therapeutics (Inst), Lilly (Inst), Merck (Inst), Takeda (Inst), Zymeworks (Inst), Cullinan (Inst). Receiving travel, and accommodation expenses from Eisai, and Merck. Other Relationship with: IBM. She is supported in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.
Mario M. Laitao Jr. is an ad hoc speaker for Intuitive Surgical, Inc., has consulted for Medtronic, and has served on the advisory boards of Ethicon/Johnson & Johnson and Immunogen.
Ane Gerda Eriksson reports receiving funds from Intuitive Surgical, Inc. and AstraZeneca.
Nadeem R. Abu-Rustum reports grant funding from GRAIL paid to the institution.
a-Kaplan meier curve comparing progression-free survival for study population based on extent of lympho-invasion, N=1551. b-Multivariate Cox regression analysis for progression-free survival adjusted for clustering effect using the Wei, lin, Weissfeld’s estimate, N=1551