You are here

  • Home
  • Online First
  • Oncologic outcomes based on lymphovascular space invasion in node-negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study

Article Text

Article menu
Download PDFPDF
Original research
Oncologic outcomes based on lymphovascular space invasion in node-negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study
  1. Christian Dagher1,
  2. Pernille Bjerre Trent2,3,
  3. Rofieda Alwaqfi4,
  4. Ben Davidson3,5,
  5. Lora Ellenson4,
  6. Qin C Zhou6,
  7. Alexia Iasonos6,
  8. Jennifer J Mueller1,7,
  9. Kaled Alektiar8,
  10. Vicky Makker9,10,
  11. Sarah Kim1,7,
  12. Mario M Leitao Jr1,7,
  13. Nadeem R Abu-Rustum1,7 and
  14. Ane Gerda Z Eriksson2,3
    1. 1 Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    2. 2 Department of Gynecologic Oncology, Division of Cancer Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
    3. 3 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
    4. 4 Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    5. 5 Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
    6. 6 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    7. 7 Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
    8. 8 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    9. 9 Gynecology Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
    10. 10 Department of Medicine, Weill Cornell Medical College, New York, New York, USA
    1. Correspondence to Dr Nadeem R Abu-Rustum, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; abu-rusn{at}mskcc.org

    Abstract

    Background The 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system includes lymphovascular invasion quantification as a staging criterion for endometrioid endometrial carcinomas; no lymphovascular invasion and focal invasion (≤4 vessels involved) are grouped as one category, and substantial invasion as another.

    Objective To assess the association between lymphovascular invasion and oncologic outcomes.

    Methods We retrospectively identified patients with FIGO 2009 stage I endometrioid endometrial cancer treated surgically with total hysterectomy and lymph node assessment at two tertiary care centers between January 1, 2012, and December 31, 2019. Lymphovascular space invasion was categorized as focal (<5 vessels involved), substantial (≥5 vessels involved), and no lymphovascular invasion using WHO criteria.

    Results Of 1555 patients included, 65 (4.2%) had substantial, 119 (7.7%) had focal, and 1371 (88.2%) had no lymphovascular invasion. Median age was 64 years (range 24–92). Thirty-five patients (53.8%) with substantial, 44 (37%) with focal, and 115 (8.4%) with no lymphovascular invasion had stage IB disease (p<0.001); 21 (32.3%) with substantial, 24 (20.2%) with focal, and 91 (6.6%) with no lymphovascular invasion had grade 3 disease (p<0.001). Thirty-six patients (55.4%) with substantial, 80 (67.2%) with focal, and 207 (15.1%) with no lymphovascular invasion received adjuvant treatment (p<0.001). Median follow-up was 61.5 months (range 0.8–133.9). Five-year progression-free survival rates were 68.7% (substantial), 70.5% (focal), and 90.7% (no invasion) (p<0.001). On multivariate analysis, any lymphovascular invasion was associated with increased risk of progression/death (adjusted HR (aHR)=1.84 (95% CI 1.73 to 1.96) for focal; 2.17 (95% CI 1.96 to 2.39) for substantial). Compared with focal, substantial lymphovascular invasion was associated with an aHR for disease progression of 1.18 (95% CI 1.00 to 1.39).

    Conclusions Focal and substantial lymphovascular invasion were associated with increased risk of disease progression and do not appear to be prognostically distinct. Focal versus no lymphovascular invasion have different prognostic outcomes and should not be combined into one category.

    • endometrium
    • retrospective study
    • lymphatic metastasis

    Data availability statement

    Data are available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

    https://doi.org/10.1136/ijgc-2024-005746

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Data availability statement

      Data are available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

      View Full Text

      Footnotes

      • X @ChrisDagherMD, @BjerreTrent, @leitaoMD, @AbuRustumMD, @agz_eriksson

      • Presented at This work was presented as an oral plenary session at the 2024 European Society of Gynaecologic Oncology Annual Meeting.

      • Contributors CD: conceptualization, methodology, data curation, visualization, writing - original draft. PKBT: data curation, writing - review and editing. RA, BD, LE: pathology review, writing - review and editing. QCZ, AI: formal analysis, visualization, writing - review and editing. JM, KA, VM: writing - review and editing. SK: resources. ML: supervision, conceptualization, writing - review and editing. NRA-R: supervision, conceptualization, methodology, writing – original draft, guarantor. AGE: supervision, conceptualization, writing - review and editing.

      • Funding This research was funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748. CD was supported in part by the Bobst International Fellowship for Citizens of Lebanon.

      • Competing interests AGE reports speakers fee from Intuitive Surgical and GSK. BD is a speaker and consultant for MSD. NRA-R reports research funding from GRAIL paid to the institution. ML reports personal fees from Medtronic, Intuitive Surgical, J&J/Ethicon, and Immunogen. VM is supported (all funding to institution)/unpaid consultancy/advisory board membership from AstraZeneca, Clovis, Duality, Eisai, Faeth, Genentech, GSK, Immunocore, iTEOS, Kartos, Karyopharm, Moreo, Morphosys, MSD, Novartis, Takeda, and Zymeworks. The other authors have nothing to disclose.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

      Linked Articles