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. 2019 Sep;30(5):e84.
doi: 10.3802/jgo.2019.30.e84.

Lymph-vascular space invasion (LVSI) as a strong and independent predictor for non-locoregional recurrences in endometrial cancer: a Danish Gynecological Cancer Group Study

Gitte Ørtoft  1 , Lisa Lausten-Thomsen  2 , Claus Høgdall  3 , Estrid S Hansen  4 , Margit Dueholm  5
Affiliations

Lymph-vascular space invasion (LVSI) as a strong and independent predictor for non-locoregional recurrences in endometrial cancer: a Danish Gynecological Cancer Group Study

Gitte Ørtoft et al. J Gynecol Oncol. 2019 Sep.

Abstract

Objective: To evaluate the effect of lymph-vascular space invasion (LVSI) on location of recurrences in Danish patients with endometrial cancer.

Methods: This national cohort study (2005-2012) included 4,380 radically operated patients (no visual tumor, all distant metastasis removed). LVSI status was recorded in 3,377 (77.1%). In stage I patients, 2.6% received adjuvant radiotherapy and 1.4% adjuvant chemotherapy. Adjusted Cox regression was used to compare actuarial recurrence rates.

Results: LVSI was present in 18.7% of 3,377 patients with known LVSI status. Of these, 7.6% stage I patients with LVSI experienced an isolated locoregional and 19.4% a non-locoregional recurrence. Compared to no LVSI, 5-year recurrence rate was higher (25.5% vs. 8.5%) in patients with LVSI and the frequency of distant recurrences was strikingly higher (stage I: 15.2% vs. 2.7%), the effect being similar across International Federation of Gynecology and Obstetrics stages and histological types. In intermediate-risk stage I patients with LVSI, 8.0% experienced an isolated locoregional recurrence compared to 20.1% with non-locoregional recurrence, giving these patients a seriously adverse risk of survival. A separate analysis in patients with recurrences demonstrated that those with LVSI had significantly more distant recurrences (55.4% vs. 29.9%) and fewer isolated vaginal recurrences (24.3% vs. 42.8%) than patients with no LVSI.

Conclusion: LVSI is a strong independent risk factor for the development of non-locoregional recurrences even in intermediate-risk stage I endometrial cancer. The non-locoregional recurrence pattern suggests a future focus for optimization of postoperative treatment in these patients.

Keywords: Endometrial Cancer; Lymph Vascular Space Invasion; Recurrences; Risk Groups; Survival.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Five-year recurrence rates of cases with or without LVSI subdivided into endometrioid and non-endometrioid cancers. Recurrences divided into total number of recurrences at each location: vaginal, pelvic, abdominal, or distant recurrences. If a patient had recurrences at several sites, the patient can be represented more than once.
LVSI, lymph-vascular space invasion. *The p<0.05 LVSI tested against no LVSI using adjusted Cox analysis.
Fig. 2
Fig. 2. Five-year actuarial recurrence rates of cases with and without LVSI sub-divided into (A) Low-, intermediate-, and high-risk stage I and (B) Lymph node stage and negative low-, intermediate-, and high-risk stage I. Recurrences divided into total number of recurrences at each location: vaginal, pelvic, abdominal, or distant recurrences. If a patient had recurrences at several sites, the patient can be represented more than once.
LVSI, lymph-vascular space invasion. *The p<0.05 testing LVSI against no LVSI using adjusted Cox analysis.
See this image and copyright information in PMC

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