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

• Published in: Journal of gynecologic oncology Vol. 30; no. 5; p. e84
• Main Authors: Ørtoft, Gitte, Lausten-Thomsen, Lisa, Høgdall, Claus, Hansen, Estrid S, Dueholm, Margit
• Format: Journal Article
• Language: English
• Published: Korea (South) 대한부인종양학회 01-09-2019
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Endometrioid - mortality; Carcinoma, Endometrioid - pathology; Denmark - epidemiology; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Female; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Prognosis; Prospective Studies; Risk Factors; Young Adult; 산부인과학; Denmark; Endometrial Cancer; Risk Groups; Lymph Vascular Space Invasion; Survival; Recurrences
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2019.30.e84

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