Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-Risk Endometrial Cancer

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Approximately 15% of patients with endometrial cancer present with high-risk disease (HREC). Moreover, assessing the extent of lymphovascular space invasion (LVSI) may provide prognostic insight among patients with HREC. The aim of this study was to determine whether the extent of LVSI can serve as a prognostic factor in HREC. All cases of ESMO-ESGO-ESTRO 2016 classified HREC in the Danish Gynecological Cancer Database (DGCD) diagnosed from 2005 to 2012 were reviewed for the presence and extent of LVSI (categorized using a 3-tiered definition). We used the Kaplan-Meier analysis to calculate actuarial survival rates, both adjusted and unadjusted Cox regression analyses were used to calculate the proportional hazard ratio (HR). A total of 376 patients were included in our analysis. Among 305 patients with stage I/II HREC, 8.2% and 6.2% had focal or substantial LVSI, respectively, compared with 12.7% and 38.0% of 71 patients with stage III/IV HREC, respectively. Moreover, the estimated 5-yr recurrence-free survival rate was significantly lower among patients with substantial LVSI compared with patients with no LVSI for both stage I/II (HR: 2.8; P=0.011) and stage III/IV (HR: 2.9; P=0.003) patients. Similarly, overall survival was significantly lower among patients with substantial LVSI for both stage I/II (HR: 3.1; P<0.001) and stage III/IV (HR: 3.2; P=0.020) patients. In patients with HREC, substantial LVSI is an independent adverse prognostic factor for lymph node and distant metastases, leading to reduced survival. Thus, the extent of LVSI should be incorporated into routine pathology reports in order to guide the appropriate choice of adjuvant treatment.

OriginalsprogEngelsk
TidsskriftInternational Journal of Gynecological Pathology
Vol/bind41
Udgave nummer3
Sider (fra-til)227-234
Antal sider8
ISSN0277-1691
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
From the Departments of Pathology (E.E.M.P., A.L.-C., V.T.H.B.M.S., T.B.); Radiation Oncology (C.L.C., R.A.N.), Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev (E.H., M.B.); and Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen (C.H., G.Ø.), Denmark. Present address: Elke E.M. Peters, MD, Haaglanden Medical Center, P.O. Box 432, The Hague 2501 AX, The Netherlands. Present address: Remi A. Nout, MD, PhD, Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands. E.E.M.P., C.L.C., T.B., V.T.H.B.M.S., and R.A.N.: conceptualization. A.L.-C. and G.Ø.: data curation. G.Ø.: formal analyses. E.E.M.P., A.L.-C., T.B., V.T.H.B.M.S., and G.Ø.: investigation. E.E.M.P. and G.Ø.: methodology. E.H., M.B., C.H., and G.Ø.: resources. C.L.C. and V.T.H.B.M.S.: supervision. E.E.M.P.: writing original draft. A.L.-C., C.L.C., C.H., E.H., E.E.M.P., G.Ø., M.B., R.A.N., T.B., and V.T.H.B. M.S.: manuscript review and editing. R.A.N. reports grants by the Dutch Cancer Society, Dutch Research Council, Elekta, Varian and Accuracy, all unrelated to this work. C.L.C. reports grants from the Dutch Cancer Society. The remaining authors declare no conflict of interest. Address correspondence to Tjalling Bosse, MD, PhD, Department of Pathology, L1-Q, P.O. Box 9600, Leiden 2300 RC, The Netherlands. E-mail: t.bosse@lumc.nl. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.intjgynpathology.com.

Funding Information:
Acknowledgments: The authors thank Curtis F. Barrett, PhD of English Editing Solutions, Bunnik, The Netherlands for providing medical editorial support, which was funded by Leiden University Medical Center, Leiden, The Netherlands.

Publisher Copyright:
© 2021 International Society of Gynecological Pathologists

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