Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma

Ashley E Veade,Brittany A Davidson,Gloria Broadwater,Jonathan Foote,Paula S Lee,Angeles Alvarez Secord,Andrew Berchuck,Laura J Havrilesky,Jessie Ehrisman

doi:10.1186/s12957-019-1620-x

Ashley E Veade, Brittany A Davidson + Show 7 more

Open Access

https://doi.org/10.1186/s12957-019-1620-x

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Abstract

ObjectiveTo investigate the predictive value of lymphovascular space invasion (LVSI) for nodal recurrence and overall survival (OS) in patients with stage I endometrioid endometrial cancer (EC) following surgical staging that included adequate lymph node sampling.MethodsRetrospective analyses of patients undergoing surgical staging for FIGO stage I endometrioid EC between 1998 and 2015 were performed using an institutional database and the National Cancer Database (NCDB). Using the institutional database, logistic regression modeling identified predictors of nodal recurrence; Cox proportional hazards modeling was used to predict progression-free survival (PFS). Utilizing NCDB, Cox proportional hazards modeling was used to predict OS. The Kaplan-Meier method was used to estimate hazard ratios (HR). Survival curves were compared using the log-rank test.ResultsAmong 275 institutional cases, LVSI was present in 48 (17.5%). There were 11 nodal recurrences: 18.8% (9/48) of cases with LVSI had a nodal recurrence compared to 0.88% (2/227) of those without LVSI. In multivariate analysis of institutional data, LVSI was the only significant predictor of nodal recurrence (p = 0.002). Among 28,076 NCDB cases, LVSI was present in 3766 (13.5%). In multivariate analysis of NCDB, grade 3, LVSI, and depth of invasion (all p < 0.001) were prognostic for OS after adjusting for adjuvant radiation.ConclusionLVSI is an independent prognostic factor for nodal recurrence in stage I endometrial cancer with lymph node assessment. LVSI is associated with lower OS in NCDB. Given these findings, adjuvant therapy could be considered in these patients.

Highlights

Endometrial cancer (EC) is the most common cancer of the female reproductive tract in the USA [1,2,3,4,5]
lymphovascular space invasion (LVSI) was present in 17.5% (48/275) of subjects from the Duke EC database and in 13.5% (3766/27,801) of those in the National Cancer Database (NCDB)
The current study identifies LVSI as a significant predictor of nodal recurrence with over 20-fold increased risk, from < 1% to over 18%

Summary

Introduction

Endometrial cancer (EC) is the most common cancer of the female reproductive tract in the USA [1,2,3,4,5]. According to the American Cancer Society, over 60,000 new cases of endometrial cancer were diagnosed and about 10,000 women died from the disease in 2016. The majority of patients present with FIGO stage I endometrioid cancers and do not have lymph node metastases at surgical staging. Despite uterine-limited disease on final pathology, 10–20% of these cancers recur [1, 2, 6]. Relapse usually occurs within 24 months of diagnosis [1, 2, 6]. Deep myometrial invasion, higher grade, and lymphovascular space invasion (LVSI) all have consistently been associated with an increased risk of recurrence of earlystage endometrial cancers [1, 2, 4, 5, 7, 8]

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