Abstract
Objective: The purpose of this case-control study was to investigate the effect of lymphovascular space invasion on recurrence patterns and survival in patients with stage IIIC endometrioid type endometrial cancer.Study Design: A multicenter, retrospective, department database review was performed to identify lymphovascular space invasion-negative and lymphovascular space invasion-positive stage IIIC endometrioid endometrial cancer at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Cases and controls were matched in terms of age at diagnosis, grade of tumor, depth of myometrial invasion, sub-stage and adjuvant treatment.Results: Forty-one patients in the case group and 82 patients in the control group were eligible for the study. The 5-year OS rates were 94.4% in the lymphovascular space invasion-negative group and 77.2% in the LVSI-positive group (p=0.058). Advanced age (58 years) (HR 3.73; 95% CI: 1.19-11.69, p=0.02), grade 3 tumor (HR 2.57; 95% CI: 1.002-6.62, p=0.048) and cervical involvement (HR 2.62; 95% CI: 1.03-6.67, p= 0.04) appeared to be as independent predictors of decreased overall survival (OS). There was a trend towards statistical significance between the presence of lymphovascular space invasion and OS in regression analysis (HR 3.10; 95% CI 0.90-10.67, p=0.05). Recurrence rates were 17.0% (7/41) and 24.4% (20/82) in lymphovascular space invasion-negative and lymphovascular space invasion-positive groups, respectively (p=0.48). There were 5 cases of retroperitoneal recurrences in the lymphovascular space invasion-positive group and no retroperitoneal recurrence among lymphovascular space invasion-negative women.Conclusion: Lymphovascular space invasion status seems to be of borderline significance for OS in stage IIIC endometrioid endometrial cancer and impacts recurrence patterns as retroperitoneal recurrences are strongly related to positive lymphovascular space invasion status.
Highlights
Advanced age (≥58 years) (HR 3.73; 95% confidence interval (CI): 1.19-11.69, p=0.02), grade 3 tumor (HR 2.57; 95% CI: 1.002-6.62, p=0.048) and cervical involvement (HR 2.62; 95% CI: 1.03-6.67, p= 0.04) appeared to be as independent predictors of decreased overall survival (OS)
There was a trend towards statistical significance between the presence of lymphovascular space invasion and OS in regression analysis (HR 3.10; 95% CI 0.90-10.67, p=0.05)
Lymphovascular space invasion status seems to be of borderline significance for OS in stage IIIC endometrioid endometrial cancer and impacts recurrence patterns as retroperitoneal recurrences are strongly related to positive lymphovascular space invasion status
Summary
Between November 1998 and November 2016, a multicenter retrospective analysis of patients with surgically staged EC at five gynecologic oncology institutions from Turkey was carried out, following the approval of the Local Institutional Review Boards (Approval number: 28/12/2017-6). We performed a retrospective database search from our prospectively maintained electronic database to find out patients diagnosed as stage IIIC Endometrioid type EC with LVSI negative. The case group consisted of 41 patients who had FIGO stage IIIC LVSI-negative endometrioid type EC according to the final pathology reports. For each patient with LVSI-negative endometrioid type EC, two women with FIGO stage IIIC LVSI-positive endometrioid type EC were selected from the same database for comparison. Patients with non-endometrioid or mixed histologic types, women with inadequate lymphadenectomy, those with incomplete medical records and women with synchronous malignancies were excluded from the study. Data regarding patient medical histories, surgical staging and tumor pathology were gathered from the databases of the five institutions
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