<b>Objectives:</b> Approximately one in five women with early-stage endometrial cancer (EC) will have lymphovascular space invasion (LVI). Reporting of LVI requires skilled pathologic evaluation and has important prognostic implications on adjuvant treatment. Access to gynecologic pathologists (GPath) varies by region and may contribute to disparate healthcare outcomes. We aimed to describe reporting rate and survival outcomes of LVI in stage I-II EC in a practice setting with no employed gynecologic pathologist. <b>Methods:</b> A multi-center, IRB-approved retrospective chart review was performed at three hospitals with no employed gynecologic pathologist. Women with stage I-II EC treated with hysterectomy from 2013-2019 were included. Women were excluded if they presented with stage III or IV disease or had systemic or radiation therapy prior to surgical staging. Demographic, pathologic, treatment, and survival data were collected. Descriptive statistics were performed for the entire cohort as well as for the subset, GOG99-like (myoin- vaive, endometrioid histology, with a lymph node assessment). <b>Results:</b> Of the 129 women included, 67 were non-Hispanic White (51.9%), 55 non-Hispanic Black (42.6%), followed by three Hispanic (2.3%), two others (1.6%), one Asian (0.7%), and one unknown (0.7%). Twenty-nine patients (22.5%) were privately insured, 30 (23.3%) had Medicare or other public insurance, 37 (28.7%) had Medicaid, and 33 (25.6%) were uninsured. Median BMI was 37.6 (95% CI: 36.6-39.8), and Charlson Comorbidity Index was 4.0 (95% CI: 3.8-4.4). For surgical staging, hysterectomy was accomplished minimally invasively in 59 (46.8%) cases, and 74 (57.4%) had a lymph node assessment. Most were stage IA (<i>n</i>=90, 69.8%), followed by stage IB (<i>n</i>=22, 17.1%), and stage II (<i>n</i>=17, 13.2%). The median depth of invasion was 16 mm (95% CI: 19.7-29.2). Endometrioid histology was most common (<i>n</i>=106, 82.2%), but type II histologies were seen 17.8% (<i>n</i>=23) of the time. Among the cases, 66 were grade 1 (51.6%), 32 grade 2 (25.0%), and 30 grade 3 (23.4%). One case (1.8%) was reviewed by a gynecologic pathologist. Fifteen women (11.6%) were LVI positive: four focal, one diffuse, and eight not further described. At a median of 23.0 months (95% CI: 23.5-31.1) follow-up from diagnosis, 113 patients (87.6%) were alive with no evidence of malignancy (NEM). For MI+ subjects, ten (12.2%) were LVI positive. At a median of 28.0 (95% CI: 23.4-32.6) months, 74 (90.3%) MI+ subjects were alive with NEM. In the 50 GOG99-like subjects, six (12.0%) were LVSI positive. At a median of 23.6 (95% CI: 23.4-32.6) months, 47 (94%) were alive with NEM; four (67.7%) of LVI positive, and 43 (97.8%) of LVI negative women were alive with NEM. Three patients (6%) had the recurrent disease at that time. Table 1 <b>Conclusions:</b> We report rates of LVI and stage I-II EC survival outcomes in a diverse patient population in a region with limited access to formal GPath review. In GOG99, rates of reported LVI were 23.2%, and at 24 months, the cumulative incidence of recurrence in the treatment group was 3% (90% CI: 2-6%). Here, our rates of reported LVI were 11.6% overall and 12% in our GOG99-like group. With a median of two years of follow-up, 10% of our total cohort and 2.3% of a GOG99-like cohort recurred. "Missed" LVI would likely result in detrimental survival outcomes in the LVI negative group. Our LVI population performed well. Their excellent survival and recurrence rates are at expected levels, and reassuringly signals that missed LVI are not contributing detectably to mismanagement.
Search from 250 M+ research papersSearch from 250 M+ research papers
Aug 1, 2022
Soyoun Rachel Kim + 9
Open Access