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Lucia Tortorella,Stefano Restaino,Gianfranco Zannoni,Giuseppe Vizzielli,Vito Chiantera,Serena Cappuccio,Alessandro Gioè,Eleonora La Fera,Giorgia Dinoi,Giuseppe Angelico,Giovanni Scambia,Francesco Fanf 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objective: The aim of this study is to analyze the prognostic role of lymph-vascular spaceinvasion (LVSI), evaluated in a semi-quantitative fashion on prognosis of early stage, low riskendometrial cancer (EC). Methods: We enrolled patients who underwent surgery for endometrial cancer between2003 and 2018 in two referral cancer center. All patients had endometrioid EC, G1–G2, withmyometrial invasion <50%, and no lymph-node involvement. LVSI was analyzed in a semi quantitative way, according to a 3-tiered scoring system in absent, focal and substantial. Results: Among 524 patients, any positive LVSI was found in 57 patients (10.9%) with focalLVSI (n=35, 6.7%) and substantial LVSI (n=22, 4.2%). Substantial LVSI was associated tohigher rate of G2 (p<0.001), myometrial infiltration (p=0.002) and greater tumor dimensions(p=0.014). Patients with substantial LVSI were more likely to receive adjuvant treatment(6.6% vs. 52.6%, p<0.001). The 5-year OS was 99.5% in patients with absent LVSI and 70.6%in those with substantial LVSI (p<0.001). The 5-year disease free survival (DFS) was 93.6%in patients with absent LVSI and 56.5% in those with substantial LVSI (p<0.001). The rate ofdistant failures increased from 1.8% for absent LVSI to 22.7% for substantial LVSI (p=0.002). In univariate analysis substantial LVSI was the strongest predictor of poor overall survival(hazard ratio [HR]=11.9, p=0.001). Multivariate analysis showed that substantial LVSI wasan independent predictive factor of both recurrence (HR=5.88, p=0.001) and distant failure(HR=10.6, p=0.006). Conclusions: Substantial LVSI represents the strongest independent risk factor for decreasedsurvival and distant relapse, indicating a role for potential hematogenous dissemination.
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