S Jaishankar1, P M Pifer1, R Bhargava2, A Keller1, H B Musunuru1, A K Patel3, P Sukumvanich4, M Boisen4, J L Berger4, S Taylor4, M Courtney-Brooks4, A Olawaiye4, J Lesnock4, R Edwards4, J A Vargo1, S Beriwal5. 1. Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Department of Pathology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 3. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA. 4. Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 5. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA; Varian Medical Systems, Charlottesville, VA, USA. Electronic address: sushilberiwal@gmail.com.
Abstract
AIMS: Substantial lymphovascular space invasion (LVSI) compared with none or focal LVSI is predictive of lymph node involvement and worse clinical outcomes in endometrioid-type endometrial carcinoma. We aimed to quantify the incidence of substantial LVSI in type II (clear cell and serous) endometrial cancer and correlate the extent of LVSI with clinical outcomes. MATERIALS AND METHODS: A retrospective review was conducted on type II endometrial cancer patients who underwent surgical management from July 2017 to December 2019 using the three-tier LVSI scoring system. Binary logistic regression and Cox regression were used to analyse predictors of lymph node involvement or survival outcomes, respectively. The Kaplan-Meier method and Log-rank test were used to analyse differences in locoregional disease-free survival (LR-DFS), distant metastasis disease-free survival (DM-DFS) and overall survival between patients with substantial versus none/focal LVSI. RESULTS: In 79 patients with type II endometrial carcinoma, no LVSI, focal LVSI and substantial LVSI was present in 48.1%, 15.2% and 36.7% of patients, respectively. Lymph nodes were involved in 0.0% with no LVSI, 20.0% with focal LVSI and 60.0% with substantial LVSI (P < 0.001). The median follow-up was 22.2 months. In patients with none/focal versus substantial LVSI, the 2-year LR-DFS and DM-DFS rates were 91.5% versus 71.4% (P = 0.01) and 90.2% versus 63.8% (P = 0.005), respectively. On univariate analysis, myometrial invasion ≥50%, tumour size ≥3.6 cm, substantial versus none/focal LVSI, lymph node involvement and omission of adjuvant radiotherapy were significant predictors for worse LR-DFS and DM-DFS (P < 0.05). DISCUSSION: Substantial LVSI has a high incidence in type II pathology at our institution and predicts for lymph node involvement and worse clinical outcomes.
AIMS: Substantial lymphovascular space invasion (LVSI) compared with none or focal LVSI is predictive of lymph node involvement and worse clinical outcomes in endometrioid-type endometrial carcinoma. We aimed to quantify the incidence of substantial LVSI in type II (clear cell and serous) endometrial cancer and correlate the extent of LVSI with clinical outcomes. MATERIALS AND METHODS: A retrospective review was conducted on type II endometrial cancer patients who underwent surgical management from July 2017 to December 2019 using the three-tier LVSI scoring system. Binary logistic regression and Cox regression were used to analyse predictors of lymph node involvement or survival outcomes, respectively. The Kaplan-Meier method and Log-rank test were used to analyse differences in locoregional disease-free survival (LR-DFS), distant metastasis disease-free survival (DM-DFS) and overall survival between patients with substantial versus none/focal LVSI. RESULTS: In 79 patients with type II endometrial carcinoma, no LVSI, focal LVSI and substantial LVSI was present in 48.1%, 15.2% and 36.7% of patients, respectively. Lymph nodes were involved in 0.0% with no LVSI, 20.0% with focal LVSI and 60.0% with substantial LVSI (P < 0.001). The median follow-up was 22.2 months. In patients with none/focal versus substantial LVSI, the 2-year LR-DFS and DM-DFS rates were 91.5% versus 71.4% (P = 0.01) and 90.2% versus 63.8% (P = 0.005), respectively. On univariate analysis, myometrial invasion ≥50%, tumour size ≥3.6 cm, substantial versus none/focal LVSI, lymph node involvement and omission of adjuvant radiotherapy were significant predictors for worse LR-DFS and DM-DFS (P < 0.05). DISCUSSION: Substantial LVSI has a high incidence in type II pathology at our institution and predicts for lymph node involvement and worse clinical outcomes.
Keywords:
Clear cell endometrial carcinoma; serous endometrial carcinoma; substantial lymphovascular space invasion; type II endometrial carcinoma; uterine cancer
Authors: Tjalling Bosse; Elke E M Peters; Carien L Creutzberg; Ina M Jürgenliemk-Schulz; Jan J Jobsen; Jan Willem M Mens; Ludy C H W Lutgens; Elzbieta M van der Steen-Banasik; Vincent T H B M Smit; Remi A Nout Journal: Eur J Cancer Date: 2015-06-03 Impact factor: 9.162
Authors: Elizabeth A Barnes; Kevin Martell; Carlos Parra-Herran; Amandeep S Taggar; Elysia Donovan; Eric Leung Journal: Brachytherapy Date: 2021-01-21 Impact factor: 2.362
Authors: Justine M Briët; Harry Hollema; Nathalie Reesink; Jan G Aalders; Marian J E Mourits; Klaske A ten Hoor; Elisabeth Pras; H Marike Boezen; Ate G J van der Zee; Hans W Nijman Journal: Gynecol Oncol Date: 2005-03 Impact factor: 5.482
Authors: C L Creutzberg; W L van Putten; P C Koper; M L Lybeert; J J Jobsen; C C Wárlám-Rodenhuis; K A De Winter; L C Lutgens; A C van den Bergh; E van de Steen-Banasik; H Beerman; M van Lent Journal: Lancet Date: 2000-04-22 Impact factor: 79.321
Authors: R A Nout; V T H B M Smit; H Putter; I M Jürgenliemk-Schulz; J J Jobsen; L C H W Lutgens; E M van der Steen-Banasik; J W M Mens; A Slot; M C Stenfert Kroese; B N F M van Bunningen; A C Ansink; W L J van Putten; C L Creutzberg Journal: Lancet Date: 2010-03-06 Impact factor: 79.321
Authors: C A Hamilton; M K Cheung; K Osann; L Chen; N N Teng; T A Longacre; M A Powell; M R Hendrickson; D S Kapp; J K Chan Journal: Br J Cancer Date: 2006-03-13 Impact factor: 7.640
Authors: B G Wortman; C L Creutzberg; H Putter; I M Jürgenliemk-Schulz; J J Jobsen; L C H W Lutgens; E M van der Steen-Banasik; J W M Mens; A Slot; M C Stenfert Kroese; B van Triest; H W Nijman; E Stelloo; T Bosse; S M de Boer; W L J van Putten; V T H B M Smit; R A Nout Journal: Br J Cancer Date: 2018-10-25 Impact factor: 7.640