SAN DIEGO – The presence of lymphovascular space invasion in the setting of early-stage endometrial cancer is a more potent independent predictor of associated pelvic lymph node metastases than previously recognized, Dr. Soledad Jorge reported at the annual meeting of the Society of Gynecologic Oncology.
Indeed, she found in her large, population-based study that lymphovascular space invasion (LVSI) was the strongest predictor of nodal disease, even more robust than tumor grade. LVSI also was associated with a 1.92-fold increased risk of mortality at 45 months’ follow-up after adjustment for the presence of lymph node metastases.
This was a study of 25,907 women with surgically staged endometrioid adenocarcinoma of the endometrium who underwent hysterectomy and lymphadenectomy during 2010-2012 and were registered in the National Cancer Data Base. Seventy-two percent of them had T1A disease, defined by less than 50% myometrial invasion, while the remaining 28% had T1B disease with greater than 50% myoinvasion, according to Dr. Jorge of Columbia University in New York.
LVSI was present in 15.2% of the women. Lymph node metastases were detected in 5% of the overall study population. Twenty-one percent of women with LVSI had positive pelvic lymph nodes, compared with just 2.1% of patients without LVSI, she said.
When patients were stratified by tumor depth and invasion, LVSI was independently associated with a 3- to 16-fold increased risk of nodal metastases. In a more comprehensive multivariate regression analysis adjusted for age, tumor stage and grade, and other demographic and clinical factors, the relative risk of lymph node metastases in patients with T1A disease and LVSI was increased 9.2-fold, compared with that of patients with no LVSI. Patients with T1B disease and LVSI were at 4.6-fold greater risk for lymph node metastases than were T1B patients without LVSI, Dr. Jorge said.
LVSI was associated with significantly reduced survival out to 45 months in all patient subgroups except those having Stage IA, grade 1 tumors.
Dr. Jorge reported having no financial conflicts regarding this study, which was conducted free of commercial support.