J Gynecol Oncol.  2015 Jul;26(3):208-213. 10.3802/jgo.2015.26.3.208.

Lymph node metastasis and pattern of recurrence in clinically early stage endometrial cancer with positive lymphovascular space invasion

• Mahdi H
• Jernigan A
• Nutter B
• Michener C
• Rose PG

• KMID: 2160807
• DOI: http://doi.org/10.3802/jgo.2015.26.3.208

Abstract

OBJECTIVE
To investigate the rate, predictors of lymph node metastasis (LNM) and pattern of recurrence in clinically early stage endometrial cancer (EC) with positive lymphovascular space invasion (LVSI).
METHODS
Women with clinically early stage EC and positive LVSI 2005 to 2012 were identified. Kaplan-Meier curves and logistic regression models were used.
RESULTS
One hundred forty-eight women were identified. Of them, 25.7% had LNM (21.7% pelvic LNM, 18.5% para-aortic LNM). Among patients with LNM who had both pelvic and para-aortic lymphadenectomy, isolated pelvic, para-aortic and both LNM were noted in 51.4%, 17.1%, and 31.4% respectively. Age and depth of myometrial invasion were significant predictors of LNM in LVSI positive EC. Node positive patients had high recurrence rate (47% vs. 11.8%, p<0.05) especially distant (60.9% vs. 7.9%, p<0.001) and para-aortic (13.2% vs. 1.8%, p=0.017) recurrences compared to node negative EC. LNM was associated with lower progression-free survival (p=0.002) but not overall survival (p=0.73).
CONCLUSION
EC with positive LVSI is associated with high risk of LNM. LNM is associated with high recurrence rate especially distant and para-aortic recurrences. Adjuvant treatments should target prevention of recurrences in these areas.

Keyword

Survival; Endometrial Neoplasms; Recurrence; Lymph Nodes; Lymphovascular Space Invasion; Retrospective Studies

MeSH Terms

Aged
Chemoradiotherapy, Adjuvant
Disease-Free Survival
Endometrial Neoplasms/mortality/*pathology/therapy
Female
Humans
Lymph Node Excision/mortality
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local/mortality/*pathology/therapy
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 (A) Kaplan-Meier curves for progression-free survival in stage I to III endometrial cancer patients with positive lymphovascular space invasion stratified by node status. (B) Kaplan-Meier curves for overall survival in stage I to III endometrial cancer patients with positive lymphovascular space invasion stratified by node status.

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