title: Impact of lymphovascular space invasion on a nomogram for predicting lymph node metastasis in endometrial cancer.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on nomogram-based predictions of lymph node (LN) metastasis in endometrial cancer.
  
  
  METHODS
  The data from 485 patients with presumed stage I or II endometrial cancer who underwent hysterectomy and lymphadenectomy were analyzed. Calibration curves were designed and compared for three different subgroups: LVSI-positive tumors (n=113), LVSI-negative tumors (n=213) and LVSI-undetermined tumors (n=159).
  
  
  RESULTS
  In the entire population, the nomogram showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.80 and was well calibrated. In the subgroup analyses, in LVSI-positive, LVSI-negative and LVSI-undetermined patients, the nomogram was not well calibrated (p of the U index of 0.028, 0.087 and 0.011, respectively) with underestimation in LVSI-positive patients and overestimation in LVSI-negative and LVSI-undetermined patients of LN metastasis. In the univariate analysis and after adjusting for the LN metastasis probability provided by the nomogram, LVSI-positive tumors were associated with an increased risk for LN metastasis compared with LVSI-negative tumors (RR=7.29 [3.87-13.7] and 5.04 [2.30-11.08], respectively). In contrast, the univariate analysis and after adjusting for the LN metastasis probability provided by the nomogram showed that LVSI-undetermined tumors were not associated with an increased risk for LN metastasis compared with LVSI-negative tumors (RR=0.73 [0.32-1.69] and 1.26 [0.47-3.37], respectively).
  
  
  CONCLUSIONS
  Our results suggested that LVSI should be considered to be an independent risk factor for LN metastasis. In this multicenter study, the risk for LN metastasis is similar when the LVSI is negative or is not detailed in the pathological report.
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France. martin.koskas@bch.aphp.fr
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.forename: Karine
authors.initials: K
authors.lastname: Bassot
authors.forename: Olivier
authors.initials: O
authors.lastname: Graesslin
authors.forename: Patrick
authors.initials: P
authors.lastname: Aristizabal
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Bassam
authors.initials: B
authors.lastname: Haddad
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.forename: Emile
authors.initials: E
authors.lastname: Darai
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016014:Linear Models; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D012372:ROC Curve; D012306:Risk