title: A suggested modification to FIGO stage I endometrial cancer.
abstract: OBJECTIVE
  FIGO stage I endometrial cancers are divided into two substages, regardless of the presence or absence of lymphovascular space invasion (LVSI). The aim of this study was to investigate whether stratification based on the LVSI status would better predict mortality.
  
  
  METHODS
  Using a multicentric database, we identified patients who underwent endometrial cancer operations between 2000 and 2010. The staging performance was quantified with respect to discrimination.
  
  
  RESULTS
  The study cohort included 508 patients (198 with LVSI-positive tumors and 310 with LVSI-negative tumors). The survival difference between the stage I patients with LVSI-positive and LVSI-negative tumors was highly significant (81% and 97%, respectively P=.009), whereas the difference between the stage I patients with tumors invading greater or less than half of the myometrium was not (87% and 96%, respectively P=0.09). The 5-year OS rates for the patients with LVSI-negative tumors invading less than half of the myometrium, with LVSI-negative tumors invading more than half of the myometrium and with LVSI-positive invading more than or less than half of the myometrium were 98%, 95%, and 81%, respectively (P=.03). Separating the LVSI-negative and LVSI-positive tumors would improve discrimination (concordance index, 77% vs. 75%, respectively, using the actual staging system).
  
  
  CONCLUSIONS
  A LVSI-positive status has a significantly worse prognosis. In this study, the distinction by LVSI status appears to be more relevant than the distinction between stages IA and IB for predicting survival in stage I endometrial cancer. This difference in prognosis would favor restaging these two entities.
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Aristizabal
authors.affiliation: Department of Obstetrics and Gynaecology, CHU Reims, Reims, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Graesslin
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Lariboisiere, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.affiliation: INSERM, Unité Mixte de Recherche 1018, Villejuif Institut Curie, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Department of Obstetrics and Gynaecology, CHIC, Créteil, France.
authors.forename: Bassam
authors.initials: B
authors.lastname: Haddad
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University, Paris 07, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.affiliation: UMR S 938, CdR St Antoine UPMC University, Paris 06, France; Department of Obstetrics and Gynaecology, APHP Hôpital Tenon, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Darai
authors.affiliation: EA 7285, UVSQ, Montigny-le-Bretonneux, France; Department of Gynaecology, Institut Curie, Paris, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University, Paris 07, France; UMR S 938, CdR St Antoine UPMC University, Paris 06, France; EA 7285, UVSQ, Montigny-le-Bretonneux, France. Electronic address: martin.koskas@bch.aphp.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000401:mortality / Q000473:pathology*; D018262:Adenocarcinoma, Clear Cell / Q000145:classification / Q000401:mortality / Q000473:pathology; D000231:Adenocarcinoma, Papillary / Q000145:classification / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000145:classification / Q000401:mortality / Q000473:pathology; D002296:Carcinosarcoma / Q000145:classification / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010388:Pelvis; D011379:Prognosis; D012189:Retrospective Studies
keywords: Endometrial cancer; Prediction; Staging; Survival