title: Lymph node metastasis and pattern of recurrence in clinically early stage endometrial cancer with positive lymphovascular space invasion.
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).
  
  
  CONCLUSIONS
  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.
authors: Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland, OH, USA. mahdih6281@gmail.com.
authors: Haider
authors: H
authors: Mahdi
authors: Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland, OH, USA.
authors: Amelia
authors: A
authors: Jernigan
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Benjamin
authors: B
authors: Nutter
authors: Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland, OH, USA.
authors: Chad
authors: C
authors: Michener
authors: Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland, OH, USA.
authors: Peter G
authors: PG
authors: Rose
mesh_terms: D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Endometrial Neoplasms; Lymph Nodes; Lymphovascular Space Invasion; Recurrence; Retrospective Studies; Survival