title: Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer.
abstract: OBJECTIVE
  The prognostic significance of lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer is not established. We sought to determine if LVSI status in patients with early-stage low-risk endometrial cancer correlates with recurrence and survival.
  
  
  METHODS
  The records of all women who underwent hysterectomy for primary treatment of endometrial cancer from January 2006 through January 2011 at 1 academic institution were reviewed. Patients with grade 1 or 2 endometrioid histology, myometrial invasion less than 50%, and disease confined to the uterus (clinical International Federation of Obstetrics and Gynecology stage IA) were analyzed. Fisher exact test and the Wilcoxon rank-sum test were applied to compare patients with and without LVSI. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Two hundred forty patients met the inclusion criteria. Forty (16.7%) had LVSI. Ninety-one patients (37.9%) underwent lymphadenectomy. Median tumor size was 30 mm in patients with and 26 mm in patients without LVSI (P = 0.150). Thirty patients (12.5%) received adjuvant therapy. Site of recurrence did not differ between patients with and without LVSI. Patients with LVSI were more likely to have myometrial invasion (P < 0.001), postoperative pathologic grade 2 disease (P < 0.001), to undergo lymphadenectomy (P = 0.049) and receive adjuvant therapy (P < 0.001). The 5-year cumulative incidence of recurrence was 3.8% in the no-LVSI group and 14.2% in the LVSI group (P = 0.053). The presence of LVSI was significantly associated with worse RFS (P = 0.002) and OS (P = 0.013).
  
  
  CONCLUSIONS
  Patients with low-risk endometrial cancer and LVSI have worse RFS and OS despite being more likely to undergo lymphadenectomy and adjuvant therapy.
authors.affiliation: *Gynecologic Oncology Department, Barretos Cancer Hospital, São Paulo, Brazil; and Departments of †Gynecologic Oncology and Reproductive Medicine and ‡Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ricardo
authors.initials: R
authors.lastname: dos Reis
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Burzawa
authors.forename: Audrey T
authors.initials: AT
authors.lastname: Tsunoda
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Hosaka
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D055815:Young Adult