Lymphovascular space invasion in uterine corpus cancer: What is its prognostic significance in the absence of lymph node metastases?
Lymphovascular space invasion (LVSI) is a poor prognostic indicator in uterine cancer, primarily due to its association with lymph node metastases. We sought to determine if LVSI provides any prognostic information for uterine cancer subjects in the absence of nodal disease.



A retrospective review was performed using a database of women treated for uterine cancer at MUSC from 2005 to 2012. Subjects with negative nodes after complete staging were identified. Multiple regression modeling was used to adjust for demographic and histopathologic covariates. The C-index was calculated for models of survival that included LVSI and those that did not. Competing risks analysis was conducted to examine factors associated with time to recurrence.



Two hundred and five subjects were completely staged and had negative nodes, 24 with LVSI and 181 without. Factors significantly associated with survival included age, race, stage, grade, histology, and LVSI. Regression models for recurrence-free survival (RFS) and overall survival (OS) had similar C-indices regardless of whether LVSI was included. Competing risks analysis confirmed no significant difference in time to recurrence for subjects with LVSI compared to those without, after adjusting for other prognostic factors (P=0.53).



LVSI is associated with shorter recurrence-free and overall survival in uterine cancer subjects with negative lymph nodes. However, after adjusting for other prognostic factors, LVSI status does not provide additional prognostic information. This finding suggests that recurrence-free and overall survival for uterine cancer patients with negative lymph nodes can be estimated without factoring in LVSI.
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA. Electronic address: shelby.addison@gmail.com.
Shelby A
SA
Neal
Division of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Charleston, SC, USA.
Whitney S
WS
Graybill
Hollings Cancer Center, Charleston, SC, USA; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Elizabeth
E
Garrett-Mayer
Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC, USA.
Misty L
ML
McDowell
Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, NY, USA.
Virginia E
VE
McLean
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.
Catherine H
CH
Watson
Division of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Charleston, SC, USA.
Jennifer Y
JY
Pierce
Division of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Charleston, SC, USA.
Matthew F
MF
Kohler
Division of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Charleston, SC, USA.
William T
WT
Creasman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000473:pathology*
Endometrial cancer; Lymphovascular space invasion