Honing the classification of high-risk endometrial cancer with inclusion of lymphovascular space invasion.
OBJECTIVE
The purpose of this study was to analyse the clinical impact of LVSI status in a large French multicentre cohort of women with high-risk ECs according to the ESMO classification.


METHODS
Data of 258 women with high-risk EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. The end points were the recurrence and the lymph node metastasis (LNM) rates. Recurrence free survival (RFS) and overall survival (OS) were analyzed.


RESULTS
The recurrence and LNM rates in the whole population were 32.9% and 34.5%, respectively. The median follow-up and initial recurrence times were 27 (range: 1-151) and 23.5 (range: 1-151) months, respectively. The respective 3-year RFS rates according to the LNM and LVSI status were, 78.3% (95% CI, 70.1-87.3), 53.7% (95% CI, 40.8-70.6), 65.5% (95% CI, 46.1-93.2), 43.5% (95% CI, 30.3-62.3) for women with no LN metastasis/no LVSI; no LN metastasis/LVSI present; LN metastasis/no LVSI; LN metastasis/LVSI present, respectively (p = 0.0005).


CONCLUSIONS
LVSI status remains a strong prognostic factor in high-risk ECs associated with a higher recurrence rate and lower RFS and OS whatever the histological type and lymph node status. It could thus be considered in future trials to guide decision-making about adjuvant therapy in high-risk ECs.
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France. Electronic address: sofiane.bendifallah@aphp.fr.
Sofiane
S
Bendifallah
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
Morgane
M
Perrin
Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France.
Lobna
L
Ouldamer
CRLCC Eugène-Marquis, service de gynécologie, CHU de Rennes, université de Rennes 1, France.
Vincent
V
Lavoué
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France.
Geoffroy
G
Canlorbe
Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
Emilie
E
Raimond
Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
Delphine
D
Hudry
Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
Charles
C
Coutant
Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
Olivier
O
Graesslin
Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France.
Cyril
C
Touboul
Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France.
Pierre
P
Collinet
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France.
Emile
E
Daraï
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France.
Marcos
M
Ballester
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000145:classification* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate