Matsuo Koji, Yoshino Kiyoshi, Hiramatsu Kosuke, Banzai Chiaki, Hasegawa Kosei, Yasuda Masanori, Nishimura Masato, Sheridan Todd B, Ikeda Yuji, Shiki Yasuhiko, Mabuchi Seiji, Enomoto Takayuki, Kimura Tadashi, Fujiwara Keiichi, Roman Lynda D, Sood Anil K
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; the Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, University of Tokushima, Tokushima, Niigata University Graduate School of Medicine, Niigata, and Osaka Rosai Hospital, Sakai, Osaka, Japan; the Department of Pathology, Mercy Medical Center, Baltimore, Maryland; the Departments of Gynecologic Oncology and Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; and the Department of Gynecologic Oncology and Cancer Biology, MD Anderson Cancer Center, University of Texas, and the Center for RNA Interference and non-Coding RNA, University of Texas, Houston, Texas.
Obstet Gynecol. 2014 May;123(5):957-965. doi: 10.1097/AOG.0000000000000240.
OBJECTIVE: To evaluate the effect of lymphovascular space invasion on survival of patients with early-stage epithelial ovarian cancer. METHODS: A multicenter retrospective study was conducted for patients with stage IA-C epithelial ovarian cancer who underwent primary comprehensive surgery including lymphadenectomy. Histopathology slides for ovarian tumors were examined by gynecologic pathologists for the presence or absence of lymphovascular space invasion. Survival analysis was performed examining tumoral factors. RESULTS: A total of 434 patients were included in the analysis. Lymphovascular space invasion was detected in 76 (17.5%) patients associated with histology (P=.042) and stage (P=.044). Lymphovascular space invasion was significantly associated with decreased survival outcomes (disease-free survival, 5-year rate 78.4% compared with 90.7%, P=.024 and overall survival, 84.9% compared with 93.2%, P=.031) in univariate analysis. In multivariate analysis, lymphovascular space invasion did not remain a significant variable for disease-free survival (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.97-3.97, P=.059) or overall survival (HR 2.41, 95% CI 0.99-5.85, P=.052). Lymphovascular space invasion was associated with increased risk of hematogenous and lymphatic metastasis (HR 4.79, 95% CI 1.75-13.2, P=.002) but not peritoneal metastasis (P=.33) in multivariate analysis. Among lymphovascular space invasion-expressing tumors, patients who received fewer than six cycles of postoperative chemotherapy had significantly poorer disease-free survival than those who received six or more cycles (HR 4.59, 95% CI 1.20-17.5, P=.015). CONCLUSION: Lymphovascular space invasion is an important histologic feature to identify a subgroup of patients with increased risk of recurrence in stage I epithelial ovarian cancer. LEVEL OF EVIDENCE: III.
目的：评估淋巴管间隙浸润对早期上皮性卵巢癌患者生存的影响。 方法：对接受包括淋巴结清扫术在内的初次综合手术的IA - C期上皮性卵巢癌患者进行多中心回顾性研究。妇科病理学家检查卵巢肿瘤的组织病理学切片，以确定是否存在淋巴管间隙浸润。进行生存分析，检查肿瘤因素。 结果：共有434例患者纳入分析。76例（17.5%）患者检测到淋巴管间隙浸润，其与组织学（P = 0.042）和分期（P = 0.044）相关。单因素分析显示，淋巴管间隙浸润与生存结局降低显著相关（无病生存，5年率78.4%对比90.7%，P = 0.024；总生存，84.9%对比93.2%，P = 0.031）。多因素分析中，淋巴管间隙浸润对于无病生存（风险比[HR] 1.98，95%置信区间[CI] 0.97 - 3.97，P = 0.059）或总生存（HR 2.41，95% CI 0.99 - 5.85，P = 0.052）不再是显著变量。多因素分析中，淋巴管间隙浸润与血行和淋巴转移风险增加相关（HR 4.79，95% CI 1.75 - 13.2，P = 0.002），但与腹膜转移无关（P = 0.33）。在有淋巴管间隙浸润的肿瘤中，接受少于六个周期术后化疗的患者无病生存明显差于接受六个或更多周期化疗的患者（HR 4.59，95% CI 1.20 - 17.5，P = 0.015）。 结论：淋巴管间隙浸润是识别I期上皮性卵巢癌复发风险增加亚组患者的重要组织学特征。 证据级别：III级
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