Winer Ira, Ahmed Quratulain F, Mert Ismail, Bandyopadhyay Sudeshna, Cote Michele, Munkarah Adnan R, Hussein Yaser, Al-Wahab Zaid, Elshaikh Mohamed A, Alosh Baraa, Schultz Daniel S, Mahdi Haider, Nucci Marisa R, Van de Vijver Koen K, Morris Robert T, Oliva Esther, Ali-Fehmi Rouba
Wayne State University (I.W., Q.A., I.M., S.B., M.C., Z.A.W., B.A., R.T.M.) Henry Ford Hospital (A.R.M., M.A.E., D.S.S.) Memorial Sloan-Kettering Cancer Center (Y.H.) Cleveland Clinic (H.M.) Brigham and Women's Hospital (M.R.N.) Massachusetts General Hospital (K.K.V.d.V., E.O.) Department of Pathology (R.A.F.), Harper University Hospital, Detroit, Michigan.
Int J Gynecol Pathol. 2015 Jan;34(1):47-56. doi: 10.1097/PGP.0000000000000113.
To analyze the clinical significance of the extent of lymphovascular space invasion (LVI) in patients with uterine serous carcinoma. After IRB approval, 232 patients with uterine serous carcinoma from the pathology databases of 4 large academic institutions were included. Patients were divided into 3 groups based on extent of LVI. Extensive LVI (E-LVI) was defined as ≥3 vessel involvement; low LVI (L-LVI) was defined <3 vessel involvement; and the third group consisted of tumors with no LVI (A-LVI). The association between LVI and myometrial invasion, cervical involvement, lower uterine segment involvement, positive peritoneal washings, lymph node involvement, stage, and survival were analyzed. Of 232 patients, 47 had E-LVI (20.3%), 83 had L-LVI (35.8%), and 102 had A-LVI (44%). A total of 9.8% of the patients with A-LVI had lymph node involvement as compared with 18.1% in the L-LVI group and 55.4% in the E-LVI group (P<0.0001). Fifty-nine percent of the patients in A-LVI, 85% in L-LVI, and 100% in the E-LVI group demonstrated myometrial invasion (P<0.0001). Cervical involvement was noted in 23%, 43%, 66% (P<0.0001) and lower uterine segment involvement involvement in 31%, 43%, and 42% of A-LVI, L-LVI, and E-LVI (P<0.0001), respectively. Stage III and IV disease were seen in 29%, 38%, and 79% of the patients with A-LVI, L-LVI, and E-LVI, respectively (P<0.0001). The median overall survival was 172, 95, and 39 mo for the A-LVI, L-LVI, and E-LVI groups, respectively (P<0.0001). The racial distribution was significant with African American patients demonstrating significantly more L-LVI (27.8%) and E-LVI (40.4%) when compared with A-LVI (19.6%) (P=0.040). In a subgroup analysis including patients with Stage I and II (n=123) revealed median survivals of 172, 169, and 38 mo in the A-LVI, L-LVI, and E-LVI groups, respectively (P<0.0001). Fifty percent of these patients with E-LVI, 20% in L-LVI group, and 15% in A-LVI group had disease recurrence (P=0.040). The extent of LVI was associated with multiple pathologic factors and was found to be a negative prognostic factor for overall survival and disease recurrence.
分析子宫浆液性癌患者淋巴管间隙浸润（LVI）程度的临床意义。经机构审查委员会（IRB）批准，纳入了来自4家大型学术机构病理数据库的232例子宫浆液性癌患者。根据LVI程度将患者分为3组。广泛LVI（E-LVI）定义为累及≥3条血管；低LVI（L-LVI）定义为累及<3条血管；第三组为由无LVI的肿瘤组成（A-LVI）。分析LVI与肌层浸润、宫颈受累、子宫下段受累、腹腔冲洗液阳性、淋巴结受累、分期及生存之间的关联。232例患者中，47例有E-LVI（20.3%），83例有L-LVI（35.8%），102例有A-LVI（44%）。A-LVI组患者中共有9.8%有淋巴结受累，而L-LVI组为18.1%，E-LVI组为55.4%（P<0.0001）。A-LVI组59%、L-LVI组85%、E-LVI组100%的患者有肌层浸润（P<0.0001）。宫颈受累分别见于A-LVI组的23%、L-LVI组的43%、E-LVI组的66%（P<0.0001），子宫下段受累分别见于A-LVI组的31%、L-LVI组的43%、E-LVI组的42%（P<0.0001）。III期和IV期疾病分别见于A-LVI组29%、L-LVI组38%、E-LVI组79%的患者（P<0.0001）。A-LVI组、L-LVI组和E-LVI组的总生存中位数分别为172个月、95个月和39个月（P<0.0001）。种族分布具有显著性，非裔美国患者的L-LVI（27.8%）和E-LVI（40.4%）显著多于A-LVI（19.6%）（P=0.040）。在一项包括I期和II期患者（n=123）的亚组分析中，A-LVI组、L-LVI组和E-LVI组的生存中位数分别为172个月、169个月和38个月（P<0.0001）。这些E-LVI患者中有50%、L-LVI组中有20%、A-LVI组中有15%出现疾病复发（P=0.040）。LVI程度与多种病理因素相关，并且被发现是总生存和疾病复发的不良预后因素。
