Department of Pathology, Leiden University Medical Center, The Netherlands.
Department of Radiotherapy, Leiden University Medical Center, The Netherlands.
Eur J Cancer. 2015 Sep;51(13):1742-50. doi: 10.1016/j.ejca.2015.05.015. Epub 2015 Jun 3.
Lymph-vascular space invasion (LVSI) is an important adverse prognostic factor in endometrial cancer (EC). However, its role in relation to type of recurrence and adjuvant treatment is not well defined, and there is significant interobserver variation. This study aimed to quantify LVSI and correlate this to risk and type of recurrence.
In the post operative radiation therapy in endometrial carcinoma (PORTEC)-trials stage I EC patients were randomised to receive external beam radiotherapy (EBRT) versus no additional treatment after surgery (PORTEC-1, n=714), or to EBRT versus vaginal brachytherapy (PORTEC-2, n=427). In tumour samples of 926 (81.2%) patients with endometrioid tumours LVSI was quantified using 2-, 3- and 4-tiered scoring systems. Cox proportional hazard models were used for time-to-event analysis.
Any degree of LVSI was identified in 129 cases (13.9%). Substantial LVSI (n=44, 4.8%) using the 3-tiered approach had the strongest impact on the risk of distant metastasis (hazard ratio (HR) 4.5 confidence interval (CI) 2.4-8.5). In multivariate analysis (including: age, depth of myometrial invasion, grade, treatment) substantial LVSI remained the strongest independent prognostic factor for pelvic regional recurrence (HR 6.2 CI 2.4-16), distant metastasis (HR 3.6 CI 1.9-6.8) and overall survival (HR 2.0 CI 1.3-3.1). Only EBRT (HR 0.3 CI 0.1-0.8) reduced the risk of pelvic regional recurrence.
Substantial LVSI, in contrast to focal or no LVSI, was the strongest independent prognostic factor for pelvic regional recurrence, distant metastasis and overall survival. Therapeutic decisions should be based on the presence of substantial, not 'any' LVSI. Adjuvant EBRT and/or chemotherapy should be considered for stage I EC with substantial LVSI.
淋巴血管空间侵犯（LVSI）是子宫内膜癌（EC）的一个重要不良预后因素。然而，它与复发类型和辅助治疗的关系尚未得到明确界定，并且存在显著的观察者间差异。本研究旨在量化 LVSI 并将其与复发风险和类型相关联。
在手术后放疗在子宫内膜癌（PORTEC）试验中，I 期 EC 患者被随机分为接受外部束放疗（EBRT）与手术后不进行额外治疗（PORTEC-1，n=714），或接受 EBRT 与阴道近距离放疗（PORTEC-2，n=427）。在 926 名（81.2%）子宫内膜样肿瘤患者的肿瘤样本中，使用 2 级、3 级和 4 级评分系统量化 LVSI。使用 Cox 比例风险模型进行生存时间分析。
129 例（13.9%）患者存在任何程度的 LVSI。使用 3 级评分系统，大量 LVSI（n=44，4.8%）对远处转移的风险影响最大（风险比（HR）4.5，95%置信区间（CI）2.4-8.5）。在多变量分析（包括年龄、子宫肌层浸润深度、分级、治疗）中，大量 LVSI 仍然是盆腔区域复发（HR 6.2，95%CI 2.4-16）、远处转移（HR 3.6，95%CI 1.9-6.8）和总生存（HR 2.0，95%CI 1.3-3.1）的最强独立预后因素。只有 EBRT（HR 0.3，95%CI 0.1-0.8）降低了盆腔区域复发的风险。
与局灶性或无 LVSI 相比，大量 LVSI 是盆腔区域复发、远处转移和总生存的最强独立预后因素。治疗决策应基于大量 LVSI 的存在，而不是“任何”LVSI 的存在。对于存在大量 LVSI 的 I 期 EC，应考虑辅助 EBRT 和/或化疗。
