淋巴管间隙浸润预示低风险子宫内膜癌预后不良。
Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer.
作者信息
dos Reis Ricardo, Burzawa Jennifer K, Tsunoda Audrey T, Hosaka Masayoshi, Frumovitz Michael, Westin Shannon N, Munsell Mark F, Ramirez Pedro T
机构信息
*Gynecologic Oncology Department, Barretos Cancer Hospital, São Paulo, Brazil; and Departments of †Gynecologic Oncology and Reproductive Medicine and ‡Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Int J Gynecol Cancer. 2015 Sep;25(7):1292-9. doi: 10.1097/IGC.0000000000000490.
OBJECTIVE
The prognostic significance of lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer is not established. We sought to determine if LVSI status in patients with early-stage low-risk endometrial cancer correlates with recurrence and survival.
METHODS
The records of all women who underwent hysterectomy for primary treatment of endometrial cancer from January 2006 through January 2011 at 1 academic institution were reviewed. Patients with grade 1 or 2 endometrioid histology, myometrial invasion less than 50%, and disease confined to the uterus (clinical International Federation of Obstetrics and Gynecology stage IA) were analyzed. Fisher exact test and the Wilcoxon rank-sum test were applied to compare patients with and without LVSI. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method.
RESULTS
Two hundred forty patients met the inclusion criteria. Forty (16.7%) had LVSI. Ninety-one patients (37.9%) underwent lymphadenectomy. Median tumor size was 30 mm in patients with and 26 mm in patients without LVSI (P = 0.150). Thirty patients (12.5%) received adjuvant therapy. Site of recurrence did not differ between patients with and without LVSI. Patients with LVSI were more likely to have myometrial invasion (P < 0.001), postoperative pathologic grade 2 disease (P < 0.001), to undergo lymphadenectomy (P = 0.049) and receive adjuvant therapy (P < 0.001). The 5-year cumulative incidence of recurrence was 3.8% in the no-LVSI group and 14.2% in the LVSI group (P = 0.053). The presence of LVSI was significantly associated with worse RFS (P = 0.002) and OS (P = 0.013).
CONCLUSIONS
Patients with low-risk endometrial cancer and LVSI have worse RFS and OS despite being more likely to undergo lymphadenectomy and adjuvant therapy.
目的
早期子宫内膜癌患者中淋巴管间隙浸润（LVSI）的预后意义尚未明确。我们试图确定早期低风险子宫内膜癌患者的LVSI状态是否与复发及生存相关。
方法
回顾了2006年1月至2011年1月在1家学术机构接受子宫切除术以进行子宫内膜癌初始治疗的所有女性的记录。分析了组织学为1级或2级子宫内膜样、肌层浸润小于50%且疾病局限于子宫（临床国际妇产科联盟分期IA期）的患者。采用Fisher精确检验和Wilcoxon秩和检验比较有和无LVSI的患者。采用Kaplan-Meier法计算无复发生存期（RFS）和总生存期（OS）。
结果
240例患者符合纳入标准。40例（16.7%）有LVSI。91例（37.9%）接受了淋巴结切除术。有LVSI的患者肿瘤中位大小为30mm，无LVSI的患者为26mm（P = 0.150）。30例（12.5%）接受了辅助治疗。有和无LVSI的患者复发部位无差异。有LVSI的患者更可能有肌层浸润（P < 0.001）、术后病理2级疾病（P < 0.001）、接受淋巴结切除术（P = 0.049）和辅助治疗（P < 0.001）。无LVSI组5年累积复发率为3.8%，LVSI组为14.2%（P = 0.053）。LVSI的存在与更差的RFS（P = 0.002）和OS（P = 0.013）显著相关。
结论
低风险子宫内膜癌且有LVSI的患者尽管更可能接受淋巴结切除术和辅助治疗，但RFS和OS更差。
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