Jorge Soledad, Hou June Y, Tergas Ana I, Burke William M, Huang Yongmei, Hu Jim C, Ananth Cande V, Neugut Alfred I, Hershman Dawn L, Wright Jason D
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Gynecol Oncol. 2016 Mar;140(3):387-93. doi: 10.1016/j.ygyno.2016.01.002. Epub 2016 Jan 6.
While lymphvascular space invasion (LVSI) is a risk factor for nodal metastasis in endometrial cancer, the magnitude of risk is poorly described. We examined the risk of nodal metastasis associated with LVSI for various combinations of tumor grade and depth of invasion and examined the effect of LVSI on survival.
We identified patients with T1A (<50% myoinvasion) and T1B (>50% myoinvasion) endometrioid adenocarcinomas of the endometrium diagnosed between 2010 and 2012 and recorded in the National Cancer Database. The risk of nodal metastasis associated with LVSI stratified by grade and stage is reported. The association of LVSI and survival was examined using Kaplan-Meier analyses and Cox proportional hazards models.
We identified 25,907 patients, including 3928 (15.2%) with LVSI. Among patients with LVSI, 21.0% had positive lymph nodes, compared to 2.1% in patients without LVSI (P<0.0001). In analyses stratified by stage and grade, LVSI was associated with increased risks of LN metastasis by a magnitude of 3 to over 10-fold. In a multivariable model controlling for clinical and demographic characteristics, the risk ratio of nodal disease with LVSI was 9.29 (95% CI, 7.29-11.84) for T1A tumors and 4.64 (95% CI 3.99-5.39) for T1B tumors. LVSI was associated with decreased survival even after adjustment for the presence of lymph node metastases (HR=1.92, 95% CI 1.56-2.36).
LVSI is independently associated with lymph node metastases in women with apparent early-stage endometrial cancer and an independent predictor of survival even after adjustment for the presence of lymph node metastases.
虽然淋巴管间隙浸润（LVSI）是子宫内膜癌发生淋巴结转移的一个危险因素，但风险程度描述欠佳。我们研究了LVSI与肿瘤分级和浸润深度的各种组合相关的淋巴结转移风险，并研究了LVSI对生存的影响。
我们确定了2010年至2012年间诊断并记录在国家癌症数据库中的T1A（肌层浸润<50%）和T1B（肌层浸润>50%）子宫内膜样腺癌患者。报告了按分级和分期分层的与LVSI相关的淋巴结转移风险。使用Kaplan-Meier分析和Cox比例风险模型研究LVSI与生存的关联。
我们确定了25907例患者，其中3928例（15.2%）有LVSI。在有LVSI的患者中，21.0%有淋巴结阳性，而无LVSI的患者中这一比例为2.1%（P<0.0001）。在按分期和分级分层的分析中，LVSI与淋巴结转移风险增加相关，增加幅度为3至10倍以上。在控制临床和人口统计学特征的多变量模型中，T1A肿瘤有LVSI时发生淋巴结疾病的风险比为9.29（95%CI，7.29-11.84），T1B肿瘤为4.64（95%CI 3.99-5.39）。即使在调整了淋巴结转移的存在后，LVSI仍与生存降低相关（HR=1.92，95%CI 1.56-2.36）。
LVSI与明显早期子宫内膜癌女性的淋巴结转移独立相关，并且即使在调整了淋巴结转移的存在后，也是生存的独立预测因素。
