Departments of Obstetrics and Gynecology.
Urology, and.
Int J Gynecol Cancer. 2018 Jun;28(5):875-881. doi: 10.1097/IGC.0000000000001262.
Although lymphovascular space invasion is a prognostic factor for the recurrence of resectable endometrial cancer, the differential impacts of lymphatic vessel invasion (LVI) and blood vessel invasion (BVI) on the recurrence of endometrial cancer are poorly described. We investigated the prognostic significance of LVI and BVI on the recurrence of endometrial cancer and their association with patterns of recurrence.
We retrospectively reviewed 376 patients with stage I to III endometrial cancer who underwent surgery with curative intent at our institution between 2007 and 2015. The associations of the presence of lymphovascular space invasion or LVI and BVI with recurrence-free survival and patterns of recurrence were evaluated.
Lymphovascular space invasion positivity was an independent prognostic factor for recurrence-free survival (hazards ratio [HR], 3.070; 95% confidence interval [CI], 1.404-6.824; P = 0.0048). However, when categorized by LVI versus BVI, the latter was a strong independent prognostic factor (HR, 2.697; CI, 1.288-5.798; P = 0.0081), whereas the former was not (HR, 1.740; CI, 0.795-3.721; P = 0.1637). Hematogenous metastasis was the most prevalent form of recurrence in endometrial cancer (24 [50%] of all 48 recurrent cases). Notably, 17 (19.5%) of 87 patients with BVI developed hematogenous metastases, compared with 7 (2.4%) of 289 without BVI (χ test, P < 0.0001).
Blood vessel invasion rather than LVI was a strong predictor of postoperative recurrence in stage I to III endometrial cancer, probably due to its predisposition to hematogenous metastases.
尽管淋巴管侵犯是可切除子宫内膜癌复发的预后因素，但淋巴管侵犯（LVI）和血管侵犯（BVI）对子宫内膜癌复发的不同影响描述甚少。我们研究了 LVI 和 BVI 对子宫内膜癌复发的预后意义及其与复发模式的关系。
我们回顾性分析了 2007 年至 2015 年在我院接受根治性手术治疗的 376 例 I 期至 III 期子宫内膜癌患者。评估了存在淋巴管侵犯或 LVI 和 BVI 与无复发生存率及复发模式的关系。
淋巴管侵犯阳性是无复发生存率的独立预后因素（风险比 [HR]，3.070；95%置信区间 [CI]，1.404-6.824；P = 0.0048）。然而，当 LVI 与 BVI 分类时，后者是一个强有力的独立预后因素（HR，2.697；CI，1.288-5.798；P = 0.0081），而前者不是（HR，1.740；CI，0.795-3.721；P = 0.1637）。血液转移是子宫内膜癌最常见的复发形式（48 例复发病例中有 24 例[50%]）。值得注意的是，87 例 BVI 患者中有 17 例（19.5%）发生血液转移，而 289 例无 BVI 患者中只有 7 例（2.4%）（卡方检验，P<0.0001）。
血管侵犯而不是 LVI 是 I 期至 III 期子宫内膜癌术后复发的强烈预测因素，这可能是由于其易发生血液转移。
