Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Department of Pathology, Cancer Institute Hospital, Tokyo, Japan.
Ann Surg Oncol. 2018 Sep;25(9):2756-2766. doi: 10.1245/s10434-018-6547-x. Epub 2018 Jul 3.
The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS).
This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome.
Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08).
In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.
本研究旨在探讨富含肉瘤成分的淋巴管血管间隙浸润（LVSI）对子宫癌肉瘤（UCS）患者肿瘤特征和临床结局的意义。
这是一项对先前一项多中心回顾性研究的二次分析，该研究纳入了接受初次子宫切除术的 I-IV 期 UCS 女性患者。对存档的组织病理学切片进行了回顾，并将 LVSI 评分如下：仅含有癌成分的 LVSI（LVSI-癌；n=375，76.8%）或含有肉瘤成分的 LVSI，无论是否含有癌成分（LVSI-肉瘤；n=113，23.2%）。LVSI 的定性指标与临床病理因素和生存结局相关。
与 LVSI-癌组相比，LVSI-肉瘤组的肿瘤更有可能具有肉瘤优势（82.1%比 26.4%）、异源性肉瘤成分（51.3%比 37.9%）、低级别癌（42.5%比 22.4%）和更大的肿瘤大小（81.0%比 70.2%）（均 p<0.05）。多变量分析显示，LVSI-肉瘤与无进展生存期缩短独立相关（5 年生存率：34.9%比 40.8%，调整后的风险比[HR]1.84，95%置信区间[CI]1.36-2.50，p<0.001），与 LVSI-癌相比，特异性生存时间也缩短（5 年生存率：41.8%比 55.9%，调整后的 HR 1.95，95%CI 1.39-2.75，p<0.001）。与 LVSI-癌患者相比，LVSI-肉瘤患者接受术后放疗后疾病复发/进展的降低率更高（降低 54%，p=0.04），而 LVSI-癌患者术后放疗的降低率为 26%（p=0.08）。
在 UCS 中，当肿瘤具有肉瘤优势时，LVSI 中存在肉瘤成分尤其常见。我们的研究表明，含有肉瘤成分的 LVSI 可能是 UCS 患者生存时间缩短的预测因素。
