Department of Radiation Oncology, University of Utah.
Department of Radiation Oncology, University of Miami, Miami, FL.
Am J Clin Oncol. 2019 Jul;42(7):549-554. doi: 10.1097/COC.0000000000000559.
Lymphovascular space invasion (LVSI) is a known prognostic factor for endometrial carcinomas. However, LVSI as a determinant of treatment benefit has not been fully elucidated.
Data from the National Cancer Database for endometrial cancer from 2004 to 2012 was obtained. Univariate and multivariate analysis was performed to assess the impact of LVSI on overall survival (OS). Survival analysis was performed utilizing log-rank and Kaplan-Meier analyses. The difference in OS between external beam radiation therapy (EBRT) and vaginal brachytherapy (VBT) in LVSI-positive patients was analyzed with propensity score matching.
A total of 32,150 patients with surgical stage I to III endometrial carcinomas were available for analysis with a median follow-up of 30 months. Twenty-nine percent were LVSI positive and received adjuvant radiotherapy (aRT) more often than if LVSI negative (57% vs. 37%). On multivariate analysis, LVSI (hazard ratio, 1.94; P<0.01) was associated with an increased risk of death. aRT improved OS for LVSI-negative patients (87% without aRT, 90% with aRT; P=0.006). aRT was particularly effective in LVSI-positive patients: all stages of LVSI-positive patients were associated with an OS benefit (P<0.01), whereas among LVSI-negative patients, only stage III benefited from aRT (P<0.01). After propensity score match, there was no OS difference between EBRT and VBT among LVSI-positive patients (hazard ratio, 1.15; P=0.44).
LVSI is an independent prognostic factor in locoregional endometrial carcinomas. aRT benefited all stages of LVSI-positive patients, but only stage III of LVSI-negative patients. Among LVSI-positive patients, we did not find an OS difference between adjuvant EBRT versus VBT.
淋巴管血管空间侵犯（LVSI）是子宫内膜癌的已知预后因素。然而，LVSI 作为治疗获益的决定因素尚未得到充分阐明。
从 2004 年至 2012 年的国家癌症数据库中获得了子宫内膜癌的数据。进行了单变量和多变量分析，以评估 LVSI 对总生存期（OS）的影响。利用对数秩和 Kaplan-Meier 分析进行生存分析。利用倾向评分匹配分析 LVSI 阳性患者中外部束放射治疗（EBRT）与阴道近距离放射治疗（VBT）之间的 OS 差异。
共有 32150 例手术分期 I 至 III 期子宫内膜癌患者可进行分析，中位随访时间为 30 个月。29%为 LVSI 阳性，接受辅助放疗（aRT）的比例高于 LVSI 阴性（57%比 37%）。多变量分析显示，LVSI（风险比，1.94；P<0.01）与死亡风险增加相关。aRT 改善了 LVSI 阴性患者的 OS（无 aRT 的 87%，有 aRT 的 90%；P=0.006）。aRT 对 LVSI 阳性患者尤其有效：所有 LVSI 阳性患者的各期均与 OS 获益相关（P<0.01），而 LVSI 阴性患者中仅 III 期从 aRT 中获益（P<0.01）。在倾向评分匹配后，LVSI 阳性患者中 EBRT 与 VBT 之间的 OS 无差异（风险比，1.15；P=0.44）。
LVSI 是局部子宫内膜癌的独立预后因素。aRT 使所有 LVSI 阳性患者获益，但仅使 LVSI 阴性患者的 III 期获益。在 LVSI 阳性患者中，我们未发现辅助 EBRT 与 VBT 之间的 OS 差异。
