Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Urology, Roskilde Hospital, Roskilde, Denmark.
J Gynecol Oncol. 2019 Sep;30(5):e84. doi: 10.3802/jgo.2019.30.e84.
To evaluate the effect of lymph-vascular space invasion (LVSI) on location of recurrences in Danish patients with endometrial cancer.
This national cohort study (2005-2012) included 4,380 radically operated patients (no visual tumor, all distant metastasis removed). LVSI status was recorded in 3,377 (77.1%). In stage I patients, 2.6% received adjuvant radiotherapy and 1.4% adjuvant chemotherapy. Adjusted Cox regression was used to compare actuarial recurrence rates.
LVSI was present in 18.7% of 3,377 patients with known LVSI status. Of these, 7.6% stage I patients with LVSI experienced an isolated locoregional and 19.4% a non-locoregional recurrence. Compared to no LVSI, 5-year recurrence rate was higher (25.5% vs. 8.5%) in patients with LVSI and the frequency of distant recurrences was strikingly higher (stage I: 15.2% vs. 2.7%), the effect being similar across International Federation of Gynecology and Obstetrics stages and histological types. In intermediate-risk stage I patients with LVSI, 8.0% experienced an isolated locoregional recurrence compared to 20.1% with non-locoregional recurrence, giving these patients a seriously adverse risk of survival. A separate analysis in patients with recurrences demonstrated that those with LVSI had significantly more distant recurrences (55.4% vs. 29.9%) and fewer isolated vaginal recurrences (24.3% vs. 42.8%) than patients with no LVSI.
LVSI is a strong independent risk factor for the development of non-locoregional recurrences even in intermediate-risk stage I endometrial cancer. The non-locoregional recurrence pattern suggests a future focus for optimization of postoperative treatment in these patients.
评估淋巴管血管间隙浸润（LVSI）对丹麦子宫内膜癌患者复发部位的影响。
本项全国性队列研究（2005-2012 年）纳入了 4380 例接受根治性手术的患者（无肉眼肿瘤，所有远处转移均已清除）。3377 例患者（77.1%）记录了 LVSI 状态。在 I 期患者中，2.6%接受了辅助放疗，1.4%接受了辅助化疗。采用校正的Cox 回归比较了累积复发率。
在已知 LVSI 状态的 3377 例患者中，LVSI 阳性率为 18.7%。其中，7.6%的 I 期 LVSI 患者出现孤立的局部区域复发，19.4%出现非局部区域复发。与无 LVSI 相比，LVSI 患者 5 年复发率更高（25.5% vs. 8.5%），远处复发频率明显更高（I 期：15.2% vs. 2.7%），这种效应在国际妇产科联合会（FIGO）分期和组织学类型之间相似。在有 LVSI 的中危 I 期患者中，8.0%出现孤立的局部区域复发，而非局部区域复发的比例为 20.1%，这使这些患者的生存风险严重恶化。对有复发的患者进行的单独分析表明，LVSI 患者远处复发的比例显著更高（55.4% vs. 29.9%），孤立阴道复发的比例更低（24.3% vs. 42.8%）。
即使在中危 I 期子宫内膜癌中，LVSI 也是非局部区域复发的一个强有力的独立危险因素。非局部区域复发模式提示未来需要优化这些患者的术后治疗。
