Gynecologic Oncology, New York University, New York, USA.
Obstetrics and Gynecology, Columbia University, New York, USA.
Int J Gynecol Cancer. 2020 Jun;30(6):735-743. doi: 10.1136/ijgc-2019-000849. Epub 2020 Mar 15.
Data regarding the prognostic significance of lymphovascular space invasion (LVSI) for stage IA1 and IA2 cervical cancer are limited. Specifically, the role of LVSI as an independent risk factor for mortality in stage IA disease has not been shown.
We examined the association between LVSI and nodal metastases and survival for women with stage IA1 and IA2 cervical cancer.
We used the National Cancer Database to identify patients with stage IA adenocarcinoma or squamous carcinoma of the cervix from January 2010 through December 2015 for whom LVSI status was known. Mixed-effect log-Poisson models were used to identify predictors of LVSI. Cox proportional hazard models and Kaplan-Meier curves were used to compare all-cause mortality.
We identified 3239 patients with stage IA1 and 1049 patients with stage IA2 carcinoma of the cervix. Among patients with stage IA1 and IA2 disease, 10.5% and 18.8% had LVSI, respectively. Less than 1% of patients with stage IA1 disease without LVSI had positive nodes compared with 7.8% of those with LVSI (p<0.001). Lymphatic metastases were identified in 1.7% of stage IA2 cases without LVSI versus 14.6% for those with LVSI (p<0.001). Among both stage IA1 and IA2 patients, squamous histology, grade 3 tumor differentiation, and white race were associated with LVSI (p<0.05 for all). In a univariable model, the hazard ratio for death associated with LVSI was 1.05 (95% CI 0.45 to 2.45) for women with stage IA1 tumors and 2.36 (95% CI 1.04 to 5.33) for those with IA2 neoplasms.
LVSI is associated with lymph node metastases in patients with stage IA cervical cancer. LVSI is associated with decreased survival for women with stage IA2 cervical cancer.
关于淋巴血管空间侵犯（LVSI）对 IA1 和 IA2 期宫颈癌的预后意义的数据有限。具体来说，LVSI 作为 IA 期疾病死亡的独立危险因素的作用尚未得到证实。
我们研究了 LVSI 与淋巴结转移和 IA1 和 IA2 期宫颈癌患者生存之间的关系。
我们使用国家癌症数据库，从 2010 年 1 月至 2015 年 12 月期间，确定了已知 LVSI 状态的 IA 型腺癌或宫颈鳞癌患者。混合效应对数泊松模型用于识别 LVSI 的预测因素。Cox 比例风险模型和 Kaplan-Meier 曲线用于比较全因死亡率。
我们确定了 3239 例 IA1 期和 1049 例 IA2 期宫颈癌患者。IA1 和 IA2 期疾病患者中，分别有 10.5%和 18.8%有 LVSI。IA1 期无 LVSI 的患者中，淋巴结阳性的患者不足 1%，而有 LVSI 的患者为 7.8%（p<0.001）。IA2 期无 LVSI 的患者中，发现淋巴转移的比例为 1.7%，而有 LVSI 的患者为 14.6%（p<0.001）。在 IA1 和 IA2 期患者中，鳞癌组织学、分化程度 3 级肿瘤和白种人都与 LVSI 相关（p<0.05）。在单变量模型中，IA1 期肿瘤患者 LVSI 相关的死亡风险比为 1.05（95%CI 0.45 至 2.45），IA2 期肿瘤患者为 2.36（95%CI 1.04 至 5.33）。
LVSI 与 IA 期宫颈癌患者的淋巴结转移相关。LVSI 与 IA2 期宫颈癌患者的生存率降低相关。
