Gynecologic Surgery, CHU Toulouse, Toulouse, Midi-Pyrénées, France
Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France.
Int J Gynecol Cancer. 2020 Oct;30(10):1493-1499. doi: 10.1136/ijgc-2020-001274. Epub 2020 Jun 21.
Few prognostic factors likely to influence therapeutic management of early-stage cervical cancer are currently recognized. The objective of this study was to determine the prognostic value of lymphovascular space invasion (LVSI) in overall survival of patients with early-stage cervical cancer.
This is a retrospective study of patients treated for early-stage cervical cancer between January 1996 and December 2013 at Toulouse University Hospital and the Cancer Center Claudius Regaud Institute. Patients were included if they had FIGO 2018 stage IA1, IA2, IB1/2, or IIA1 cervical cancer. All patients had to have had surgery (conization, radical hysterectomy, or radical trachelectomy). The presence of LVSI was evaluated in the initial anatomic pathology reports of the excised tissue. The presence of LVSI was defined by the presence of epithelial tumor cells in the lumen of vessels, lined by endothelial cells. If the data were missing, the slides were reviewed by an expert pathologist. Comparative analyses of patient populations with and without LVSI invasion were performed, as well as analyses of overall and disease-free survival.
A total of 158 patients were included in the analysis. Seventy-two (45.6%) patients had LVSI. More patients with LVSI received external radiotherapy in addition to standard treatment than patients without LVSI (53% vs 14%, p<0.0001). The overall survival of patients with LVSI (89.8%) was similar to that of patients without LVSI (91.5%) (p=0.39). For patients without lymph node involvement but with LVSI, disease-free survival at 5 years tended to be higher among those treated with external radiotherapy in addition to standard treatments (92.6% vs 79.8%, difference not tested due to the small number of events).
Patients with early-stage cervical cancer with LVSI received external radiotherapy more often, and therefore had an overall survival at 5 years identical to patients without LVSI.
目前很少有预后因素可能影响早期宫颈癌的治疗管理。本研究的目的是确定淋巴血管空间侵犯（LVSI）对早期宫颈癌患者总生存率的预后价值。
这是一项回顾性研究，纳入了 1996 年 1 月至 2013 年 12 月在图卢兹大学医院和克劳德·雷高德癌症中心接受治疗的早期宫颈癌患者。纳入标准为FIGO 2018 分期 IA1、IA2、IB1/2 或 IIA1 宫颈癌患者。所有患者均需接受手术（子宫颈锥切术、根治性子宫切除术或根治性宫颈切除术）。在切除组织的初始解剖病理学报告中评估 LVSI 的存在。LVSI 的存在定义为上皮肿瘤细胞存在于血管管腔中，内皮细胞排列。如果数据缺失，则由专家病理学家对切片进行复查。对存在和不存在 LVSI 侵犯的患者人群进行了比较分析，以及总生存率和无病生存率的分析。
共有 158 例患者纳入分析。72 例（45.6%）患者存在 LVSI。与无 LVSI 患者相比，存在 LVSI 的患者除标准治疗外，更多地接受了外部放疗（53% vs 14%，p<0.0001）。存在 LVSI 的患者的总生存率（89.8%）与无 LVSI 的患者相似（91.5%）（p=0.39）。对于无淋巴结受累但存在 LVSI 的患者，在接受标准治疗加外部放疗的患者中，5 年无病生存率较高（92.6% vs 79.8%，由于事件数量较少，未进行差异检验）。
存在 LVSI 的早期宫颈癌患者更常接受外部放疗，因此 5 年总生存率与无 LVSI 的患者相同。
