Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy.
Università Cattolica Del Sacro Cuore, Roma, Italy.
Eur J Cancer. 2021 Jan;142:29-37. doi: 10.1016/j.ejca.2020.10.011. Epub 2020 Nov 17.
The interpretation of lymph-vascular space invasion (LVSI) is usually qualitative, as presence or absence. The aim of this study is to investigate the prognostic role of LVSI in patients affected by endometrial cancer, when evaluated with a semiquantitative analysis.
This retrospective multicentre study enrolled patients who received a histologically confirmed diagnosis of endometrial cancer. The assessment of LVSI was semiquantitative in accordance with the three-tiered scoring system (absent, focal and diffuse).
Among 1258 patients with surgical-stage endometrial cancer, LVSI has been found in 32.8% of cases (n = 412), whose 12.7% (n = 160) were focal, and 20% (n = 252) diffuse. The rate of lymph node metastasis increased from the 5% in patients with no LVSI to 15% in patients with focal LVSI and 33% in those with diffuse LVSI (p < 0.001). Distant recurrences were more frequent in patients with diffuse LVSI than in focal or no LVSI (24.9% versus 14.7% and 6.6%, respectively, p < 0.001). Diffuse LVSI was found to significantly increase the risk of distant metastasis (adjusted odds ratio (A OR) 2.57, p < 0.001). Adjuvant radiation were associated with improved overall survival (OS) and disease-free survival (DFS) in patients with diffuse LVSI.
The presence of diffuse LVSI is an independent risk factor for both lymph node metastasis and distant recurrence in endometrial cancer patients, and it is associated with a significantly decreased OS and DFS. Adjuvant radiation improved survival regardless of grading, histotype and lymph nodal metastasis in women with diffuse LVSI.
淋巴管血管间隙浸润（LVSI）的解读通常是定性的，即存在或不存在。本研究旨在探讨 LVSI 在子宫内膜癌患者中的预后作用，当采用半定量分析评估时。
这项回顾性多中心研究纳入了经组织学证实为子宫内膜癌的患者。LVSI 的评估是按照三级评分系统（无、局灶性和弥漫性）进行半定量的。
在 1258 例手术分期的子宫内膜癌患者中，32.8%（n=412）发现有 LVSI，其中 12.7%（n=160）为局灶性，20%（n=252）为弥漫性。无 LVSI 患者的淋巴结转移率为 5%，局灶性 LVSI 患者为 15%，弥漫性 LVSI 患者为 33%（p<0.001）。远处复发在弥漫性 LVSI 患者中比局灶性或无 LVSI 患者更常见（分别为 24.9%、14.7%和 6.6%，p<0.001）。弥漫性 LVSI 显著增加了远处转移的风险（调整后的优势比（AOR）为 2.57，p<0.001）。在弥漫性 LVSI 患者中，辅助放疗与总生存（OS）和无病生存（DFS）的改善相关。
弥漫性 LVSI 的存在是子宫内膜癌患者淋巴结转移和远处复发的独立危险因素，与 OS 和 DFS 显著降低相关。无论分级、组织类型和淋巴结转移情况如何，辅助放疗都能改善弥漫性 LVSI 女性的生存。
