Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
Department of Clinical Science and Education, Södersjukhuset (KI-SÖS), Stockholm, Sweden.
Int J Gynecol Cancer. 2023 Nov 6;33(11):1702-1707. doi: 10.1136/ijgc-2023-004606.
Lymphovascular space invasion (LVSI) is a known prognostic factor for oncological outcome in endometrial cancer patients. However, little is known about the prognostic value of LVSI among the different molecular subgroups. The aim of this study was to determine the prognostic dependence of LVSI from the molecular signature.
This study included endometrial cancer patients who underwent primary surgical treatment between February 2004 and February 2016 at the Karolinska University Hospital, Sweden and the Bern University Hospital, Switzerland (KImBer cohort). All cases had complete molecular analysis performed on the primary tumor according to the WHO Classification of Tumors, 5th edition. LVSI was reviewed by reference pathologists for all pathology slides.
A total of 589 endometrial cancer patients were included in this study, consisting of 40 mut (polymerase epsilon ultramutated), 198 MMRd (mismatch repair deficient), 83 p53abn (p53 abnormal), and 268 NSMP (non-specific molecular profile) cases. Altogether, 17% of tumors showed LVSI: 25% of the mut, 19% of the MMRd, 30% of the p53abn, and 10% of the NSMP cases. There was a significant correlation of LVSI with lymph node metastasis in the entire study cohort (p<0.001), remaining significant in the MMRd (p=0.020), p53abn (p<0.001), and NSMP (p<0.001) subgroups. Mean follow-up was 89 months (95% CI 86 to 93). The presence of LVSI significantly decreased recurrence-free survival among patients with MMRd, p53abn, and NSMP endometrial cancer, and overall survival in patients with p53abn and NSMP tumors. In patients with NSMP endometrial cancer, evidence of substantial LVSI remained a significant independent predictor of recurrence in multivariable Cox regression analysis including tumor stage and grade (HR 7.5, 95% CI 2.2 to 25.5, p=o.001).
The presence of LVSI was associated with recurrence in each subgroup of patients with MMRd, p53abn, and NSMP endometrial cancer, and LVSI remained an independent predictor of recurrence in NSMP endometrial cancer patients.
淋巴血管空间侵犯（LVSI）是子宫内膜癌患者肿瘤预后的已知因素。然而，对于不同分子亚组中 LVSI 的预后价值知之甚少。本研究的目的是确定 LVSI 从分子特征的预后依赖性。
本研究包括 2004 年 2 月至 2016 年 2 月在瑞典卡罗林斯卡大学医院和瑞士伯尔尼大学医院（KimBer 队列）接受初次手术治疗的子宫内膜癌患者。所有病例均根据世界卫生组织肿瘤分类第 5 版对原发肿瘤进行了完整的分子分析。所有病理切片均由参考病理学家审查 LVSI。
本研究共纳入 589 例子宫内膜癌患者，其中 40 例 mut（聚合酶 epsilon 超突变）、198 例 MMRd（错配修复缺陷）、83 例 p53abn（p53 异常）和 268 例 NSMP（非特异性分子谱）病例。总的来说，17%的肿瘤显示有 LVSI：25%的 mut、19%的 MMRd、30%的 p53abn 和 10%的 NSMP 病例。在整个研究队列中，LVSI 与淋巴结转移呈显著相关性（p<0.001），在 MMRd（p=0.020）、p53abn（p<0.001）和 NSMP（p<0.001）亚组中仍有显著相关性。平均随访时间为 89 个月（95%CI 86 至 93）。在 MMRd、p53abn 和 NSMP 子宫内膜癌患者中，LVSI 的存在显著降低了无复发生存率，在 p53abn 和 NSMP 肿瘤患者中也显著降低了总生存率。在 NSMP 子宫内膜癌患者中，大量 LVSI 的存在仍然是多变量 Cox 回归分析中肿瘤分期和分级的独立复发预测因素（HR 7.5，95%CI 2.2 至 25.5，p=0.001）。
在 MMRd、p53abn 和 NSMP 子宫内膜癌患者的每个亚组中，LVSI 的存在与复发相关，在 NSMP 子宫内膜癌患者中，LVSI 仍然是复发的独立预测因素。
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