Surgical Restaging of Patients with Early‑stage Endometrial Cancer with Lymphovascular Invasion Does Not Significantly Impact Their Survival Outcomes

Overview

Journal Oncol Lett

Specialty Oncology

Date 2023 Feb 27

PMID 36844624

Authors

Beatriz Navarro

Chrysoula Margioula-Siarkou

Stamatios Petousis

Anne Floquet

Guillame Babin

Frederic Guyon

Affiliations

Soon will be listed here.

Abstract

Lymphovascular space invasion (LVSI) is considered to be a poor prognostic factor in endometrial cancer. However, management of patients with early-stage endometrial cancer with positive LVSI remains controversial. The main objective of the present study was to investigate whether surgical restaging of such patients has a significant effect on survival outcomes or may be otherwise omitted. A retrospective cohort study was conducted at the Gynaecologic Oncology Unit, Insitut Bergonie, Bordeaux, France for the period January 2003-December 2019. The present study included patients with definitive histopathological diagnosis of early-stage, grade 1-2 endometrial cancer with positive LVSI. Patients were divided into two groups: Those being restaged with pelvic and para-aortic lymphadenectomy (group 1) and those not restaged and receiving complementary therapy (group 2). The primary outcomes of the study were overall survival and progression-free survival. Epidemiological data, clinical and histopathological characteristics as well as complementary treatment received were also studied. Kaplan-Meier and Cox regression analyses were performed. Data from 30 patients were retrieved, of which restaging with lymphadenectomy was performed in 21 patients (group 1), while another 9 patients (group 2) were not restaged and received complementary therapy. Lymph node metastasis was observed in 23.8% of patients in group 1 (n=5). No significant difference was observed between groups 1 and 2 in terms of survival outcomes. The median overall survival was 91.31 months in group 1 and 90.61 months in group 2 [hazard ratio (HR), 0.71; 95% CI, 0.03-16.58; P=0.829]. The median disease-free survival was 87.95 months in group 1 and 81.52 months in group 2 (HR, 0.85; 95% CI, 0.12-5.91; P=0.869). In conclusion, restaging with lymphadenectomy did not alter prognosis of early-stage, LVSI-positive patients. As there was no clinical and therapeutic benefit, restaging with lymphadenectomy could be omitted in such patients.

Citing Articles

Prognostic significance of lymphovascular space invasion in early-stage low-grade endometrioid endometrial cancer: a fifteen-year retrospective Chinese cohort study.

Sun B, Zhang X, Dong Y, Li X, Yang X, Zhao L World J Surg Oncol. 2024; 22(1):203.

PMID: 39080611 PMC: 11290096. DOI: 10.1186/s12957-024-03483-6.

References

Sari M, Yalcin I, Sahin H, Meydanli M, Gungor T . Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 2017; 22(5):937-944. DOI: 10.1007/s10147-017-1139-5. View

Harris K, Maurer K, Jarboe E, Werner T, Gaffney D . LVSI positive and NX in early endometrial cancer: Surgical restaging (and no further treatment if N0), or adjuvant ERT?. Gynecol Oncol. 2019; 156(1):243-250. DOI: 10.1016/j.ygyno.2019.09.016. View

Bosse T, Peters E, Creutzberg C, Jurgenliemk-Schulz I, Jobsen J, Mens J . Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer--A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015; 51(13):1742-50. DOI: 10.1016/j.ejca.2015.05.015. View

Cusano E, Myers V, Samant R, Sudai T, Keller A, Le T . Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer. Int J Gynecol Cancer. 2018; 28(5):890-894. DOI: 10.1097/IGC.0000000000001229. View

Volpi L, Sozzi G, Capozzi V, Ricco M, Merisio C, Di Serio M . Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer. 2019; 29(2):312-319. DOI: 10.1136/ijgc-2018-000084. View

Zhang C, Wang C, Feng W . Clinicopathological risk factors for pelvic lymph node metastasis in clinical early-stage endometrioid endometrial adenocarcinoma. Int J Gynecol Cancer. 2012; 22(8):1373-7. DOI: 10.1097/IGC.0b013e318269f68e. View

Abu-Rustum N, Yashar C, Bradley K, Campos S, Chino J, Chon H . NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021. J Natl Compr Canc Netw. 2021; 19(8):888-895. DOI: 10.6004/jnccn.2021.0038. View

Borghesi Y, Narducci F, Bresson L, Tresch E, Meurant J, Cousin S . Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery. Ann Surg Oncol. 2015; 22 Suppl 3:S936-43. DOI: 10.1245/s10434-015-4798-3. View

Cignini P, Vitale S, Lagana A, Biondi A, La Rosa V, Cutillo G . Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up. Updates Surg. 2017; 69(1):75-82. DOI: 10.1007/s13304-017-0418-z. View

10.

Jorge S, Hou J, Tergas A, Burke W, Huang Y, Hu J . Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 2016; 140(3):387-93. PMC: 4767542. DOI: 10.1016/j.ygyno.2016.01.002. View

11.

Cohn D, Horowitz N, Mutch D, Kim S, Manolitsas T, Fowler J . Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer?. Gynecol Oncol. 2002; 87(3):243-6. DOI: 10.1006/gyno.2002.6825. View

12.

Scioscia M, Noventa M, Lagana A . Abnormal uterine bleeding and the risk of endometrial cancer: can subendometrial vascular ultrasound be of help to discriminate cancer from adenomyosis?. Am J Obstet Gynecol. 2020; 223(4):605-606. DOI: 10.1016/j.ajog.2020.05.049. View

13.

Cardosi R, Cox C, Hoffman M . Postoperative neuropathies after major pelvic surgery. Obstet Gynecol. 2002; 100(2):240-4. DOI: 10.1016/s0029-7844(02)02052-5. View

14.

Lagana A, Scioscia M . Endometrial Cancer in Women with Adenomyosis: An Underestimated Risk?. Int J Fertil Steril. 2020; 14(3):260-261. PMC: 7604710. DOI: 10.22074/ijfs.2020.44413. View

15.

Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J . ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2015; 26(1):2-30. PMC: 4679344. DOI: 10.1097/IGC.0000000000000609. View

16.

Briet J, Hollema H, Reesink N, Aalders J, Mourits M, ten Hoor K . Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol. 2005; 96(3):799-804. DOI: 10.1016/j.ygyno.2004.11.033. View

17.

Chang S, Kong T, Kim W, Yoo S, Yoon J, Chang K . Lymph-vascular space invasion as a significant risk factor for isolated para-aortic lymph node metastasis in endometrial cancer: a study of 203 consecutive patients. Ann Surg Oncol. 2010; 18(1):58-64. DOI: 10.1245/s10434-010-1206-x. View

18.

Wakayama A, Kudaka W, Matsumoto H, Aoyama H, Ooyama T, Taira Y . Lymphatic vessel involvement is predictive for lymph node metastasis and an important prognostic factor in endometrial cancer. Int J Clin Oncol. 2017; 23(3):532-538. DOI: 10.1007/s10147-017-1227-6. View

19.

Loizzi V, Cormio G, Lorusso M, Latorre D, Falagario M, Demitri P . The impact of lymph vascular space invasion on recurrence and survival in patients with early stage endometrial cancer. Eur J Cancer Care (Engl). 2013; 23(3):380-4. DOI: 10.1111/ecc.12115. View

20.

Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza M, Marnitz S . ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021; 31(1):12-39. DOI: 10.1136/ijgc-2020-002230. View