Surgical restaging of patients with early‑stage endometrial cancer with lymphovascular invasion does not significantly impact their survival outcomes

Navarro,Beatriz; Margioula-Siarkou,Chrysoula; Petousis,Stamatios; Floquet,Anne; Babin,Guillame; Guyon,Frederic

doi:10.3892/ol.2023.13708

Surgical restaging of patients with early‑stage endometrial cancer with lymphovascular invasion does not significantly impact their survival outcomes

Authors:
- Beatriz Navarro
- Chrysoula Margioula-Siarkou
- Stamatios Petousis
- Anne Floquet
- Guillame Babin
- Frederic Guyon
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Affiliations: Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France
Published online on: February 8, 2023 https://doi.org/10.3892/ol.2023.13708
Article Number: 122

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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.

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1	Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, et al: ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Int J Gynecol Cancer. 26:2–30. 2016. View Article : Google Scholar : PubMed/NCBI
2	Jorge S, Hou JY, Tergas AI, Burke WM, Huang Y, Hu JC, Ananth CV, Neugut AI, Hershman DL and Wright JD: Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 140:387–393. 2016. View Article : Google Scholar : PubMed/NCBI
3	Wakayama A, Kudaka W, Matsumoto H, Aoyama H, Ooyama T, Taira Y, Arakaki Y, Shimoji Y, Nakasone T, Nishihira K, et al: Lymphatic vessel involvement is predictive for lymph node metastasis and an important prognostic factor in endometrial cancer. Int J Clin Oncol. 23:532–538. 2018. View Article : Google Scholar : PubMed/NCBI
4	Cohn DE, Horowitz NS, Mutch DG, Kim SM, Manolitsas T and Fowler JM: Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Gynecol Oncol. 87:243–246. 2002. View Article : Google Scholar : PubMed/NCBI
5	Chang SJ, Kong TW, Kim WY, Yoo SC, Yoon JH, Chang KH and Ryu HS: 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. 18:58–64. 2011. View Article : Google Scholar : PubMed/NCBI
6	Briët JM, Hollema H, Reesink N, Aalders JG, Mourits MJE, Ten Hoor KA, Pras E, Boezen HM, van der Zee AG and Nijman HW: Lymphvascular space involvement: An independent prognostic factor in endometrial cancer. Gynecol Oncol. 96:799–804. 2005. View Article : Google Scholar : PubMed/NCBI
7	Sari ME, Yalcin İ, Sahin H, Meydanli MM and Gungor T: Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 22:937–944. 2017. View Article : Google Scholar : PubMed/NCBI
8	Vaizoglu F, Yuce K, Salman MC, Basaran D, Calis P, Ozgul N and Usubutun A: Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer. Arch Gynecol Obstet. 288:1391–1397. 2013. View Article : Google Scholar : PubMed/NCBI
9	Zhang C, Wang C and Feng W: Clinicopathological risk factors for pelvic lymph node metastasis in clinical early-stage endometrioid endometrial adenocarcinoma. Int J Gynecol Cancer. 22:1373–1377. 2012. View Article : Google Scholar : PubMed/NCBI
10	Borghesi Y, Narducci F, Bresson L, Tresch E, Meurant JP, Cousin S, Cordoba A, Merlot B and Leblanc E: Managing endometrial cancer: The role of pelvic lymphadenectomy and secondary surgery. Ann Surg Oncol. 22 (Suppl 3):S936–S943. 2015. View Article : Google Scholar : PubMed/NCBI
11	Scioscia M, Noventa M and Laganà AS: 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. 223:605–606. 2020. View Article : Google Scholar : PubMed/NCBI
12	Laganà AS and Scioscia M: Endometrial cancer in women with adenomyosis: An underestimated risk? Int J Fertil Steril. 14:260–261. 2020.PubMed/NCBI
13	Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, et al: ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 31:12–39. 2021. View Article : Google Scholar : PubMed/NCBI
14	Harris KL, Maurer KA, Jarboe E, Werner TL and Gaffney D: LVSI positive and NX in early endometrial cancer: Surgical restaging (and no further treatment if N0), or adjuvant ERT? Gynecol Oncol. 156:243–250. 2020. View Article : Google Scholar : PubMed/NCBI
15	Abu-Rustum NR, Yashar CM, Bradley K, Campos SM, Chino J, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, et al: NCCN guidelines^® insights: Uterine neoplasms, version 3.2021. J Natl Compr Canc Netw. 19:888–895. 2021. View Article : Google Scholar : PubMed/NCBI
16	Cardosi RJ, Cox CS and Hoffman MS: Postoperative neuropathies after major pelvic surgery. Obstet Gynecol. 100:240–244. 2002. View Article : Google Scholar : PubMed/NCBI
17	Volpi L, Sozzi G, Capozzi VA, Ricco M, Merisio C, Di Serio M, Chiantera V and Berretta R: 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. 29:312–319. 2019. View Article : Google Scholar : PubMed/NCBI
18	Cusano E, Myers V, Samant R, Sudai T, Keller A, Le T, E C, Grimes S and Xu Y: Prognostic significance of lymphovascular space invasion in the absence of lymph node metastases in early-stage endometrial cancer. Int J Gynecol Cancer. 28:890–894. 2018. View Article : Google Scholar : PubMed/NCBI
19	Loizzi V, Cormio G, Lorusso M, Latorre D, Falagario M, Demitri P, Scardigno D and Selvaggi LE: The impact of lymph vascular space invasion on recurrence and survival in patients with early stage endometrial cancer. Eur J Cancer Care (Engl). 23:380–384. 2014. View Article : Google Scholar : PubMed/NCBI
20	Bosse T, Peters EEM, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JWM, Lutgens LCHW, van der Steen-Banasik EM, Smit VTHBM and Nout RA: 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. 51:1742–1750. 2015. View Article : Google Scholar : PubMed/NCBI
21	Cignini P, Vitale SG, Laganà AS, Biondi A, Valentina Lucia La Rosa VL and Cutillo G: Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up. Updates Surg. 69:75–82. 2017. View Article : Google Scholar : PubMed/NCBI