Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study
Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma. Material and methods: As regard the study design, this is a cohort study based on prospectively recorded d...
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| creator | Stålberg, Karin Bjurberg, Maria Borgfeldt, Christer Carlson, Joseph Dahm-Kähler, Pernilla Flöter-Rådestad, Angelique Hellman, Kristina Hjerpe, Elisabet Holmberg, Erik Kjølhede, Preben Marcickiewicz, Janusz Rosenberg, Per Tholander, Bengt Åvall-Lundqvist, Elisabeth Högberg, Thomas |
| description | Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma.
Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated.
Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p |
| doi_str_mv | 10.1080/0284186X.2019.1643036 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1080_0284186X_2019_1643036</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>31373248</sourcerecordid><originalsourceid>FETCH-LOGICAL-c699t-e50507f5b51bd1b6f8537a4d1e144070fa56a5ca3413ec4dd78dbfdba3fb53863</originalsourceid><addsrcrecordid>eNp9kt2O0zAQhSMEYsvCI4B8yUqbYsex49yxKktBqsQFP9o7y_FP15DGkZ206mvxhEy23XK1lTJKMvOdM5Z8suwtwXOCBf6AC1ESwe_mBSb1nPCSYsqfZTPCGcmLgt89z2YTk0_QRfYqpd8Y44JW7GV2QQmtaFGKWfZ3td_092Grkh5bFVHqlbbId9DwoUMqIYX6aI3Xg99a5JQeQkQOqp2EqAvGoo0dVILHAt0ZlMa49VvVgg2ynQkwjj548_8HZlp12kaUg__3Hfine7Tcd1aHNqy9RovDeBnD2KP3QCwXyyuUhtHsX2cvnGqTfXN8X2Y_P9_-WHzJV9-WXxc3q1zzuh5yyzDDlWMNI40hDXeC0UqVhlhSlrjCTjGumFa0JNTq0phKmMaZRlHXMCo4vczyg2_a2X5sZB_9RsW9DMrLY-sPfFlZVlXNJn71JN-OPVQDNQmaqrS2YVxqxgTIeSMVE6V0BYXDEuwwc2fXr8EOWusHN7jk4mH99ZP8J__rRoa4luMoaS1Ewc7an_DWj5KwWlQEeHbgdQwpRetOCoLllEj5mEg5JVIeEwm6dwcdLNlYc1I9RhCAjwfAdxCrjdqF2Bo5qH0boosQA58APrvjH0qm9d8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study</title><source>Taylor & Francis</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><source>SWEPUB Freely available online</source><creator>Stålberg, Karin ; Bjurberg, Maria ; Borgfeldt, Christer ; Carlson, Joseph ; Dahm-Kähler, Pernilla ; Flöter-Rådestad, Angelique ; Hellman, Kristina ; Hjerpe, Elisabet ; Holmberg, Erik ; Kjølhede, Preben ; Marcickiewicz, Janusz ; Rosenberg, Per ; Tholander, Bengt ; Åvall-Lundqvist, Elisabeth ; Högberg, Thomas</creator><creatorcontrib>Stålberg, Karin ; Bjurberg, Maria ; Borgfeldt, Christer ; Carlson, Joseph ; Dahm-Kähler, Pernilla ; Flöter-Rådestad, Angelique ; Hellman, Kristina ; Hjerpe, Elisabet ; Holmberg, Erik ; Kjølhede, Preben ; Marcickiewicz, Janusz ; Rosenberg, Per ; Tholander, Bengt ; Åvall-Lundqvist, Elisabeth ; Högberg, Thomas</creatorcontrib><description>Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma.
Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated.
Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p < .001) followed by deep myometrial invasion (RR = 1.64, CI 1.13-2.37). In the multivariable survival analyses, LVSI (EMR = 7.69, CI 2.03-29.10,) and non-diploidy (EMR = 3.23, CI 1.25-8.41) were associated with decreased relative survival. In sub-analyses including only patients with complete para-aortic and pelvic lymphadenectomy and negative lymph nodes (n = 404), only LVSI (HR = 2.50, CI 1.05-5.98) was associated with a worsened overall survival.
Conclusion: This large nationwide study identified LVSI as the strongest independent risk factor for lymph node metastases and decreased survival in patients with endometrioid adenocarcinomas. Moreover, decreased overall survival was also seen in patients with LVSI-positive tumors and negative lymph nodes, indicating that hematogenous dissemination might also be important.</description><identifier>ISSN: 0284-186X</identifier><identifier>ISSN: 1651-226X</identifier><identifier>EISSN: 1651-226X</identifier><identifier>DOI: 10.1080/0284186X.2019.1643036</identifier><identifier>PMID: 31373248</identifier><language>eng</language><publisher>England: Taylor & Francis</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Blood Vessels - pathology ; Cancer and Oncology ; Cancer och onkologi ; Carcinoma, Endometrioid - mortality ; Carcinoma, Endometrioid - pathology ; Clinical Medicine ; depth ; disease ; Endometrial Neoplasms - mortality ; Endometrial Neoplasms - pathology ; Female ; Humans ; involvement ; Klinisk medicin ; lvsi ; Lymph Nodes - pathology ; Lymphatic Metastasis - diagnosis ; Lymphatic Metastasis - pathology ; Lymphatic Vessels - pathology ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Middle Aged ; Neoplasm Invasiveness ; Obstetrics, Gynecology and Reproductive Medicine ; Oncology ; patterns ; Prognosis ; prognostic-factors ; recurrence ; register ; Registries ; Reproduktionsmedicin och gynekologi ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Survival Rate ; Sweden - epidemiology ; women ; Young Adult</subject><ispartof>Acta oncologica, 2019-11, Vol.58 (11), p.1628-1633</ispartof><rights>2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c699t-e50507f5b51bd1b6f8537a4d1e144070fa56a5ca3413ec4dd78dbfdba3fb53863</citedby><cites>FETCH-LOGICAL-c699t-e50507f5b51bd1b6f8537a4d1e144070fa56a5ca3413ec4dd78dbfdba3fb53863</cites><orcidid>0000-0001-5702-4116 ; 0000-0001-5527-8796 ; 0000-0001-9456-5392 ; 0000-0001-5107-4550</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.tandfonline.com/doi/pdf/10.1080/0284186X.2019.1643036$$EPDF$$P50$$Ginformaworld$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.tandfonline.com/doi/full/10.1080/0284186X.2019.1643036$$EHTML$$P50$$Ginformaworld$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,27901,27902,59620,60409</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31373248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-159871$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-398825$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/284256$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://lup.lub.lu.se/record/b74eeb56-c558-476b-a584-f2351b10f05f$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:141546222$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Stålberg, Karin</creatorcontrib><creatorcontrib>Bjurberg, Maria</creatorcontrib><creatorcontrib>Borgfeldt, Christer</creatorcontrib><creatorcontrib>Carlson, Joseph</creatorcontrib><creatorcontrib>Dahm-Kähler, Pernilla</creatorcontrib><creatorcontrib>Flöter-Rådestad, Angelique</creatorcontrib><creatorcontrib>Hellman, Kristina</creatorcontrib><creatorcontrib>Hjerpe, Elisabet</creatorcontrib><creatorcontrib>Holmberg, Erik</creatorcontrib><creatorcontrib>Kjølhede, Preben</creatorcontrib><creatorcontrib>Marcickiewicz, Janusz</creatorcontrib><creatorcontrib>Rosenberg, Per</creatorcontrib><creatorcontrib>Tholander, Bengt</creatorcontrib><creatorcontrib>Åvall-Lundqvist, Elisabeth</creatorcontrib><creatorcontrib>Högberg, Thomas</creatorcontrib><title>Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study</title><title>Acta oncologica</title><addtitle>Acta Oncol</addtitle><description>Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma.
Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated.
Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p < .001) followed by deep myometrial invasion (RR = 1.64, CI 1.13-2.37). In the multivariable survival analyses, LVSI (EMR = 7.69, CI 2.03-29.10,) and non-diploidy (EMR = 3.23, CI 1.25-8.41) were associated with decreased relative survival. In sub-analyses including only patients with complete para-aortic and pelvic lymphadenectomy and negative lymph nodes (n = 404), only LVSI (HR = 2.50, CI 1.05-5.98) was associated with a worsened overall survival.
Conclusion: This large nationwide study identified LVSI as the strongest independent risk factor for lymph node metastases and decreased survival in patients with endometrioid adenocarcinomas. Moreover, decreased overall survival was also seen in patients with LVSI-positive tumors and negative lymph nodes, indicating that hematogenous dissemination might also be important.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Vessels - pathology</subject><subject>Cancer and Oncology</subject><subject>Cancer och onkologi</subject><subject>Carcinoma, Endometrioid - mortality</subject><subject>Carcinoma, Endometrioid - pathology</subject><subject>Clinical Medicine</subject><subject>depth</subject><subject>disease</subject><subject>Endometrial Neoplasms - mortality</subject><subject>Endometrial Neoplasms - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>involvement</subject><subject>Klinisk medicin</subject><subject>lvsi</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis - diagnosis</subject><subject>Lymphatic Metastasis - pathology</subject><subject>Lymphatic Vessels - pathology</subject><subject>Medical and Health Sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Obstetrics, Gynecology and Reproductive Medicine</subject><subject>Oncology</subject><subject>patterns</subject><subject>Prognosis</subject><subject>prognostic-factors</subject><subject>recurrence</subject><subject>register</subject><subject>Registries</subject><subject>Reproduktionsmedicin och gynekologi</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>Survival Rate</subject><subject>Sweden - epidemiology</subject><subject>women</subject><subject>Young Adult</subject><issn>0284-186X</issn><issn>1651-226X</issn><issn>1651-226X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>0YH</sourceid><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp9kt2O0zAQhSMEYsvCI4B8yUqbYsex49yxKktBqsQFP9o7y_FP15DGkZ206mvxhEy23XK1lTJKMvOdM5Z8suwtwXOCBf6AC1ESwe_mBSb1nPCSYsqfZTPCGcmLgt89z2YTk0_QRfYqpd8Y44JW7GV2QQmtaFGKWfZ3td_092Grkh5bFVHqlbbId9DwoUMqIYX6aI3Xg99a5JQeQkQOqp2EqAvGoo0dVILHAt0ZlMa49VvVgg2ynQkwjj548_8HZlp12kaUg__3Hfine7Tcd1aHNqy9RovDeBnD2KP3QCwXyyuUhtHsX2cvnGqTfXN8X2Y_P9_-WHzJV9-WXxc3q1zzuh5yyzDDlWMNI40hDXeC0UqVhlhSlrjCTjGumFa0JNTq0phKmMaZRlHXMCo4vczyg2_a2X5sZB_9RsW9DMrLY-sPfFlZVlXNJn71JN-OPVQDNQmaqrS2YVxqxgTIeSMVE6V0BYXDEuwwc2fXr8EOWusHN7jk4mH99ZP8J__rRoa4luMoaS1Ewc7an_DWj5KwWlQEeHbgdQwpRetOCoLllEj5mEg5JVIeEwm6dwcdLNlYc1I9RhCAjwfAdxCrjdqF2Bo5qH0boosQA58APrvjH0qm9d8</recordid><startdate>20191102</startdate><enddate>20191102</enddate><creator>Stålberg, Karin</creator><creator>Bjurberg, Maria</creator><creator>Borgfeldt, Christer</creator><creator>Carlson, Joseph</creator><creator>Dahm-Kähler, Pernilla</creator><creator>Flöter-Rådestad, Angelique</creator><creator>Hellman, Kristina</creator><creator>Hjerpe, Elisabet</creator><creator>Holmberg, Erik</creator><creator>Kjølhede, Preben</creator><creator>Marcickiewicz, Janusz</creator><creator>Rosenberg, Per</creator><creator>Tholander, Bengt</creator><creator>Åvall-Lundqvist, Elisabeth</creator><creator>Högberg, Thomas</creator><general>Taylor & Francis</general><scope>0YH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><scope>ACNBI</scope><scope>DF2</scope><scope>F1U</scope><scope>AGCHP</scope><scope>D95</scope><orcidid>https://orcid.org/0000-0001-5702-4116</orcidid><orcidid>https://orcid.org/0000-0001-5527-8796</orcidid><orcidid>https://orcid.org/0000-0001-9456-5392</orcidid><orcidid>https://orcid.org/0000-0001-5107-4550</orcidid></search><sort><creationdate>20191102</creationdate><title>Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study</title><author>Stålberg, Karin ; Bjurberg, Maria ; Borgfeldt, Christer ; Carlson, Joseph ; Dahm-Kähler, Pernilla ; Flöter-Rådestad, Angelique ; Hellman, Kristina ; Hjerpe, Elisabet ; Holmberg, Erik ; Kjølhede, Preben ; Marcickiewicz, Janusz ; Rosenberg, Per ; Tholander, Bengt ; Åvall-Lundqvist, Elisabeth ; Högberg, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c699t-e50507f5b51bd1b6f8537a4d1e144070fa56a5ca3413ec4dd78dbfdba3fb53863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Vessels - pathology</topic><topic>Cancer and Oncology</topic><topic>Cancer och onkologi</topic><topic>Carcinoma, Endometrioid - mortality</topic><topic>Carcinoma, Endometrioid - pathology</topic><topic>Clinical Medicine</topic><topic>depth</topic><topic>disease</topic><topic>Endometrial Neoplasms - mortality</topic><topic>Endometrial Neoplasms - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>involvement</topic><topic>Klinisk medicin</topic><topic>lvsi</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis - diagnosis</topic><topic>Lymphatic Metastasis - pathology</topic><topic>Lymphatic Vessels - pathology</topic><topic>Medical and Health Sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Obstetrics, Gynecology and Reproductive Medicine</topic><topic>Oncology</topic><topic>patterns</topic><topic>Prognosis</topic><topic>prognostic-factors</topic><topic>recurrence</topic><topic>register</topic><topic>Registries</topic><topic>Reproduktionsmedicin och gynekologi</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>Survival Rate</topic><topic>Sweden - epidemiology</topic><topic>women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stålberg, Karin</creatorcontrib><creatorcontrib>Bjurberg, Maria</creatorcontrib><creatorcontrib>Borgfeldt, Christer</creatorcontrib><creatorcontrib>Carlson, Joseph</creatorcontrib><creatorcontrib>Dahm-Kähler, Pernilla</creatorcontrib><creatorcontrib>Flöter-Rådestad, Angelique</creatorcontrib><creatorcontrib>Hellman, Kristina</creatorcontrib><creatorcontrib>Hjerpe, Elisabet</creatorcontrib><creatorcontrib>Holmberg, Erik</creatorcontrib><creatorcontrib>Kjølhede, Preben</creatorcontrib><creatorcontrib>Marcickiewicz, Janusz</creatorcontrib><creatorcontrib>Rosenberg, Per</creatorcontrib><creatorcontrib>Tholander, Bengt</creatorcontrib><creatorcontrib>Åvall-Lundqvist, Elisabeth</creatorcontrib><creatorcontrib>Högberg, Thomas</creatorcontrib><collection>Taylor & Francis Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><collection>SWEPUB Uppsala universitet full text</collection><collection>SWEPUB Uppsala universitet</collection><collection>SWEPUB Göteborgs universitet</collection><collection>SWEPUB Lunds universitet full text</collection><collection>SWEPUB Lunds universitet</collection><jtitle>Acta oncologica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stålberg, Karin</au><au>Bjurberg, Maria</au><au>Borgfeldt, Christer</au><au>Carlson, Joseph</au><au>Dahm-Kähler, Pernilla</au><au>Flöter-Rådestad, Angelique</au><au>Hellman, Kristina</au><au>Hjerpe, Elisabet</au><au>Holmberg, Erik</au><au>Kjølhede, Preben</au><au>Marcickiewicz, Janusz</au><au>Rosenberg, Per</au><au>Tholander, Bengt</au><au>Åvall-Lundqvist, Elisabeth</au><au>Högberg, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study</atitle><jtitle>Acta oncologica</jtitle><addtitle>Acta Oncol</addtitle><date>2019-11-02</date><risdate>2019</risdate><volume>58</volume><issue>11</issue><spage>1628</spage><epage>1633</epage><pages>1628-1633</pages><issn>0284-186X</issn><issn>1651-226X</issn><eissn>1651-226X</eissn><abstract>Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma.
Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated.
Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p < .001) followed by deep myometrial invasion (RR = 1.64, CI 1.13-2.37). In the multivariable survival analyses, LVSI (EMR = 7.69, CI 2.03-29.10,) and non-diploidy (EMR = 3.23, CI 1.25-8.41) were associated with decreased relative survival. In sub-analyses including only patients with complete para-aortic and pelvic lymphadenectomy and negative lymph nodes (n = 404), only LVSI (HR = 2.50, CI 1.05-5.98) was associated with a worsened overall survival.
Conclusion: This large nationwide study identified LVSI as the strongest independent risk factor for lymph node metastases and decreased survival in patients with endometrioid adenocarcinomas. Moreover, decreased overall survival was also seen in patients with LVSI-positive tumors and negative lymph nodes, indicating that hematogenous dissemination might also be important.</abstract><cop>England</cop><pub>Taylor & Francis</pub><pmid>31373248</pmid><doi>10.1080/0284186X.2019.1643036</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-5702-4116</orcidid><orcidid>https://orcid.org/0000-0001-5527-8796</orcidid><orcidid>https://orcid.org/0000-0001-9456-5392</orcidid><orcidid>https://orcid.org/0000-0001-5107-4550</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Acta oncologica, 2019-11, Vol.58 (11), p.1628-1633 |
| issn | 0284-186X 1651-226X 1651-226X |
| language | eng |
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| source | Taylor & Francis; MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; SWEPUB Freely available online |
| subjects | Adult Aged Aged, 80 and over Blood Vessels - pathology Cancer and Oncology Cancer och onkologi Carcinoma, Endometrioid - mortality Carcinoma, Endometrioid - pathology Clinical Medicine depth disease Endometrial Neoplasms - mortality Endometrial Neoplasms - pathology Female Humans involvement Klinisk medicin lvsi Lymph Nodes - pathology Lymphatic Metastasis - diagnosis Lymphatic Metastasis - pathology Lymphatic Vessels - pathology Medical and Health Sciences Medicin och hälsovetenskap Middle Aged Neoplasm Invasiveness Obstetrics, Gynecology and Reproductive Medicine Oncology patterns Prognosis prognostic-factors recurrence register Registries Reproduktionsmedicin och gynekologi Retrospective Studies Risk Factors Survival Analysis Survival Rate Sweden - epidemiology women Young Adult |
| title | Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T03%3A10%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-pubmed_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lymphovascular%20space%20invasion%20as%20a%20predictive%20factor%20for%20lymph%20node%20metastases%20and%20survival%20in%20endometrioid%20endometrial%20cancer%20-%20a%20Swedish%20Gynecologic%20Cancer%20Group%20(SweGCG)%20study&rft.jtitle=Acta%20oncologica&rft.au=St%C3%A5lberg,%20Karin&rft.date=2019-11-02&rft.volume=58&rft.issue=11&rft.spage=1628&rft.epage=1633&rft.pages=1628-1633&rft.issn=0284-186X&rft.eissn=1651-226X&rft_id=info:doi/10.1080/0284186X.2019.1643036&rft_dat=%3Cpubmed_cross%3E31373248%3C/pubmed_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/31373248&rfr_iscdi=true |