Oncologic outcomes based on lymphovascular space invasion in node-negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study

Christian Dagher ¹, Pernille Bjerre Trent ², Rofieda Alwaqfi ³

¹Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
²Department of Gynecologic Oncology, Division of Cancer Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁴Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
⁵Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁶Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA.
⁷Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁸Gynecology Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.

⁰Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society +

|

April 14, 2025

View abstract on PubMed

Summary

Lymphovascular invasion in endometrial cancer increases progression risk. Focal and substantial invasion are not distinct prognostically and should not be grouped with no invasion.

Area Of Science

Gynecologic Oncology
Pathology
Cancer Staging

Background

The 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system incorporates lymphovascular invasion (LVI) quantification for endometrioid endometrial carcinomas.
Current FIGO criteria group 'no LVI' and 'focal LVI' (≤4 vessels) into one category, and 'substantial LVI' (≥5 vessels) into another.

Purpose Of The Study

To evaluate the association between the extent of lymphovascular invasion and oncologic outcomes in early-stage endometrioid endometrial cancer.
To determine if focal and substantial LVI have distinct prognostic implications.

Main Methods

Retrospective analysis of 1555 patients with FIGO 2009 stage I endometrioid endometrial cancer undergoing hysterectomy and lymph node assessment (2012-2019).
Lymphovascular space invasion was classified as focal (<5 vessels), substantial (≥5 vessels), or absent using World Health Organization criteria.
Oncologic outcomes, including progression-free survival, were analyzed using multivariate analysis.

Main Results

Patients with substantial (4.2%) and focal (7.7%) LVI had significantly higher rates of stage IB disease and grade 3 tumors compared to those with no LVI (88.2%).
Five-year progression-free survival was markedly lower for patients with substantial (68.7%) and focal (70.5%) LVI compared to no LVI (90.7%) (p<0.001).
Any LVI (focal or substantial) was associated with an increased risk of progression/death (aHR 1.84-2.17). Substantial LVI showed a trend towards worse outcomes than focal LVI (aHR 1.18).

Conclusions

Both focal and substantial lymphovascular invasion are associated with an elevated risk of disease progression in endometrioid endometrial cancer.
Focal and substantial LVI do not appear to be prognostically distinct and should not be combined into a single category.
Focal LVI demonstrates different prognostic outcomes compared to no LVI, supporting its separation into a distinct category.

Keywords:

endometrium lymphatic metastasis retrospective study