Research Article
The investigation of poor prognostic factors related to lymphovascular space invasion in endometrium cancer
Abstract
Aim: It was aimed to investigate the relationship between the presence of lymphovascular space invasion (LVSI) in endometrial cancer (EC) and poor prognostic factors such as tumoral grade, myometrial invasion, lymph node metastasis and stage of the disease in this study.
Materiasl and methods: Forty-four patients who underwent total hysterectomy + bilateral salpingoophorectomy ± pelvic and/or paraaortic lymphadenectomy + omentectomy for EC in our clinic were retrospectively analyzed. According to the pathology results, the patients were divided into 2 groups as LVSI positive and negative. A control group with 29 patients without LVSI and a study group with 15 patients with positive LVSI were conducted.
Results: A statistically significant difference was found between two groups in terms of nuclear grade (p=0.001 and p<0.05). Although there was no statistically significant difference between the two groups in terms of the presence of myometrial invasion (p=0.999 and p<0.05), the depth of myometrial invasion was found to be significantly deeper in the study group (p=0.001 and p<0.05). Statistically significant differences were found in the group with positive LVSI in terms of right (p=0.003 and p<0.005) and left (p=0.001 and p<0.05) pelvic lymph node involvement. When both groups were compared in terms of main material surgical staging, we found that the LVSI positive group had more advanced stage disease (p=0.009 and p<0.05).
Conclusion: High-grade tumor, deep myometrial invasion, increased lymph node involvement and more advanced disease are detected in the presence of LVSI in EC.
References
- Cancer Facts & Figures 2019 2019. Available from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html
- Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer 2015;136(5):E359-E86.
- Türkiye Kanser İstatistikleri 2017. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2017.pdf.
- Huvila J, Laajala T, Edqvist P, Talve L, Ponten F, Grenman S, et al., editors. Combined ASRGL1 and p53 immunohistochemistry as an independent predictor of survival in endometrioid endometrial adenocarcinoma. Virchows Archiv; 2017: Springer 233 Spring St, New York, Ny 10013 Usa.
- Creutzberg CL, van Putten WLJ, Koper PC, Lybeert MLM, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecologic Oncology 2003;89(2):201-9.
- Mori Y, Yamawaki K, Ishiguro T, Yoshihara K, Ueda H, Sato A, et al. ALDH-Dependent Glycolytic Activation Mediates Stemness and Paclitaxel Resistance in Patient-Derived Spheroid Models of Uterine Endometrial Cancer. Stem Cell Reports 2019;13(4):730-46.
- Uharček P. Prognostic factors in endometrial carcinoma. Journal of Obstetrics and Gynaecology Research 2008;34(5):776-83.
- Stålberg K, Bjurberg M, Borgfeldt C, Carlson J, Dahm-Kähler P, Flöter-Rådestad A, et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer–a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncologica. 2019;58(11):1628-33.
- Creutzberg CL, Van Stiphout RG, Nout RA, Lutgens LC, Jürgenliemk-Schulz IM, Jobsen JJ, et al. Nomograms for prediction of outcome with or without adjuvant radiation therapy for patients with endometrial cancer: a pooled analysis of PORTEC-1 and PORTEC-2 trials. International Journal of Radiation Oncology Biology Physics 2015;91(3):530-9.
- Hanson MB, van Nagell Jr JR, Powell DE, Donaldson ES, Gallion H, Merhige M, et al. The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer. Cancer 1985;55(8):1753-1757.
- Abeler V, Kjørstad K, Berle E. Carcinoma of the endometrium in Norway: a histopathological and prognostic survey of a total population. International Journal of Gynecologic Cancer 1992;2(1).
- Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998;280(17):1510-7.
- Aristizabal P, Graesslin O, Barranger E, Clavel-Chapelon F, Haddad B, Luton D, et al. A suggested modification to FIGO stage I endometrial cancer. Gynecologic Oncology 2014;133(2):192-196.
- Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet 2005;366(9484):491-505.
- Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecologic Oncology 1991;40(1):55-65.
- Malik TY, Chishti U, Aziz AB, Sheikh I. Comparison of risk factors and survival of type 1 and type II endometrial cancers. Pakistan Journal of Medical Sciences. 2016;32(4):886.
- Hag-Yahia N, Gemer O, Eitan R, Raban O, Vaknin Z, Levy T, et al. Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study. Acta Obstetricia et Gynecologica Scandinavica 2021;100(3):444-52.
- Wong AS-W, Cheung CW, Fung LW-Y, Lao TT-H, Mol BWJ, Sahota DS. Development and validation of prediction models for endometrial cancer in postmenopausal bleeding. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;203:220-4.
- Clarke MA, Long BJ, Morillo ADM, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Internal Medicine 2018;178(9):1210-22.
- Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet 2005;366(9484):491-505.
- Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study—On behalf of the Swedish Gynecological Cancer Group. International Journal of Cancer 2017;140(12):2693-700.
- Cunningham FG. Williams Jinekoloji. 15 ed: Nobel Tıp Kitabevi; 2015
- Zaino RJ, Kurman RJ, Diana KL, Morrow CP. Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage--a Gynecologic Oncology Group study. Cancer 1996;77(6):1115-21. Epub 1996/03/15. PubMed PMID: 8635132.
- Yan B, Zhao T, Liang X, Niu C, Ding C. Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer? Acta Radiologica 2018;59(3):363-70.
- Ayhan A, Taskiran C, Yuce K, Kucukali T. The prognostic value of nuclear grading and the revised FIGO grading of endometrial adenocarcinoma. International Journal of Gynecological Pathology. 2003;22(1):71-4.
- Boronow R, Morrow C, Creasman W, Disaia P, Silverberg S, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstetrics and Gynecology 1984;63(6):825-32.
- Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecologic Oncology 1997;64(3):411-7.
- Berchuck A, Anspach C, Evans AC, Soper JT, Rodriguez GC, Dodge R, et al. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecologic Oncology 1995;59(1):20-4.
- Dane C, Bakir S. The effect of myometrial invasion on prognostic factors and survival analysis in endometrial carcinoma. African Health Sciences 2019;19(4):3235-41.
- De Góis N, Martins NV, Abrão F, De Lima G, Alves AC. Peritumorous lymph-vascular invasion, grade of histologic differentiation, and myometrial infiltration as prognostic factors of endometrial carcinoma. Revista Paulista de Medicina. 1993;111(3):385-90.
- Ayhan A, Şahin H, Sari ME, Yalçin I, Haberal A, Meydanli MM. Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer 2019;29(3):505-512. doi:10.1136/ijgc-2018-000069
- Şahin B, Güner E, Kara OF. Endometrial Kanser Cerrahisi Yapılan Olgularda Prognozu Etkileyen Klinik ve Patolojik Faktörler. Türk Jinekolojik Onkoloji Dergisi 2018:2 :17-23.
- Sadozye AH, Harrand RL, Reed NS. Lymphovascular Space Invasion as a Risk Factor in Early Endometrial Cancer. Curr Oncol Rep 2016;18(4):24. doi:10.1007/s11912-016-0505-1
- Neal SA, Graybill WS, Garrett-Mayer E, McDowell ML, McLean VE, Watson CH, et al. Lymphovascular space invasion in uterine corpus cancer: what is its prognostic significance in the absence of lymph node metastases? Gynecologic Oncology 2016;142(2):278-82.
- Gemer O, Arie AB, Levy T, Gdalevich M, Lorian M, Barak F, et al. Lymphvascular space involvement compromises the survival of patients with stage I endometrial cancer: results of a multicenter study. European Journal of Surgical Oncology (EJSO) 2007;33(5):644-7.
Endometrium kanserinde lenfovasküler saha i̇nvazyonu ile kötü prognostik faktörlerinin i̇lişkisinin i̇ncelenmesi
Abstract
Amaç: Bu çalışmada endometrium kanserinde (EK) lenfovasküler saha invazyonu varlığının (LVSİ) tümör differansiasyon düzeyi (grade), miyometrial invazyon, lenf nodu metastazı ve tümör evresi gibi kötü prognostik faktörler ile ilişkisinin incelenmesi amaçlanmıştır.
Gereç ve yöntem: Kliniğimizde EK nedeniyle total histerektomi + bilateral salpingooferektomi ± pelvik ve/veya paraaortik lenfadenektomi + omentektomi yapılmış 44 hasta retrospektif olarak incelenmiştir. Patoloji sonuçlarına göre hastalar LVSİ pozitif ve negatif olmak üzere 2 gruba ayrılmıştır. LVSİ olmayan 29 hasta ile kontrol grubu ve LVSİ pozitif olan 15 hasta ile çalışma grubu oluşturulmuştur.
Bulgular: Çalışma grubunda istatistiksel olarak kontrol grubuna göre ana materyal nükleer grade daha yüksek bulunmuştur (p=0.001 ve p<0.05). Miyometrial invazyon varlığı açısından her iki grup arasında istatistiksel olarak anlamlı farklılık bulunamamış (p=0.999 ve p<0.05) olmasına rağmen LVSİ pozitif olan çalışma grubunda miyometrial invazyon derinliğinin istatistiksel olarak anlamlı şekilde daha fazla olduğu tespit edilmiştir (p=0.001 ve p<0.05). LVSİ pozitif olan grupta istatistiksel olarak anlamlı olacak şekilde pelvik lenf nodu tutulumu daha fazladır (sağ pelvik lenf nodu için p=0,003 ve p<0,005; sol pelvik lenf nodu için p=0.001 ve p<0.05). LVSİ pozitif olan grupta istatistiksel olarak anlamlı şekilde daha ileri evre hastalık bulunmuştur (p=0.009 ve p<0.05).
Sonuç: EK’de LVSİ varlığında yüksek gradeli tümör, derin myometrial invazyon, artmış lenf nodu tutulumu ve daha ileri evre hastalık tespit edilmektedir.
References
- Cancer Facts & Figures 2019 2019. Available from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html
- Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer 2015;136(5):E359-E86.
- Türkiye Kanser İstatistikleri 2017. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2017.pdf.
- Huvila J, Laajala T, Edqvist P, Talve L, Ponten F, Grenman S, et al., editors. Combined ASRGL1 and p53 immunohistochemistry as an independent predictor of survival in endometrioid endometrial adenocarcinoma. Virchows Archiv; 2017: Springer 233 Spring St, New York, Ny 10013 Usa.
- Creutzberg CL, van Putten WLJ, Koper PC, Lybeert MLM, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecologic Oncology 2003;89(2):201-9.
- Mori Y, Yamawaki K, Ishiguro T, Yoshihara K, Ueda H, Sato A, et al. ALDH-Dependent Glycolytic Activation Mediates Stemness and Paclitaxel Resistance in Patient-Derived Spheroid Models of Uterine Endometrial Cancer. Stem Cell Reports 2019;13(4):730-46.
- Uharček P. Prognostic factors in endometrial carcinoma. Journal of Obstetrics and Gynaecology Research 2008;34(5):776-83.
- Stålberg K, Bjurberg M, Borgfeldt C, Carlson J, Dahm-Kähler P, Flöter-Rådestad A, et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer–a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncologica. 2019;58(11):1628-33.
- Creutzberg CL, Van Stiphout RG, Nout RA, Lutgens LC, Jürgenliemk-Schulz IM, Jobsen JJ, et al. Nomograms for prediction of outcome with or without adjuvant radiation therapy for patients with endometrial cancer: a pooled analysis of PORTEC-1 and PORTEC-2 trials. International Journal of Radiation Oncology Biology Physics 2015;91(3):530-9.
- Hanson MB, van Nagell Jr JR, Powell DE, Donaldson ES, Gallion H, Merhige M, et al. The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer. Cancer 1985;55(8):1753-1757.
- Abeler V, Kjørstad K, Berle E. Carcinoma of the endometrium in Norway: a histopathological and prognostic survey of a total population. International Journal of Gynecologic Cancer 1992;2(1).
- Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998;280(17):1510-7.
- Aristizabal P, Graesslin O, Barranger E, Clavel-Chapelon F, Haddad B, Luton D, et al. A suggested modification to FIGO stage I endometrial cancer. Gynecologic Oncology 2014;133(2):192-196.
- Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet 2005;366(9484):491-505.
- Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecologic Oncology 1991;40(1):55-65.
- Malik TY, Chishti U, Aziz AB, Sheikh I. Comparison of risk factors and survival of type 1 and type II endometrial cancers. Pakistan Journal of Medical Sciences. 2016;32(4):886.
- Hag-Yahia N, Gemer O, Eitan R, Raban O, Vaknin Z, Levy T, et al. Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study. Acta Obstetricia et Gynecologica Scandinavica 2021;100(3):444-52.
- Wong AS-W, Cheung CW, Fung LW-Y, Lao TT-H, Mol BWJ, Sahota DS. Development and validation of prediction models for endometrial cancer in postmenopausal bleeding. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;203:220-4.
- Clarke MA, Long BJ, Morillo ADM, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Internal Medicine 2018;178(9):1210-22.
- Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet 2005;366(9484):491-505.
- Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study—On behalf of the Swedish Gynecological Cancer Group. International Journal of Cancer 2017;140(12):2693-700.
- Cunningham FG. Williams Jinekoloji. 15 ed: Nobel Tıp Kitabevi; 2015
- Zaino RJ, Kurman RJ, Diana KL, Morrow CP. Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage--a Gynecologic Oncology Group study. Cancer 1996;77(6):1115-21. Epub 1996/03/15. PubMed PMID: 8635132.
- Yan B, Zhao T, Liang X, Niu C, Ding C. Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer? Acta Radiologica 2018;59(3):363-70.
- Ayhan A, Taskiran C, Yuce K, Kucukali T. The prognostic value of nuclear grading and the revised FIGO grading of endometrial adenocarcinoma. International Journal of Gynecological Pathology. 2003;22(1):71-4.
- Boronow R, Morrow C, Creasman W, Disaia P, Silverberg S, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstetrics and Gynecology 1984;63(6):825-32.
- Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecologic Oncology 1997;64(3):411-7.
- Berchuck A, Anspach C, Evans AC, Soper JT, Rodriguez GC, Dodge R, et al. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecologic Oncology 1995;59(1):20-4.
- Dane C, Bakir S. The effect of myometrial invasion on prognostic factors and survival analysis in endometrial carcinoma. African Health Sciences 2019;19(4):3235-41.
- De Góis N, Martins NV, Abrão F, De Lima G, Alves AC. Peritumorous lymph-vascular invasion, grade of histologic differentiation, and myometrial infiltration as prognostic factors of endometrial carcinoma. Revista Paulista de Medicina. 1993;111(3):385-90.
- Ayhan A, Şahin H, Sari ME, Yalçin I, Haberal A, Meydanli MM. Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer 2019;29(3):505-512. doi:10.1136/ijgc-2018-000069
- Şahin B, Güner E, Kara OF. Endometrial Kanser Cerrahisi Yapılan Olgularda Prognozu Etkileyen Klinik ve Patolojik Faktörler. Türk Jinekolojik Onkoloji Dergisi 2018:2 :17-23.
- Sadozye AH, Harrand RL, Reed NS. Lymphovascular Space Invasion as a Risk Factor in Early Endometrial Cancer. Curr Oncol Rep 2016;18(4):24. doi:10.1007/s11912-016-0505-1
- Neal SA, Graybill WS, Garrett-Mayer E, McDowell ML, McLean VE, Watson CH, et al. Lymphovascular space invasion in uterine corpus cancer: what is its prognostic significance in the absence of lymph node metastases? Gynecologic Oncology 2016;142(2):278-82.
- Gemer O, Arie AB, Levy T, Gdalevich M, Lorian M, Barak F, et al. Lymphvascular space involvement compromises the survival of patients with stage I endometrial cancer: results of a multicenter study. European Journal of Surgical Oncology (EJSO) 2007;33(5):644-7.
There are 35 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 28, 2023 |
| Submission Date | June 12, 2023 |
| Published in Issue | Year 2023 Volume: 23 Issue: 3 |
