Survival outcomes of endometrial cancer patients with lymphovascular space invasion: A multicenter, retrospective cohort study.

Abstract

Objectives: This study aimed to evaluate the prognostic impact of lymphovascular space invasion (LVSI) on treatment outcomes and survival in patients with endometrial cancer (EC).

Materials and methods: We conducted a multicenter, retrospective study of 298 EC patients who underwent hysterectomy-based surgery between January 2011 and June 2021. Clinical and pathological data, including LVSI status, were collected. Cox regression and multivariate analyses were performed to assess recurrence, progression-free survival (PFS), and overall survival (OS), with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) reported.

Results: LVSI-positive patients (n = 99) were more likely to present with advanced Federation of Gynecology and Obstetrics stage, lymph node involvement, and to receive adjuvant radiotherapy (RT) and chemotherapy (all P < 0.0001). LVSI was an independent predictor of recurrence (aHR: 7.76, P = 0.0064), but its association with PFS and OS was not significant in multivariate analysis, likely due to the effects of adjuvant treatment. The absence of RT or chemotherapy substantially increased the risk of recurrence and mortality in LVSI-positive patients. High-grade tumors (grade 3) were associated with poorer OS (aHR: 3.87, P = 0.0092), and older age was also linked to worse survival (aHR: 1.05, 95% CI: 1.01-1.10). Histological type 2 tumors were associated with increased recurrence.

Conclusion: LVSI is an independent predictor of recurrence in EC but may not significantly affect PFS or OS after adjusting for treatment. These findings highlight the need for tailored adjuvant therapy in LVSI-positive patients and further research to clarify its prognostic value.