Impact of depth and extent of lymphovascular space invasion on lymph node metastasis and recurrence patterns in endometrial cancer

Background and Objectives To determine the significance of depth and extent of lymphovascular space invasion (LVSI) on lymph node metastasis and recurrence in endometrial cancer. Methods A case‐control study was conducted to examine LVSI‐positive (n = 70) and LVSI‐negative (n = 641) stage I–III endometrial cancer cases that underwent hysterectomy‐based surgical staging. The risk of lymph node metastasis and distant recurrence was estimated based on LVSI patterns. Results In multivariate analysis, deep (>50% invasion), and extensive (≥7 foci/slide) LVSI patterns had a significantly increased risk of lymph node metastasis (incidence 57.6% and 72.7%, odds ratio 33.8 and 49.9, respectively, P  < 0.001) as compared to other traditional uterine factors (>50% myometrial tumor invasion, cervical stromal invasion, and adnexal involvement: incidence range 30.4–37.9%, odds ratio range 3.80–7.03). Deep and extensive of LVSI patterns were both significantly correlated to distant recurrence ( P  < 0.001). Among women who received postoperative chemotherapy, deep and extensive LVSI patterns did not have increased risks for distant recurrence compared to no LVSI ( P  = 0.47 and 0.32, respectively). Among women who received postoperative radiotherapy, the depth of LVSI was significantly associated with recurrence outside the radiated field ( P  = 0.02). Conclusions Depth and extent of LVSI are important predictors for lymph node metastasis and distant recurrence in endometrial cancer. J. Surg. Oncol. 2015;112:669–676 . © 2015 Wiley Periodicals, Inc.