Surgical restaging of patients with early‑stage endometrial cancer with lymphovascular invasion does not significantly impact their survival outcomes

Abstract

Lymphovascular space invasion (LVSI) is consid‑ ered to be a poor prognostic factor in endometrial cancer. However, management of patients with early‑stage endo‑ metrial cancer with positive LVSI remains controversial. The main objective of the present study was to investigate whether surgical restaging of such patients has a significant effect on survival outcomes or may be otherwise omitted. A retrospective cohort study was conducted at the Gynaecologic Oncology Unit, Insitut Bergonie, Bordeaux, France for the period January 2003‑December 2019. The present study included patients with definitive histopathological diagnosis of early‑stage, grade 1‑2 endometrial cancer with positive LVSI. Patients were divided into two groups: Those being restaged with pelvic and para‑aortic lymphadenectomy (group 1) and those not restaged and receiving complementary therapy (group 2). The primary outcomes of the study were overall survival and progression‑free survival. Epidemiological data, clinical and histopathological characteristics as well as complementary treatment received were also studied. Kaplan‑Meier and Cox regression analyses were performed. Data from 30 patients were retrieved, of which restaging with lymphadenectomy was performed in 21 patients (group 1), while another 9 patients (group 2) were not restaged and received complementary therapy. Lymph node metastasis was observed in 23.8% of patients in group 1 (n=5). No significant difference was observed between groups 1 and 2 in terms of survival outcomes. The median overall survival was 91.31 months in group 1 and 90.61 months in group 2 [hazard ratio (HR), 0.71; 95% CI, 0.03‑16.58; P=0.829]. The median disease‑free survival was 87.95 months in group 1 and 81.52 months in group 2 (HR, 0.85; 95% CI, 0.12‑5.91; P=0.869). In conclusion, restaging with lymphadenectomy did not alter prognosis of early‑stage, LVSI‑positive patients. As there was no clinical and therapeutic benefit, restaging with lymphadenectomy could be omitted in such patients.