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Is focal LVSI a benign finding in FIGO 2023 stage 1 endometrial cancer? A large cohort analysis
Kevser Arkan1, Mesut Ali Halisçelik1, Ali Deniz Erkmen1, Gül Çavuşoğlu Çolak2, Gül Ay Karahan3, Sultan Seren Karakuş4, Sedat Akgöl11Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey2Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
4Department of Obstetrics and Gynecology, Private Clinic, Istanbul, Turkey
INTRODUCTION: To evaluate whether focal lymphovascular space invasion (LVSI) affects 5-year disease-free survival (DFS) in patients with stage 1 endometrial cancer according to the 2023 FIGO classification.
METHODS: This retrospective cohort study included 475 patients with FIGO 2023 stage 1 endometrial cancer treated between 2014 and 2018. Patients were categorized as LVSI-negative (n=444) or focal LVSI (n=31). Those with substantial LVSI were excluded. Clinicopathological variables, recurrence patterns, and survival outcomes were compared between the groups. Kaplan–Meier analysis and Cox regression models were used to identify prognostic factors for DFS.
RESULTS: Focal LVSI was present in 6.5% of patients. The focal LVSI and LVSI-negative groups were comparable in terms of age, grade, menopausal status, and depth of myometrial invasion. During a median follow-up of 67 months, 12 recurrences occurred in the LVSI-negative group, whereas no recurrences were observed among patients with focal LVSI. The 5-year DFS rates were 97.3% and 100%, respectively (log-rank p=0.48). In multivariate Cox regression analysis, focal LVSI was not an independent predictor of DFS (p=0.982).
DISCUSSION AND CONCLUSION: Focal LVSI, as defined by FIGO 2023 and WHO criteria, was not associated with an increased risk of recurrence or reduced DFS in stage 1 endometrial cancer. These results suggest that patients with focal LVSI may not require adjuvant therapy, supporting a more individualized and conservative management approach, pending validation in prospective molecularly characterized studies.
Keywords: Disease-free survival, endometrial cancer, FIGO 2023, focal LVSI, lymphovascular space invasion, prognosis.
Manuscript Language: English
