LVSI positive and NX in early endometrial cancer: Surgical restaging (and no further treatment if N0), or adjuvant ERT?

Early endometrial cancer has an overall survival of greater than 80% (1). One of the poor prognostic factors that may be associated with the 20% who do not survive 5 years is the presence of lymphovascular space invasion (LVSI). LVSI is associated with increased nodal metastasis and decreased progre...

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Bibliographic Details
Published in:Gynecologic oncology 2020-01, Vol.156 (1), p.243-250
Main Authors: Harris, Katherine L., Maurer, Kathryn A., Jarboe, Elke, Werner, Theresa L., Gaffney, David
Format: Article
Language:English
Subjects:
Adjuvant treatment
Early endometrial cancer
Endometrial Neoplasms - pathology
Endometrial Neoplasms - radiotherapy
Endometrial Neoplasms - surgery
Endometrial Neoplasms - therapy
Female
Humans
Lymphatic Metastasis
Lymphatic System - pathology
Lymphovascular space invasion
Neoplasm Staging
Radiotherapy, Adjuvant
Unstaged
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Summary:Early endometrial cancer has an overall survival of greater than 80% (1). One of the poor prognostic factors that may be associated with the 20% who do not survive 5 years is the presence of lymphovascular space invasion (LVSI). LVSI is associated with increased nodal metastasis and decreased progression free survival (PFS) and overall survival (OS). (2–8). Therefore, unstaged, LVSI positive early endometrial cancer requires additional management with either completion of staging with lymphadenectomy or adjuvant radiation. We focus on reviewing the management of natural history and management of early endometrial cancer followed by the prognostic impact of LVSI, management options and recommendations. •Endometrial cancer with positive LVSI has increased lymph nodes metastasis, recurrence and decreased overall survival.•LVSI positive, unstaged, early endometrial cancer requires additional management.•Surgically staged, node negative, early endometrial cancer with positive LVSI has worse outcomes.•Tiered system of quantifying LVSI may be beneficial.•Adjuvant ERT should be considered for multifocal LVSI in unstaged early endometrial cancer.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2019.09.016