The role of semiquantitative evaluation of lympho-vascular space invasion in early stage cervical cancer patients

• Published in: Gynecologic oncology 2021-08, Vol.162 (2), p.299-307
• Main Authors: Ronsini, Carlo, Anchora, Luigi Pedone, Restaino, Stefano, Fedele, Camilla, Arciuolo, Damiano, Teodorico, Elena, Bizzarri, Nicolò, Zannoni, Gian Franco, Ferrandina, Gabriella, Scambia, Giovanni, Fanfani, Francesco
• Format: Article
• Language: English
• Subjects: Cervical cancer; Early stage cervical cancer; LVSI
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2021.06.002

Lymph vascular space involvement (LVSI) is one of the most important prognostic factors in early stage cervical cancer. Its qualitative evaluation represents a milestone for patient risk stratification and treatment choice, but a semi-quantitative analysis of LVSI may offer a more truthful risk model, as already demonstrated for endometrial cancer. The present study aims to investigate the performances of a semi-quantitative evaluation of LVSI in terms of patient risk assessment. In this retrospective study were enrolled patients underwent surgical treatment for early cervical cancer from January 2009 to October 2018. A semi-quantitative evaluation such as the “three-tiered approach” was used to classify the LVSI pathway: negative vs. focal vs. diffuse. Diffuse LVSI was found to be a risk factor for lymph node metastasis (OR: 9.844, p < 0.001), and parametrial involvement (OR: 5.566, p < 0.001). Lymph nodal recurrences were more frequent in diffuse LVSI group (LVSI negative vs. focal LVSI p = 0.369; LVSI negative vs. diffuse LVSI p = 0.002; Focal LVSI vs. diffuse LVSI p = 0.214); and so distant recurrences (LVSI negative vs. focal LVSI p = 0.623; LVSI negative vs. diffuse LVSI p = 0.002; Focal LVSI vs. diffuse LVSI p = 0.026). Patients with diffuse LVSI showed a worse disease-free survival (DFS) than patients with focal or absent involvement (DFS LVSI negative vs. focal LVSI p = 0.938; LVSI negative vs. diffuse LVSI p < 0.001; focal LVSI vs. diffuse LVSI p = 0.036). Semi-quantitative evaluation of LVSI may be useful to identify risk patients for shorter disease-free survival and lymphatic and distant recurrences in patients with early stage. •In Early stage Cervical cancer, diffuse Lymph Vascular Space Involvement (LVSI) are a risk factor for lymph node metastasis.•Patients with diffuse LVSI show a worse disease-free survival (DFS) than patients with focal or absent involvement.•Lymph nodal and distant recurrences are more frequent in patients with diffuse LVSI.