912 Am J Clin Pathol 2008;129:912-917 912 DOI: 10.1309/CP3HGX7H753QQU8T © American Society for Clinical Pathology Anatomic Pathology / LVI In EndomEtrIaL CanCEr Lymphovascular Invasion Is a Significant Predictor for Distant Recurrence in Patients With Early-Stage Endometrial Endometrioid Adenocarcinoma Sharon Nofech-Mozes, MD, 1,2 Ida Ackerman, MD, FRCPC, 2,3 Zeina Ghorab, MD, 1,2 Nadia Ismiil, MD, FRCPC, 1,2 Gillian Thomas, MD, FRCPC, FRCR(Hon), 2,3 Al Covens, MD, FRCPC, 3 and Mahmoud A. Khalifa, MD, PhD, FRCPC 1,2 Key Words: Endometrial endometrioid adenocarcinoma; Pathologic features; Lymphovascular invasion; Prognosis; Distant recurrence; Adjuvant therapy DOI: 10.1309/CP3HGX7H753QQU8T Abstract To evaluate the value of lymphovascular invasion (LVI) in endometrial endometrioid adenocarcinoma (EEA) as a predictor for distant recurrence, we analyzed the histopathologic features of 513 consecutive cases of nonsurgically staged EEA limited to the uterus. Grade, myoinvasion, cervical involvement, and LVI were evaluated. With a median follow-up of 28 months (range, 2-144 months), 67 cases (13.1%) recurred, 37 (7.2%) had locoregional recurrence, and 30 (5.8%) developed distant recurrence. LVI was identified in 116 cases (22.6%) cases and was the only adverse histopathologic finding in 23 cases; 5 (22%) of the 23 recurred. Multivariate analysis demonstrated a significant association between any type of recurrence and cervical involvement (hazard ratio [HR], 2.760; 95% confidence interval [CI], 1.621-4.698) and LVI (HR, 2.717; CI, 1.568- 4.707). Multivariate analysis revealed LVI as the only independent predictor for distant recurrence (HR, 2.841; CI, 1.282-6.297). Studies to examine the role of adjuvant systemic therapy in patients with early-stage disease should be considered. Endometrial endometrioid adenocarcinoma (EEA), the most common type of uterine cancer, is confined to the uterine corpus at the time of diagnosis in the majority of patients. In general, endometrial carcinoma has a favorable prognosis, with an 80% 5-year survival. Numerous studies have demonstrated that cell type, histologic grade, depth of myometrial invasion, cervical involvement, and lymphovas- cular involvement (LVI) can predict recurrence and survival in patients with endometrial cancer. 1,2 Based on these histo- pathologic findings, patients are classified into 3 risk groups and adjuvant therapy is recommended based on the presence of these adverse histologic features. 3,4 Data from randomized clinical trials showed that in early stage, pelvic radiotherapy reduced locoregional recurrence but did not improve survival of patients with distant recurrences. 5 The findings of previous studies have been contradictory with respect to the significance of LVI as an independent prognostic factor. The present study focused on patients with early-stage EEA as defined by the pathologic findings of disease confined to the uterus in the hysterectomy specimen combined with respective clinicoradiologic assessment. Our aim was to identify a subset of patients with a higher risk for recurrence, with an emphasis on extrapelvic sites. Materials and Methods Samples and Patients A total of 827 hysterectomy specimens with pure EEA were accessioned in the Department of Anatomic Pathology, Sunnybrook Health Sciences Center, Toronto, Canada, Downloaded from https://academic.oup.com/ajcp/article/129/6/912/1760292 by guest on 23 December 2022