Lymphvascular space involvement—a prognostic indicator in patients with surgical stage I endometrial adenocarcinoma treated with postoperative radiation

The objective of this study was to evaluate the prognostic indices of lymphvascular space involvement (LVS), surgical substage and grade on recurrence and survival in patients with surgical stage I endometrial adenocarcinoma, who had received postoperative external beam radiation (ERT). The medical records of all patients who had surgical stage I endometrial cancer between January 1987 and December 1991 were reviewed. Prognostic indicators, ie LVS, surgical substage and grade were correlated with recurrence and survival by log-rank test. Recurrence and survival distributions were estimated using the product limit method. One hundred and twenty-two patients had surgical stage I endometrial cancer. Eight patients were excluded because of histologic types other than endometrioid adenocarcinoma. An additional 27 patients were excluded since they had surgical stage IA and grade I and had not received ERT. The remaining 87 patients who had surgical stage IB and IC and who had received ERT, are the focus of this study. Ten patients had recurrences, all of which were outside the prescribed field of radiation. Nine of II (82%) patients with LVS recurred and 8/11 (73%) patients with LVS died of disease ( P = 0.0001). Surgical substage did not correlate with risk for recurrence ( P < 0.51). Five-year survival for the study group was 92%. LVS correlated well with survival ( P < 0.0001), while grade and surgical substage were not significant indicators of survival in these patients, with surgically documented early disease ( P > 0.13 and P > 0.57). LVS appears to be an important prognostic indicator for both recurrence and survival in patients with surgical stage I endometrial adenocarcinoma who receive postoperative ERT.