Prognostic significance of lymphovascular space invasion for stage IA1 and IA2 cervical cancer

Background Data regarding the prognostic significance of lymphovascular space invasion (LVSI) for stage IA1 and IA2 cervical cancer are limited. Specifically, the role of LVSI as an independent risk factor for mortality in stage IA disease has not been shown. Objective We examined the association between LVSI and nodal metastases and survival for women with stage IA1 and IA2 cervical cancer. Study Design We used the National Cancer Database to identify patients with stage IA adenocarcinoma or squamous carcinoma of the cervix from January 2010 through December 2015 for whom LVSI status was known. Mixed-effect log-Poisson models were used to identify predictors of LVSI. Cox proportional hazard models and Kaplan-Meier curves were used to compare all-cause mortality. Results We identified 3239 patients with stage IA1 and 1049 patients with stage IA2 carcinoma of the cervix. Among patients with stage IA1 and IA2 disease, 10.5% and 18.8% had LVSI, respectively. Less than 1% of patients with stage IA1 disease without LVSI had positive nodes compared with 7.8% of those with LVSI (p<0.001). Lymphatic metastases were identified in 1.7% of stage IA2 cases without LVSI versus 14.6% for those with LVSI (p<0.001). Among both stage IA1 and IA2 patients, squamous histology, grade 3 tumor differentiation, and white race were associated with LVSI (p<0.05 for all). In a univariable model, the hazard ratio for death associated with LVSI was 1.05 (95% CI 0.45 to 2.45) for women with stage IA1 tumors and 2.36 (95% CI 1.04 to 5.33) for those with IA2 neoplasms. Conclusions LVSI is associated with lymph node metastases in patients with stage IA cervical cancer. LVSI is associated with decreased survival for women with stage IA2 cervical cancer.