Low-risk endometrial carcinoma: is it time to subclassify it?

Objective: Endometrial cancer in Argentina represents the second most frequent gynecological cancer, accounting for 6% of all cases of cancer in women. The prognostic significance of lymphovascular space invasion (LVSI) and the patterns of tumor penetration in patients with FIGO Stage IA endometrial adenocarcinoma have not been established. The authors sought to determine if the pattern of tumor penetration and the LVSI status in patients with early-stage, low-risk endometrial cancer are correlated with recurrence and survival. Materials and Methods: The records of all women who underwent hysterectomies for the primary treatment of endometrial cancer from June 2010 to June 2015 at the Hospital Italiano de Buenos Aires were reviewed. Patients with Grade 1 or 2 endometrioid histology and FIGO Stage IA endometrial adenocarcinoma were analyzed. Fisher's exact test and the Wilcoxon rank-sum test were used to compare patients with different types of tumor penetration [expansive or infiltrative/microcystic elongated and fragmented (MELF)J and different LVSI status. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: Eighty-two (n = 82) patients met the inclusion criteria. Those patients without myometrial infiltration (M0) were excluded (n=72). Fourteen (17%) had LVSI. Fifty-one (62.19%) had an expansive type of penetration, 20 (24.39%) had an infiltrative type of penetration, and only 11 (13.41%) had a MEI,F type of penetration. The authors recorded six (7.31%) cases of recurrence after a mean follow-up period of 1,368 days (3.8 years). Five of those six cases had recurrences at the vaginal cuff, and one had recurrence in the peritoneum. It was possible to confirm a statistically significant relation between LVSI and the recurrence index. The incidence of recurrence in patients with LVSI was 35%, and in patients without LVSI, it was 0.7% (p < 0.000). No correlation between the type of tumor penetration and the incidence of recurrence was demonstrated in this study. Conclusion: Patients with low-risk endometrial cancer and LVSI have worse RFS and OS. No correlation between the type of tumor penetration and the incidence of recurrence was demonstrated in this study.