Prognostic significance of lymphovascular space invasion in endometrial cancer and its relationship with other prognostic factors

Objective: To investigate the prognostic significance of lymphovascular space invasion (LVSI) and its relationship with other prognostic factors in patients with endometrial cancer. Material and Methods: Patients with stage 1a/1b endometrial cancer who underwent hysterectomy and/or staging surgery between January 2016 and December 2020 at a tertiary referral center were retrospectively analyzed. Pathological data including histological type, stage, grade, LVSI (lymphatic invasion, vascular invasion), tumor size, depth of myometrial invasion, cervical involvement, lymph node evaluation (pelvic, paraaortic), and peritoneal wash cytology were analyzed using univariate and multivariate methods. Results: The study included 304 patients. Non-endometrioid tumors were associated with a 6.35-fold higher risk of LVSI. Each 1 mm increase in tumor size raised the risk by 1.03-fold. LVSI was present in 53.3% of cases with lymph node metastasis and was 7.2-fold more frequent in deceased patients (odds ratio: 7.209; 95% confidence interval: 3.137-16.570; p<0.001). Multivariate analysis identified tumor grade and survival as independent predictors of LVSI: grade 3 tumors had a 4.88-fold higher risk (p=0.014), and mortality was associated with a 4.16-fold higher risk (p=0.007). Survival was significantly linked to LVSI, tumor size ≥35 mm, and recurrence, but not to age, histological type, lymph node status, or peritoneal cytology. Conclusion: Our results demonstrated that LVSI was significantly associated with histological grade and survival. Furthermore, LVSI, tumor diameter ≥35 mm, and recurrence were found to significantly affect survival, highlighting their prognostic relevance for risk assessment and postoperative management.