Prognostic impact of satellite-lymphovascular space involvement in early stage cervical cancer – LVSI in cervical cancer

Objective: The prognostic value of LVSI in patients with cervical cancer is unclear. We evaluated the prognostic impact of different categories of lymphovascular space involvement (LVSI) on overall survival (OAS) and disease free survival (DFS) in a Middle-European population.

Methods: The records of 382 women with cervical cancer undergoing primary surgical treatment at the University of Ulm School of Medicine between 1992 and 2006 were retrospectively reviewed. LVSI as determined by hematoxylin-eosin staining was topographically categorized as conjoined-LVSI and satellite-LVSI. The effect of LVSI, tumor volume, lymph node metastases and histology on OAS and DFS was calculated by Cox regression analyses.

Results: LVSI was detected in 149 out of 382 patients (39,01%). 31 patients (20,8%) were histopathologically categorized as satellite-LVSI, and 118 patients (79,2%) as conjoined-LVSI. No significant effect on survival was calculated for conventional LVSI without further differentiation. However, presence of satellite-LVSI was found to be a significant prognostic factor besides tumor size, nodal status and histological subtype. Comparing satellite-LVSI with lack of LVSI, Hazard ratios calculated for both recurrence (p=0,001; HR=4,281) and death (p=0,001; HR 4,175) showed a significant increased risk.

Conclusion: Conflicting results in the literature in patients with early cervical cancer might be caused by different proportions of prognostic not relevant conjoined-LVSI. The presence of satellite-LVSI should be determined instead of conventional (indiscriminative) LVSI, in order to assess the individual risk of patients which might benefit from adjuvant postoperative treatment.

LVSI - cervical cancer - prognosis - risk factor