Vascular Lymphatic Space invasion VLSI

VLSI occurs less frequently in endometrial cancer than cervical cancer being present in approximately 15% patients. It was associated with a 27% incidence of pelvic nodal metastases and a 19% incidence paraaortic nodal metastases in the GOG study (104). This compares with an incidence of 7% and 9% pelvic and para-aortic node metastases respectively when VLSI is absent. A similar increased risk of nodal metastases was seen when the cancer was sited in the fundus rather than the ismthmus-cervix and also when there was adnexal involvement. VLSI has been found to be present in 26.5% of patients who recurred (104). Gal et al (105) in a series of 122 patients with stage 1 endometrial cancer found only 10 recurrences but 9/11 (82%) patients had recurrent disease. Thus VSLI appears to be a definite adverse prognostic factor in this disease.

Table 18. Prognosis stage and incidence of pelvic and paraortic node metastases in endometrial cancer

FIGO

Definition

Incidence of

Incidence of para- 5 year

Stage (9)

pelvic node

aortic node métastasé survival

metastases

(104)

(104)

1

Confined to corpus

72% overall

uteri

1A

Limited to

1%

1%

endometrium

IB

Invasion <50%

5-6%

1-3%

myometrium

1C

Invasion >50%

25%

17%

myometrium

2

Extension to :

56 % overall

2A

Endoccrvical glands

16%

14%

2B

Cervical stroma

(invasion)

3

Extension to:

31.5%

3A

serosa/adnexa/

32%

20%

positive cytology

3B

Vaginal metastases

3C

Pelvic and para-artic

nodes

4

Distant metastases

0%

0 0

Post a comment