Satellite lymphovascular space invasion: An independent risk factor in early stage cervical cancer

• Comparing conjoined LVSI with satellite LVSI, satellite LVSI is correlated with higher risk for both recurrence and death.
• Satellite LVSI is an important independent prognostic factor for both recurrence and survival in early stage cervical cancer.
• Adjuvant treatment may be considered in women with satellite LVSI, even in the absence of Delgado criteria.

ObjectiveThis study was performed to determine whether satellite LVSI in women with early stage cervical carcinoma is an independent prognostic factor for recurrence and survival.MethodsA total of 210 eligible patients with FIGO stages IA2 and IB1 cervical carcinoma, who underwent radical hysterectomy or radical trachelectomy with pelvic lymphadenectomy between January 2000 and December 2012, were included. Variables studied included age, histology type, differentiation grade, tumor size (TS), depth of invasion (DI), lymph node metastasis (LNM), conjoined lymphovascular space invasion (LVSI) and satellite LVSI. Univariate and multivariate analyses were performed to define variables that best predict recurrence and survival.ResultsUnivariate analysis showed that differentiation grade, depth of invasion, tumor size, lymph node metastasis, and both conjoined LVSI and satellite LVSI were significantly associated with recurrence and survival. Using multivariate analysis, differentiation grade (HR 3.63, 95%-CI 1.51–8.72), conjoined LVSI (HR 5.95, 95%-CI 1.57–22.53) and satellite LVSI (HR 7.45, 95%-CI 3.03–18.27) were independent prognostic factors for recurrence; LNM (HR 5.55, 95%-CI 1.52–20.26) and satellite LVSI (HR 8.94, 95%-CI 2.43–32.95) were prognostic factors for overall survival. For patients with low-risk cervical cancer without LNM only satellite LVSI correlated significantly with disease-free and overall survival.ConclusionDifferentiation grade, DI, TS, LNM, and conjoined LVSI as well as satellite LVSI were prognostic factors for DFS and OS. Satellite LVSI is the most important factor predicting DFS and OS in early stage cervical cancer, especially when lymph nodes are negative.