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Nathenson MJ, Conley AP, Lin H, Fleming N, Lazar A, Wang WL, Ravi V. The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes. Int J Gynecol Cancer. 2018;28(7):1297-1310. PMID 30044322

One-paragraph summary

165 adenosarcoma patients from the MD Anderson registry, 1982–2014, with sarcoma-pathologist review. Median OS 8.5 years, DFS 4.7 years. Univariate associations with OS/DFS/LRFS: SO, myometrial invasion, LVSI, tumour size, mitoses, ER, PR, FIGO stage, age, resection status. Cox analysis retained SO, myometrial invasion, LVSI, age, resection status, FIGO stage. Median OS: SO 5.2 vs 14.5 years (p<0.0001); myometrial invasion 5.8 years vs not reached (p=0.0005); LVSI 1.0 vs 8.9 years (p=0.0021). No OS or LRFS difference for adjuvant radiation versus none (p=0.17, p=0.076). Conclusion: standard of care TAH-BSO ± lymphadenectomy and no adjuvant radiation.

Key findings

  • LVSI as a third independent pathological factor alongside SO and invasion, with a 1.0 vs 8.9 year OS split.
  • Largest single-institution adenosarcoma series with path review.
  • Direct negative finding on adjuvant radiation.

Limitations

  • Same institution as Carroll 2014; overlapping patients across 1982–2011/2014 are likely. These are not independent replications of the SO effect.
  • Radiation comparison is not randomised; Seagle NCDB found radiation associated with worse OS, the expected confounding-by-indication direction.
  • LVSI has not been shown independent of SO in a non-MD-Anderson multivariable model of similar size.

Why it matters

This is the paper that put LVSI on the prognostic list that reviews now recite, and the paper guidelines cite (implicitly) when they do not recommend adjuvant radiation for stage I.

Cited by wiki pages

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  • sarcomatous-overgrowth
  • staging-and-prognostic-factors
  • surgical-management
  • adjuvant-and-systemic-therapy
  • red-flags-and-safety-concerns
  • patient-experience-and-advocacy