Kevser ARKAN, Mesut Ali HALİSÇELİK, Ali Deniz ERKMEN, Gül ÇAVUŞOĞLU ÇOLAK, Gül AY KARAHAN, Sultan SEREN KARAKUŞ, Sedat AKGÖL
Zeynep Kamil Medical Journal - 2026;57(2):108-113
Objective: To evaluate whether focal lymphovascular space invasion (LVSI) affects 5-year disease-free survival (DFS) in patients with stage 1 endometrial cancer according to the 2023 FIGO classification. Material and Methods: This retrospective cohort study included 475 patients with FIGO 2023 stage 1 endometrial cancer treated between 2014 and 2018. Patients were categorized as LVSI-negative (n=444) or focal LVSI (n=31). Those with substantial LVSI were excluded. Clinicopathological variables, recurrence patterns, and survival outcomes were compared between the groups. Kaplan-Meier analysis and Cox regression models were used to identify prognostic factors for DFS. Results: Focal LVSI was present in 6.5% of patients. The focal LVSI and LVSI-negative groups were comparable in terms of age, grade, menopausal status, and depth of myometrial invasion. During a median follow-up of 67 months, 12 recurrences occurred in the LVSI-negative group, whereas no recurrences were observed among patients with focal LVSI. The 5-year DFS rates were 97.3% and 100%, respectively (log-rank p=0.48). In multivariate Cox regression analysis, focal LVSI was not an independent predictor of DFS (p=0.982). Conclusion: Focal LVSI, as defined by FIGO 2023 and WHO criteria, was not associated with an increased risk of recurrence or reduced DFS in stage 1 endometrial cancer. These results suggest that patients with focal LVSI may not require adjuvant therapy, supporting a more individualized and conservative management approach, pending validation in prospective molecularly characterized studies.
