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Obstet Gynecol. 2014 May;123(5):957-65. doi: 10.1097/AOG.0000000000000240.

Effect of lymphovascular space invasion on survival of stage I epithelial ovarian cancer.

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Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; the Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, University of Tokushima, Tokushima, Niigata University Graduate School of Medicine, Niigata, and Osaka Rosai Hospital, Sakai, Osaka, Japan; the Department of Pathology, Mercy Medical Center, Baltimore, Maryland; the Departments of Gynecologic Oncology and Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; and the Department of Gynecologic Oncology and Cancer Biology, MD Anderson Cancer Center, University of Texas, and the Center for RNA Interference and non-Coding RNA, University of Texas, Houston, Texas.



To evaluate the effect of lymphovascular space invasion on survival of patients with early-stage epithelial ovarian cancer.


A multicenter retrospective study was conducted for patients with stage IA-C epithelial ovarian cancer who underwent primary comprehensive surgery including lymphadenectomy. Histopathology slides for ovarian tumors were examined by gynecologic pathologists for the presence or absence of lymphovascular space invasion. Survival analysis was performed examining tumoral factors.


A total of 434 patients were included in the analysis. Lymphovascular space invasion was detected in 76 (17.5%) patients associated with histology (P=.042) and stage (P=.044). Lymphovascular space invasion was significantly associated with decreased survival outcomes (disease-free survival, 5-year rate 78.4% compared with 90.7%, P=.024 and overall survival, 84.9% compared with 93.2%, P=.031) in univariate analysis. In multivariate analysis, lymphovascular space invasion did not remain a significant variable for disease-free survival (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.97-3.97, P=.059) or overall survival (HR 2.41, 95% CI 0.99-5.85, P=.052). Lymphovascular space invasion was associated with increased risk of hematogenous and lymphatic metastasis (HR 4.79, 95% CI 1.75-13.2, P=.002) but not peritoneal metastasis (P=.33) in multivariate analysis. Among lymphovascular space invasion-expressing tumors, patients who received fewer than six cycles of postoperative chemotherapy had significantly poorer disease-free survival than those who received six or more cycles (HR 4.59, 95% CI 1.20-17.5, P=.015).


Lymphovascular space invasion is an important histologic feature to identify a subgroup of patients with increased risk of recurrence in stage I epithelial ovarian cancer.



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