The aim of this study was to determine whether the presence and extent of lymphovascular invasion (LVI) is prognostic in surgical stage I cervical squamous cell carcinoma (SCC). All available tumour slides and/or paraffin blocks from 426 patients with stage I cervical SCC treated surgically with curative intent were collected from 18 institutions and retrospectively analysed. Presence and extent of LVI (focal <5 spaces, extensive ≥5 spaces) were assessed on scanning magnification in large haematoxylin and eosin slide sets in 366 cases. Progression-free survival (PFS) was calculated as the time from surgery to first progression or death or last follow-up, whichever occurred first. Overall survival (OS) was defined as the time from surgery to death or last follow-up. Clinicopathological and statistical analyses were performed on 97 patients with the International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA and 329 patients with stage IB SCC of the cervix. LVI, both focal and extensive, was more frequent in stage IB than in stage IA (p<0.001). Patients with stage IB carcinomas with extensive LVI had worse PFS [hazard ratio (HR) 2.86; 95% confidence interval (CI) 1.49, 5.49; p=0.005] and OS (HR 2.88; 95% CI 1.38, 6.02; p=0.012) than those with focal or no LVI. In stage IA, in contrast, the presence and extent of LVI did not associate with PFS (p=0.926) or OS. Extensive LVI was not statistically correlated with PFS and OS in substages IA1, IA2 or IB2. PFS (HR 3.7; 95% CI 1.61, 8.46; p<0.001) and OS (HR 4.18; 95% CI 1.58, 11.04; p=0.002) in stage IB1, and PFS (HR 7.78; 95% CI 0.87, 69.82; p=0.039) in stage IB3 were diminished in the presence of extensive LVI. In conclusion, in patients with FIGO stage I cervical SCC, the presence and extent of LVI has prognostic significance in stage IB carcinoma, and quantifying LVI is recommended.

Department of Gynaecology Obstetrics and Neonatology General University Hospital Prague 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Pathology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Pathology A C Camargo Cancer Center Sao Paulo Brazil

Department of Pathology and Laboratory Medicine Emory University School of Medicine Atlanta USA

Department of Pathology Cleveland Clinic Cleveland USA

Department of Pathology Hospital Universitari de Bellvitge IDIBELL Barcelona Spain

Department of Pathology Laboratory Medicine Program University Health Network Toronto Canada

Department of Pathology Massachusetts General Hospital Boston MA USA

Department of Pathology Memorial Sloan Kettering Cancer Center New York NY USA

Department of Pathology Oncologic Institute Lisbon Portugal

Department of Pathology Sahlgrenska University Hospital Gothenburg Sweden

Department of Pathology Universita degli Studi di Messina Italy

Department of Pathology University of California San Diego USA

Department of Pathology University of Chicago Chicago IL USA

Department of Pathology University of Medicine Pharmacy Science and Technology 'George E Palade' of Targu Mures Targu Mures Romania

Department of Pathology University of Michigan Detroit MI USA

Department of Pathology Vancouver General Hospital Vancouver BC Canada

Department of Pathology Wayne University Detroit MI USA

Department of Surgical Oncology A C Camargo Cancer Center Brazil

Jikei University School of Medicine Tokyo Japan

Ospedale Sacro Cuore Don Calabria Negrar Italy

Regional Institute of Oncology Iasi Romania

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