Evolution of lymphovascular space invasion in early-stage endometrial carcinoma: stratification, quantification, and clinical implications: a systematic review

Endometrial carcinoma (EC) represents the most prevalent malignancy of the female genital tract in the United States, with lymphovascular space invasion (LVSI) recognized as a critical prognostic factor that significantly influences disease outcomes. This review aims to elucidate the evolving understanding of LVSI in early-stage EC, highlighting its implications for stratification, quantification, and clinical management. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches of the PubMed, Web of Science, and Embase/MEDLINE databases were performed for studies published from January 1, 1985, to November 16, 2024. Peer-reviewed articles that reported multivariable hazard ratios (HR) for LVSI in endometrial cancer were included, while meta-analyses, reviews, and case reports were excluded from analysis. A total of 6 studies involving 2,345 patients were included. The majority of the population was characterized by endometrioid histotype (85.7%) and classified as FIGO stage I (75.1%). LVSI was documented in 21.5% of cases, with 62.4% of patients receiving adjuvant treatment. The literature on LVSI was categorized into three thematic areas: stratification classifications, quantitative assessments, and guideline development, illustrating the progression from binary systems to more nuanced tiered classifications that enhance prognostic accuracy. Foundational studies established LVSI as a significant risk factor in endometrial cancer, while subsequent research has refined its classification and quantification. However, inconsistencies in LVSI thresholds among current clinical guidelines pose challenges for standardization in practice. Addressing these discrepancies through future research, including multicenter studies and the integration of emerging technologies, is crucial for improving risk stratification and clinical management of endometrial carcinoma.