{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:51Z","timestamp":1787027931970,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,8,4]],"date-time":"2024-08-04T00:00:00Z","timestamp":1722729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>This 10-year retrospective cohort study at a single-center clinic in Germany aimed to analyze the outcomes of endometrial cancer patients and explore the impact of lymphovascular invasion (LV) on patient outcomes and disease-free survival (DFS). Identifying correlations among demographic data, tumor characteristics, treatment modalities, and survival outcomes could enhance patient management and improve survival rates. The study encompassed patients diagnosed and treated for endometrial cancer from January 2010 to December 2020. Clinical and pathological data were extracted from medical records for 311 patients, focusing on variables such as age, histological type, tumor grade, type of surgical treatment, and adjuvant therapies. Survival analysis was conducted using the Kaplan\u2013Meier method and multivariate Cox proportional hazard models to identify factors independently associated with survival. The study demonstrated that lymphovascular invasion significantly impacted survival outcomes on Kaplan\u2013Meier analysis (log-rank p-value = 0.0058). Patients with LV showed a marked decrease in DFS compared to those without LV invasion, with a median DFS of 3.2 years and a hazard ratio of 2.18 (95% CI: 1.56\u20133.04, p &lt; 0.001). Furthermore, high-grade tumors and p53 positivity were strongly associated with reduced DFS, with hazard ratios of 1.93 (p = 0.001) and 2.11 (p &lt; 0.001), respectively. Patients with distant metastasis exhibited the most significant decline in survival, with a hazard ratio of 5.56 (95% CI: 2.45\u201310.18, p &lt; 0.001). Despite comprehensive surgical and adjuvant therapies, these high-risk factors dictated poorer outcomes. The presence of lymphovascular invasion, high-grade tumors, and genetic markers like MSI and p53 are pivotal in predicting the course of endometrial cancer. This study underscores the necessity for aggressive management strategies in patients exhibiting these high-risk features to potentially improve prognosis and survival outcomes. The findings advocate for enhanced therapeutic strategies tailored to the biological behavior of the tumor, thereby aiming to elevate the overall survival rates for women diagnosed with endometrial cancer.<\/jats:p>","DOI":"10.3390\/diagnostics14151686","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T07:37:30Z","timestamp":1722843450000},"page":"1686","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A 10-Year Retrospective Cohort Study of Endometrial Cancer Outcomes and Associations with Lymphovascular Invasion: A Single-Center Study from Germany"],"prefix":"10.3390","volume":"14","author":[{"given":"Alexandra","family":"Nienhaus","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Department of Obstetrics and Gynaecology \u201cAugusta Krankenanstalt\u201d Bochum, Bergstr. 26, 44807 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahavie","family":"Rajakulendran","sequence":"additional","affiliation":[{"name":"Orthopaedics and Trauma Surgery, St. Josef-Hospital and Catholic Hospital Bochum, Gudrunstra\u00dfe 56, 44791 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1084-2714","authenticated-orcid":false,"given":"Elena","family":"Bernad","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bassette, E., and Ducie, J.A. (2024). Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis. Biomedicines, 12.","DOI":"10.3390\/biomedicines12040886"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.gore.2018.04.009","article-title":"Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it","volume":"25","author":"Staples","year":"2018","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1089\/jwh.2018.6956","article-title":"Increased Incidence of Endometrial Cancer Following the Women\u2019s Health Initiative: An Assessment of Risk Factors","volume":"28","author":"Constantine","year":"2019","journal-title":"J. Womens Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7904","DOI":"10.3390\/curroncol30090574","article-title":"An Overview of Endometrial Cancer with Novel Therapeutic Strategies","volume":"30","author":"Kuhn","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Restaino, S., Paglietti, C., Arcieri, M., Biasioli, A., Della Martina, M., Mariuzzi, L., Andreetta, C., Titone, F., Bogani, G., and Raimondo, D. (2023). Management of Patients Diagnosed with Endometrial Cancer: Comparison of Guidelines. Cancers, 15.","DOI":"10.3390\/cancers15041091"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zheng, W. (2023). Molecular Classification of Endometrial Cancer and the 2023 FIGO Staging: Exploring the Challenges and Opportunities for Pathologists. Cancers, 15.","DOI":"10.3390\/cancers15164101"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ogunmuyiwa, J., and Williams, V. (2024). Emerging Advances in Endometrial Cancer: Integration of Molecular Classification into Staging for Enhanced Prognostic Accuracy and Implications for Racial Disparities. Cancers, 16.","DOI":"10.3390\/cancers16061172"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1586\/14737140.2015.992420","article-title":"Identifying aggressive forms of endometrioid-type endometrial cancer: New insights into molecular subtyping","volume":"15","author":"Liu","year":"2015","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000152","DOI":"10.1136\/bmjmed-2022-000152","article-title":"Endometrial cancer: Molecular classification and future treatments","volume":"1","author":"Corr","year":"2022","journal-title":"BMJ Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Addante, F., d\u2019Amati, A., Santoro, A., Angelico, G., Inzani, F., Arciuolo, D., Travaglino, A., Raffone, A., D\u2019Alessandris, N., and Scaglione, G. (2024). Mismatch Repair Deficiency as a Predictive and Prognostic Biomarker in Endometrial Cancer: A Review on Immunohistochemistry Staining Patterns and Clinical Implications. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25021056"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1158\/1055-9965.EPI-20-1631","article-title":"Long-term Patterns of Excess Mortality among Endometrial Cancer Survivors","volume":"30","author":"Anderson","year":"2021","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"937","DOI":"10.5114\/aoms.2010.19305","article-title":"Long-term survival of endometrioid endometrial cancer patients","volume":"6","author":"Gottwald","year":"2010","journal-title":"Arch. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.3802\/jgo.2022.33.e23","article-title":"Conditional relative survival of patients with endometrial cancer: A Korean National Cancer Registry study","volume":"33","author":"Shin","year":"2022","journal-title":"J. Gynecol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kasius, J.C., Pijnenborg, J.M.A., Lindemann, K., Forsse, D., van Zwol, J., Kristensen, G.B., Krakstad, C., Werner, H.M.J., and Amant, F. (2021). Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification. Cancers, 13.","DOI":"10.3390\/cancers13225848"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Njoku, K., Barr, C.E., and Crosbie, E.J. (2022). Current and Emerging Prognostic Biomarkers in Endometrial Cancer. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.890908"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.5144\/0256-4947.2023.315","article-title":"Overall and progression-free survival in endometrial carcinoma: A single-center retrospective study of patients treated between 2000\u20132018","volume":"43","author":"Sait","year":"2023","journal-title":"Ann. Saudi Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"572","DOI":"10.5114\/jcb.2020.101690","article-title":"Improved disease-free survival with adjuvant radiotherapy in early-stage endometrial cancer: 10-year outcome analysis","volume":"12","author":"Arslan","year":"2020","journal-title":"J. Contemp. Brachytherapy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.5114\/jcb.2023.132191","article-title":"Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country","volume":"15","author":"Zoran","year":"2023","journal-title":"J. Contemp. Brachytherapy"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Tong, N., Kumar, A., Gelowitz, G., Tinker, A., Holloway, C., and Ko, J. (2023). Impact of the adjuvant management and risk factors on survival in FIGO stage 3 endometrial cancer patients. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1035511"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1136\/ijgc-2020-001623","article-title":"Low-dose adjuvant vaginal cylinder brachytherapy for early-stage non-endometrioid endometrial cancer: Recurrence risk and survival outcomes","volume":"30","author":"Smart","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Oliver-Perez, M.R., Padilla-Iserte, P., Arencibia-Sanchez, O., Martin-Arriscado, C., Muruzabal, J.C., Diaz-Feij\u00f3o, B., Cabrera, S., Coronado, P., Mart\u00edn-Salamanca, M.B., and Pantoja-Garrido, M. (2023). Lymphovascular Space Invasion in Early-Stage Endometrial Cancer (LySEC): Patterns of Recurrence and Predictors. A Multicentre Retrospective Cohort Study of the Spain Gynecologic Oncology Group. Cancers, 15.","DOI":"10.3390\/cancers15092612"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, J., Xu, P., Yang, X., Yu, Q., Xu, X., Zou, G., and Zhang, X. (2021). Association of Myometrial Invasion with Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies with 68,870 Patients. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.762329"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1111\/jog.13615","article-title":"Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer","volume":"44","author":"Cuylan","year":"2018","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1080\/0284186X.2019.1643036","article-title":"Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer\u2014A Swedish Gynecologic Cancer Group (SweGCG) study","volume":"58","author":"Bjurberg","year":"2019","journal-title":"Acta Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S1470-2045(18)30079-2","article-title":"Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): Final results of an international, open-label, multicentre, randomised, phase 3 trial","volume":"19","author":"Powell","year":"2018","journal-title":"Lancet Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1686\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:29:46Z","timestamp":1760110186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,4]]},"references-count":25,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["diagnostics14151686"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14151686","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,4]]}}}