The Prognostic Value of Lymphovascular Invasion in Truncal and Extremity Soft Tissue Sarcomas: An Analysis from the National Cancer Database

  • Cecilia G. Ethun
  • Alexandra G. Lopez-Aguiar
  • Jeffery M. Switchenko
  • Theresa W. Gillespie
  • Keith A. Delman
  • Charles A. Staley
  • Shishir K. Maithel
  • Kenneth CardonaEmail author



The aim of this study was to determine the association between lymphovascular invasion (LVI) and overall survival (OS) in truncal/extremity soft tissue sarcomas (STS).


The National Cancer Database (NCDB) was queried for all patients, ages 18–85 years, who underwent resection of primary, truncal/extremity STS between 2010 and 2012, and had LVI data. The primary endpoint was OS.


Among 6169 patients identified, the most common histology groups were (1) liposarcoma (LPS, 24%), (2) undifferentiated pleiomorphic sarcoma (UPS, 19%), and (3) leiomyosarcoma (LMS, 15%); 449 patients (7%) were LVI-positive. There were no differences in demographics or comorbidities between the LVI groups. Compared with LVI-negative patients, LVI-positive patients were more likely to have larger (> 5 cm: 80% vs. 66%), deep (80% vs. 68%), and high-grade tumors (82% vs. 57%). They were also more likely to have positive margins (27% vs. 17%), nodal (16% vs. 2%) and metastatic disease (21% vs. 4%), and receive chemotherapy (37% vs. 18%; all p < 0.001). LVI was associated with worse median OS (39 months vs. MNR; p < 0.001), which persisted on stratum-specific analyses for all tumor grades, size categories, and stages I–III, but not stage IV. On multivariable Cox regression, LVI was associated with worse OS (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.39–2.44), while accounting for other significant prognostic factors. Among non-metastatic, curative-intent resections (n = 5696), LVI was still associated with worse OS (HR 1.79, 95% CI 1.28–2.49).


LVI appears to be an important adverse pathologic factor in truncal and extremity STS. Even when taking into account other established prognostic factors, LVI was predictive of worse OS. Knowledge of LVI status may help to better risk-stratify patients and guide management strategies, and should be considered in future prognostic classification schemes and nomograms.



Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and the National Institutes of Health/National Cancer Center (NIH/NCI) under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the investigator.




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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Cecilia G. Ethun
    • 1
  • Alexandra G. Lopez-Aguiar
    • 1
  • Jeffery M. Switchenko
    • 2
  • Theresa W. Gillespie
    • 1
  • Keith A. Delman
    • 1
  • Charles A. Staley
    • 1
  • Shishir K. Maithel
    • 1
  • Kenneth Cardona
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  2. 2.Department of Biostatistics, Rollins School of Public HealthEmory UniversityAtlantaUSA

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