Assessment of peritoneal elastic laminal invasion improves survival stratification of pT3 and pT4a colorectal cancer: a meta-analysis

Abstract

<jats:p>Evaluating peritoneal elastic laminal invasion (ELI) has been proposed as an additional assessment for pT3 colorectal cancers (CRC). Its clinical significance has not yet been established. We performed a meta-analysis to investigate the prognostic impact of ELI assessment for subcategorisation of pT3 CRC. We performed a search in three electronic databases. HR and its 95% CI for overall survival (OS) and disease-free survival (DFS) were calculated using the random effects model weighted by the inverse variance method. We identified six studies that met inclusion criteria out of an original 703 studies found with our database search terms. Our meta-analysis included 1925 patients with pT3 and pT4a CRCs. The presence of ELI in pT3 CRC was associated with shortened OS compared with ELI negative pT3 CRC (HR=1.76; 95% CI 1.21 to 2.55); whereas the DFS was not statistically significant (HR=1.79; 95% CI 0.91 to 3.52). Furthermore, pT4a patients’ OS (HR=1.84; 95% CI 1.41 to 2.40) and DFS (HR=1.88; 95% CI 1.17 to 3.04) were even worse than the OS and DFS of pT3 ELI (+) patients. ELI is a useful marker for stratifying patients with pT3 or pT4a CRCs into three prognostically distinct groups. We recommend the subcategorisation of pT3 CRC by ELI for better prognostic assessment and treatment strategy of patients with CRC.</jats:p>

Prognostic significance of additional histologic features for subclassification of pathological T3 colon cancer

“…Lu et al, proposed ELI assessed with elastic stain as prognostic factors for stage II colon cancer, and might be an indication to postoperative adjuvant chemotherapy [ 39 ]. Recently, a meta-analysis including six studies, recommended the sub-categorization of pT3 CRC by ELI for better prognostic assessment and treatment strategy of patients with CRC [ 40 ]. Our analysis failed to confirm any significant impact of ELI on oncological outcome, and ELI as predictive factor at univariable analysis.…”

Prognostic value of elastic lamina staining in patients with stage III colon cancer

“…Furthermore, excessive sample collection and staining will cause unnecessary waste. Therefore, it may be bene cial to choose patients with T3 stage tumours with peritoneal invasion for elastic lamina staining [15]. The elastic lamina has been found to move from the nontumour area of the peritoneum to the muscularis propria when the tumour invades normal tissues [11].…”

“…In colon cancer, the subserosal elastic lamina is located above the peritoneum [11]. Whether tumours have invaded tissues near the serosa can be evaluated by elastic lamina staining; such invasion is associated with worse prognoses among colon cancer patients [11][12][13][14][15]. Therefore, it has been suggested that CRC patients with ELI positive (ELI+) pT3 tumours and those with pT4a tumours should receive the same treatment [16].…”

Atypical Cells in Peritoneal Cleft: A Pitfall in Diagnosis of Colorectal Adenocarcinoma

“…1 Distinguishing pT4a from pT3 tumor (invading pericolonic fat tissue) is crucial as each command different therapeutic strategies. 6 Accurate assessment of serosal invasion is often challenging in routine clinical practice and clinical studies showed significant variabilities in reporting pT4a versus pT3 colon cancers 7 in all practice settings (academic vs private and subspecialty vs general signing out). 8 One challenge is that peritoneal clefts are often ignored/ missed, though careful sampling of these areas has been shown to enhance detection of serosal involvement.…”