Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer

Courtney, Edward; West, NP; Kaur, Chanchal Deep; Ho, Jingshan; Kalber, B.; Hagger, R; Finlayson, Caroline; Leicester, R. J.

doi:10.1111/j.1463-1318.2008.01553.x

Cited by 42 publications

(30 citation statements)

References 20 publications

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“…Vascular invasion has long been recognised to be of prognostic importance in colorectal cancer [31] although some authors report that only extramural venous invasion to be of prognostic value [15,32]. The incidence of VI in this study is similar to other reported studies in which it has been looked for [15].…”

Section: Discussionsupporting

confidence: 81%

“…The incidence of VI in this study is similar to other reported studies in which it has been looked for [15]. As is the case for PNI synoptic reporting of CRC specimens significantly increases the rate of VI reported by pathologists [30].…”

Section: Discussionsupporting

confidence: 80%

“…Emergent surgery, perioperative blood transfusion and male gender are clinical factors that have been variably reported to adversely affect prognosis [9][10][11][12] whereas, number of nodes examined, vascular invasion (VI), poor differentiation, perineural invasion (PNI), mucinous tumour type and tumour extension outside involved lymph nodes are pathological features reported by some authors to worsen prognosis in any given stage [13][14][15][16][17][18]. The reported incidence of these variables and their relative importance varies widely in the surgical literature.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

Gandhi¹,

Welsh²,

Jp³

2014

J Gastrointest Dig Syst

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Objective: To assess the importance of clinical and histopathological features in the risk stratification of resected colorectal cancer and their utility as indicators of the need for adjuvant therapy.Methods: Prospectively collected data was analysed from 524 consecutive cases of colon and rectal cancer resected by a single surgical team with a median follow up of 49 months. Multivariate analysis was used to determine clinical and pathological features that independently predicted cancer related death and their relative importance.Results: Pathological features associated with an increased risk of cancer related death were the presence of metastatic disease, penetration of the bowel wall, lymph node status, perineural invasion and vascular invasion. Emergent surgery was the only clinical feature to predict cancer related death. Adjuvant chemotherapy significantly improved the survival of colorectal cancer patients whose tumours demonstrated either vascular or perineural invasion.Conclusions: Vascular and perineural invasion and emergent surgery are independent and significant predictors of death from colorectal cancer. Adjuvant chemotherapy improved the survival of patients whose tumours demonstrated vascular or perineural invasion. The components of TNM stage alone do not provide enough information on which to make decisions on the utility of adjuvant chemotherapy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

Gandhi¹,

Welsh²,

Jp³

2014

J Gastrointest Dig Syst

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“…The meta-analysis has also shown that MRI-detected prevalence of EMVI in rectal cancer is 34.6% (CI: 23.7–47.4%) and thus amounts to over a third of all rectal cancers. Although the link between pathological EMVI and liver metastases is well-established (Talbot et al , 1980), its reporting by individual pathologists is highly variable with documented pathological underreporting of pEMVI resulting in rates of only 9–21% in published audits (Stewart et al , 2007; Courtney et al , 2009; Messenger et al , 2011, 2012; Betge et al , 2012; Bhangu et al , 2013; Kirsch et al , 2013; Gibson et al , 2014). Furthermore pathological EMVI status is only available after surgery, thus limiting the ability to tailor preoperative therapy.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

et al. 2017

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Background:Pathological extramural vascular invasion (EMVI) is an independent prognostic factor in rectal cancer, but can also be identified on MRI-detected extramural vascular invasion (mrEMVI). We perform a meta-analysis to determine the risk of metastatic disease at presentation and after surgery in mrEMVI-positive patients compared with negative tumours.Methods:Electronic databases were searched from January 1980 to March 2016. Conventional meta-analytical techniques were used to provide a summative outcome. Quality assessment of the studies was performed.Results:Six articles reported on mrEMVI in 1262 patients. There were 403 patients in the mrEMVI-positive group and 859 patients in the mrEMVI-negative group. The combined prevalence of mrEMVI-positive tumours was 0.346(range=0.198–0.574). Patients with mrEMVI-positive tumours presented more frequently with metastases compared to mrEMVI-negative tumours (fixed effects model: odds ratio (OR)=5.68, 95% confidence interval (CI) (3.75, 8.61), z=8.21, df=2, P<0.001). Patients who were mrEMVI-positive developed metastases more frequently during follow-up (random effects model: OR=3.91, 95% CI (2.61, 5.86), z=6.63, df=5, P<0.001).Conclusions:MRI-detected extramural vascular invasion is prevalent in one-third of patients with rectal cancer. MRI-detected extramural vascular invasion is a poor prognostic factor as evidenced by the five-fold increased rate of synchronous metastases, and almost four-fold ongoing risk of developing metastases in follow-up after surgery.

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“…According to ESMO guidelines (2013), adjuvant chemotherapy can be given in highrisk stage II (and stage III) rectal cancer even if the level of evidence is low [1]. In most studies reporting on lymphovascular invasion (LVI), both colonic and rectal cancer patients are included and, in the majority of the studies, the reported number of patients with LVI is low [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p ¼ .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.

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Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer

Cited by 42 publications

References 20 publications

Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

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