Impact of intramural and extramural vascular invasion on stage II‐III colon cancer outcomes

Abstract

Background and Objectives: Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II-III colon cancer. Methods: All stage II-III colon cancer patients who underwent surgery between 2004–2015 were reviewed. We divided the study group into patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n=923). Results: EMVI was associated with other high-risk features, including T4, N+ disease, lymphatic, and perineural invasion (P<0.001). EMVI+ patients had considerably higher rates of locoregional and distant recurrence and subsequently disease-specific mortality (stage-II: odds ratio (OR) 3.64, P=0.001, stage-III OR:1.94, P=0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR:1.21, P=0.764, OR:1.28, P=0.607, respectively). The adjusted hazard ratios for EMVI+ patients on disease-free survival, and disease-specific survival were 2.07 (P<0.001), 1.67 (P=0.027), respectively. Moreover, EMVI+ stage-II patients fared worse than EMVI– stage-III patients, even after adjusting for adjuvant chemotherapy. Conclusion: EMVI is a strong predictor for worse oncologic outcomes in stage II-III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.

Comparison of vascular invasion with lymph node metastasis as a prognostic factor in stage I-III colon cancer: an observational cohort study

“…However, overemphasis on LNM in the colon cancer TNM staging system is controversial. Many studies have reported the prognostic impact of high-risk features beyond LNM [11][12][13][14][15][16][17][18][19][20][21][22][23]. One study showed the relationship between the number of high-risk features and prognosis, demonstrating that 5-year OS rate was less than 20% in patients with stage II colon cancer with four or more high-risk features [18].…”

The Impact of Extramural Venous Invasion in Colorectal Cancer: A Detailed Analysis Based on Tumor Location and Evaluation Methods

“…Although the clinicopathological significance of EMVI in CRC has already been studied, EMVI based on tumor location and evaluation methods is not available. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Arterial blood is supplied from the outer layer to the inner layer of the gastrointestinal tract and comes out as venous blood. If a tumor cell invades into the vessel, regional, and distant metastases can be induced through the venous flow.…”

“…The following data were collected from the full texts of eligible studies: the first author's name, study location, information of tumor, year of publication, number of patients analyzed, evaluation method of venous invasion, the rates of EMVI, and the data for survival rate. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] We did not define a minimal number of patients to be included in a study. The estimated hazard ratio (HR) and its standard error using given parameters, which were the HR point estimate, log-rank statistic or its P value, O-E statistic (difference between numbers of observed and expected events), or its variance, were aggregated.…”

Evaluating the impact of lymph node resampling on colorectal cancer nodal stage

“…Specifically, vascular invasion was defined as extramural venous invasion, as this has been shown to carry a significantly worse prognosis than small-vessel and intramural venous invasion. 34 The slides for all ≥pN1 cases were reviewed to assess nodal and tumour deposit status within the initial and subsequent lymph node dissections. pN1c cases were analysed separately because, unlike for nodal metastases, tumour deposit staging is binary and not influenced by the number of tumour deposits.…”