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

Abstract

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.

Prognostic markers of recurrence and survival in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery

“…In our study, LVI was identified as a significant predictor of recurrence. LVI was previously reported to be a predictor of recurrence in early-stage rectal cancer [26][27][28], which is consistent with our findings. LVI could be detected in the staging MRI with high specificity and moderate sensitivity [29,30] and could potentially be used to direct intensification of NACRT.…”

Clinical Predictors for Recurrence after Curative Resection for Colorectal Cancer

“…Previous studies have identified several possible additional factors associated with recurrence. Patient factors, like intake of coffee and alcohol, smoking, weight-loss and Glascow Prognostic score [2] [3] [4] [5] [6], treatment factors like surgical experience and technique [7] [8], tumor factors like location, differentiation, vein-, nerve-and lymphatic ingrowth [9] [10] and molecular factors [11] [12] [13] [14] have been shown to influence cancer recurrence, and adjuvant oncological therapy is often recommended. In the present study, we have taken interest in what consequences repeated or aggravated inflammatory stress will inflict on the patient and influence the risk of recurrence after potential curative resection of colorectal cancer.…”

Radiomics Features of 18F-fluorodeoxyglucose Positron-Emission Tomography as a Novel Prognostic Signature in Colorectal Cancer

“…In our study, the developed nomogram incorporated a radiomics score derived from two components of the PET-based features, pN and LVI. Both are well-known clinicopathological prognostic factors in CRC patients [31][32][33]. Unexpectedly, AJCC stage was not identified as a significant factor in our multivariable COX proportional hazard model.…”