Lymphovascular Invasion and Perineural Invasion Negatively Impact Overall Survival for Stage II Adenocarcinoma of the Colon

Abstract

BACKGROUND: Lymphovascular invasion and perineural invasion are histopathological features associated with higher-risk colon cancer. OBJECTIVE: The purpose of this study was to quantify the impact of lymphovascular and perineural invasion on overall survival after diagnosis and to determine the protective effect of adjuvant chemotherapy for early adenocarcinoma with high-risk factors. DESIGN: This was a retrospective database review of the 2010–2014 National Cancer Database for colon cancer. SETTINGS: Individuals diagnosed with invasive adenocarcinoma of the colon (histology code 8140) with primary surgical resection with >12 nodes harvested and no positive nodes on pathological examination were included. PATIENTS: A total of 32,493 patients underwent surgical resection for stage II adenocarcinoma of the colon. INTERVENTIONS: The study involved multivariate Cox regression analysis of the impact of lymphovascular and perineural invasion and adjuvant chemotherapy on overall survival after a diagnosis of stage II adenocarcinoma of the colon. MAIN OUTCOME MEASURES: Survival after a diagnosis of stage II adenocarcinoma of the colon was measured. RESULTS: Five-year survival after diagnosis and surgical resection without adjuvant chemotherapy was lower for patients with lymphovascular (60.0%), perineural (56.9%), and lymphovascular and perineural invasion (55.8%) compared with double-negative disease (66.1%). Log-rank testing confirmed that adjuvant chemotherapy improved 5-year survival after diagnosis for lymphovascular (85.5%), perineural (83.6%), and lymphovascular and perineural invasion (74.3%). After controlling for differences in cohorts, Cox regression analysis showed an increased HR for mortality of 14.0% for lymphovascular (HR = 1.141 (95% CI, 1.060–1.228)), 32.1% for perineural (HR = 1.321 (95% CI, 1.176–1.483)), and 41.0% for lymphovascular and perineural invasion (HR = 1.409 (95% CI, 1.231–1.612)) compared with having neither. Chemotherapy showed a 43% reduction in hazard for mortality (HR = 0.570 (95% CI, 0.513–0.633)). LIMITATIONS: The study was limited by its retrospective review and observational bias. CONCLUSIONS: Lymphovascular and perineural invasion have a detrimental effect on survival after diagnosis of stage II adenocarcinoma of the colon. Chemotherapy may be protective specifically when lymphovascular and perineural invasion are present. See Video Abstract at http://links.lww.com/DCR/A786.

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

“…In colorectal cancer, lymphovascular invasion is considered to be an independent predictor of poor prognosis (48)(49). It is not only associated with higher T stage and poor differentiation, but also a key link of distant metastasis, and an important risk factor for cancer recurrence and shortened survival (50)(51)(52). In this meta-analysis, we observed a higher rate of lymphovascular invasion in the SEMS group.…”

<p>Comparison of Clinical Outcomes and Pathological Characteristics of Self-Expandable Stent Bridge to Surgery and Emergency Surgery in Obstructive Colon Cancer</p>

“…12 Meanwhile, a recent study showed that PNI and LVI showed negative impacts on survival even in early-stage colon cancer. 11 Therefore, it is necessary to explore any pathological differences between patients with obstructive and nonobstructive cancer as well as between patients undergoing ES and SBTS. In the present study, Cox regression analysis showed that PNI and tumor deposit were important factors for survival.…”

“…10 Furthermore, lymphovascular invasion (LVI) and perineural invasion (PNI) detrimentally affect the survival of patients with colon cancer. 11 A recent study found that obstruction is associated with PNI and may contribute to increased postoperative recurrence in colon cancer. 12 Therefore, it is important to further explore whether pathological factors such as LVI and PNI are associated with obstruction or stent placement.…”

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].…”

“…Conversely, based on the fact that the vascular system does not have a gateway like LN, we hypothesized that the tumor cells would spread through the vascular channel more aggressively and faster than through the lymphatic system. Several studies have shown that VI is a poor prognostic factor in colon cancer [11][12][13][14]. However, there were few studies that compared the prognostic impact of VI and LNM.…”