Prognostic Value of Lymphovascular Invasion in Patients with Stage III Colorectal Cancer: A Retrospective Study

Abstract

Background Lymph node metastasis and tumor progression depend on lymphovascular invasion (LVI). This study aimed to investigate the prognostic role of LVI in patients with stage III colorectal cancer (CRC) and to develop a prognostic nomogram. Material/Methods A retrospective study included 437 patients with stage III CRC. The impact of LVI on overall survival (OS) was analyzed with the Kaplan-Meier method and Cox regression model. A nomogram was constructed, and its predictive accuracy was evaluated using the concordance index (C-index) and the calibration plot. Results LVI was found in 19.7% of cases of stage III CRCs and was significantly correlated with high tumor grade (poor differentiation) and advanced tumor stage (all P<0.05). Patients age, a family history of cancer in a first-degree relative, pre-treatment levels of carcinoembryonic antigen (CEA), prognostic nutritional index (PNI), histological tumor grade, tumor-node-metastasis (TNM) stage, and LVI were independent prognostic indicators (all P<0.05). Compared with the LVI(−) group, patients in the LVI(+) group showed a 1.748-fold increased risk of death (P=0.004) and a significantly reduced OS rate (P<0.001). In the prognostic nomogram, the C-index was significantly increased with LVI compared with the TNM stage alone (0.742 vs. 0.593; P<0.001). Calibration plots showed good fitness of the nomogram for prediction of survival. Comparison of the nomograms with and without LVI showed that inclusion of LVI improved the C-index from 0.715 to 0.742. Conclusions LVI was an indicator of more aggressive biological behavior and poor prognosis in patients with stage III CRC.

Impact of Lymphovascular Invasion in Patients With Stage II Colorectal Cancer: A Propensity Score-matched Study

“…LVI is marked by freely existing malignant cells that seed lymphatic vessels or small veins, having escaped the primary tumor (8). While linked to tumor metastasis/recurrence (and perhaps worse prognosis) and cited as a prognostic factor in various cancers, including those of breast (9) and prostate (10), the impact of LVI on CRC recurrence or prognosis remains unclear.…”

Lymphovascular invasion represents a superior prognostic and predictive pathological factor of the duration of adjuvant chemotherapy for stage III colon cancer patients

“…Therefore, current practice guidelines suggest that adjuvant chemotherapy was recommended for stage II colon cancer patients with poor prognostic characteristics, including PNI and LVI. Recently, Zhong JW et al revealed that LVI was an indicator of more aggressive biological behavior and a unfavorable prognosis in patients with stage III colorectal cancer [18]. However, there were two limitations to the study by Zhong JW et al that could not con rm the prognostic value of LVI for stage III colon cancer.…”

“…However, only a limited number of studies reported the prognostic value of LVI and PNI in stage III colon cancer [18,19]. In fact, the actual prognostic effect of LVI and PNI remains unclear in stage III colon cancer patients undergoing curative treatment.…”

Prognostic Value of Lymphovascular Invasion&nbsp;in Stage Ⅱ Colorectal Cancer Patients with an Inadequate Examination of Lymph Nodes.

“…Colorectal cancer (CRC) is the third most common malignancy and the fourth leading cause of tumorrelated deaths worldwide [1]. Although advances have been achieved in early detection and effective treatment, the survival rate of CRC is still poor [2].…”

“…Lymphovascular invasion (LVI) is de ned as the existence of cancer cells in lymphatics or blood vessels, and is considered to be an early step in lymph node metastasis (Fig. 1a) [1]. Many studies have reported that LVI positivity (LVI +) is a critical prognostic indicator in some cancers, including breast, bladder, and gastric cancers [9][10][11].…”