The value of intramural vascular invasion in colorectal cancer – a systematic review and meta‐analysis

Abstract

Extramural venous invasion (EMVI) is a well-known prognostic factor in colorectal cancer (CRC). Vascular invasion within the bowel wall, intramural vascular invasion (IMVI), has received less attention and its incidence and prognostic importance in CRC is not completely known. A systematic literature search was performed focusing on the impact of IMVI in CRC. Data were analysed using Review Manager version 5.3 on incidence and clinical endpoints local recurrence, 5-year cancer-specific survival (CSS) and 5-year overall survival (OS). Meta-analysis was performed in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of the initial 1199 papers identified by our search strategy, 20 were included in this meta-analysis. Of the 8078 included patients, 1008 patients had IMVI (12.5%). Studies that re-examined histological slides showed a higher incidence of IMVI compared to studies extracting IMVI from pathology reports (17.6 versus 7.7%, P < 0.001). Detection of IMVI increased significantly with the use of additional staining (22.9 versus 12.3%, P < 0.001). IMVI was associated with a decreased CSS HR: 1.6, 95% CI 1.2-2.2 in multivariate analysis). A borderline significant effect was observed for IMVI on local recurrence (RR: 1.5, 95% CI: 0.98-2.3) and OS (RR: 1.2, 95% CI: 1.0-1.4). In conclusion, despite the limited number of studies, there is a clear association with outcome in the presence of IMVI. This warrants more attention to this under-reported prognostic factor.

Pathology Reporting of Colorectal Local Excision Specimens: Recommendations from the International Collaboration on Cancer Reporting (ICCR)

“…Intramural venous invasion is an adverse prognostic factor, but the evidence is much weaker than for extramural venous invasion. 20 Perineural invasion is extremely rare in malignant polyps but can be identified in full-thickness resection specimens and is associated with poor outcome, particularly in stage II disease. 21 I.…”

Eps15 Homology Domain-Containing Protein 3 Hypermethylation as a Prognostic and Predictive Marker for Colorectal Cancer

“…Caucasian patients with CRC and high EHD3 promoter methylation ( Figure 4 B) or low EHD3 protein expression ( Figure 4 C) also had poor prognosis. Vascular invasion and lymphatic invasion, both poor prognostic factors for CRC [ 25 , 26 ], were observed in patients with CRC with high EHD3 methylation and low EHD3 mRNA expression ( Table 1 ). These two factors may explain why EHD3 was involved in clinical prognosis.…”

Challenges in pathological assessment of endoscopic resections

“…While EMRs and ESDs do not allow for the assessment of extramural venous invasion, recent studies suggest that even intramural venous invasion is clinically relevant. 34 Staining for mucin, by way of Alcian blue, periodic acid-Schiff or mucicarmine may aid in the differentiation of poorly differentiated adenocarcinoma from squamous carcinomas within the esophagus.…”