Can Lymphovascular and Perineural Invasion be Additional Staging Criteria in Colorectal Cancer?

Abstract

To identify additional staging information, venous, lymphatic, and neural invasionas potential prognostic factors in colorectal cancer (CRC). A descriptive study. Place and Duration of the Study: University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey; from May 2007 to June 2019. Retrospective analyses were performed on 855 CRC patients, who were treated with surgery. Patient and treatment characteristics, lymphovascular (LVI), and perineural (PNI) invasion were documented. The impact of LVI and PNI was determined using Cox proportional hazards model. The cohort examined had 346 (40.5%) LVI and 150 (17.5%) PNI positive patients. After surgery, mortality was 18.4% for LVI and 8% for PNI patients. Although increased ASA score (for ASA 2 hazard ratio [HR]=0.555, p=0.001 and ASA 3-4 HR=0.723, p=0.014), adjuvant chemotherapy (HR=2.5, p<0.001), LVI (HR=1.961, p<0.001) and PNI (HR=1.625, p<0.001) involvement increased the risk of death based on univariate analysis, multivariate Cox analysis showed a risk of death increase with increased ASA score (for ASA 2 HR=0.53, p<0.001 and ASA 3-4 HR=0.703, p=0.008), adjuvant chemotherapy (HR=2.114, p<0.001) and LVI involvement (HR=1.640, p<0.001). LVI and PNI may be useful in identifying CRC patients who might benefit the most from adjuvant systemic therapy. On the other hand, the presence of LVI and PNI reflects a shorter patient survival. Key Words: Lymphovascular invasion, Perineural invasion, Colorectal cancer, Cancer staging.