Abstract
Purpose: This study aimed to evaluate the prognostic impact of vascular invasion (VI) in comparison with that of lymph node metastasis (LNM) in non-metastatic colon cancer.Methods: Patients who underwent curative surgery for stage I-III colon cancer were divided into four groups depending on the status of VI and LNM (Group I: VI-/LNM-; Group II: VI+/LNM-; Group III: VI-/LNM+; Group IV: VI+/LNM+). Group III was subdivided according to the nodal (N) stage (Group IIIA: VI-/N1; Group IIIB: VI-/N2). Oncological outcomes were compared between Groups II and III.Results: In total, 793 non-metastatic colon cancer patients were included. Group II [hazard ratio (HR) 2.34, 1.01–5.41] and Group III (HR 1.91, 1.26–2.89) were independently associated with poor disease-free survival (DFS). The 5-year DFS rates were comparable in Groups II (71.6%) and III (72.5%) (P = 0.637). When Group III was subdivided into Groups IIIA and IIIB, DFS deteriorated in the following order: Groups IIIA, II, and IIIB. The 5-year DFS rates were 79.7, 71.6, and 61.4% in Groups IIIA, II, and IIIB, respectively. Group II had a tendency toward early recurrence. The 1- and 2-year DFS rates were 76.3 and 71.6% in Group II and 88.3 and 79.8% in Group III, respectively (P = 0.067 and 0.247). All recurrences in Group II were distant metastases.Conclusion: VI is a prognostic factor as significant as LNM and may be a stronger prognostic factor than N1 stage in non-metastatic colon cancer. Furthermore, a potential association was observed between VI and recurrence patterns, such as early recurrence and distant metastasis.
Highlights
Colon cancer is one of the most common cancers worldwide [1]
This study was conducted by retrospectively reviewing the data, and the follow-up was completed in August 2019
The univariate analysis showed that both vascular invasion (VI) [hazard ratio (HR) 1.98; 95% confidence interval (CI) 1.34–2.92] and lymph node metastasis (LNM) (HR 2.26; 95% CI 1.60–3.17) were significant prognostic factors for poor disease-free survival (DFS)
Summary
Standard treatment for non-metastatic colon cancer is curative resection, followed by adjuvant chemotherapy, in selected patients [2, 3]. The survival benefit of adjuvant chemotherapy in patients with conventional tumor-node-metastasis (TNM) stage III has been well established [2, 3]. Most guidelines recommend adjuvant chemotherapy after curative resection for stage III colon cancer with lymph node metastasis (LNM). For stage II colon cancer without LNM, even with highrisk factors, adjuvant chemotherapy is considered an optional treatment modality after curative surgery [2, 3]. Highrisk features in colon cancer are as follows: T4 tumors, poorly differentiated tumors, positive margin involvement,
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