Abstract
PurposeIn colorectal cancer (CRC), lymphovascular invasion (LVI) is a predictor of poor outcome and its analysis is nowadays recommended. Literature is still extremely heterogeneous, and we hypothesize that, within such a group of patients, there are any further predictors of survival.MethodsA total of 2652 patients with I–III-stage CRC undergoing resection between 2002 and 2018 were included in a retrospective analysis of demographic, clinical, and histology with the aim of defining the impact of LVI on overall survival (OS) and its relationship with other prognostic factors.ResultsOverall, 5-year-OS was 62.6% (77-month-median survival). LVI was found in 558 (21%) specimens and resulted associated with 44.9%-5-year-OS (44 months) vs. 64.1% (104 months) of LVI cases. At multivariate analysis, LVI (p = 0.009), T3–4 (p < 0.001), and N ≠ 0 (p < 0.001) resulted independent predictors of outcome. LVI resulted as being associated with older age (p < 0.013), T3–4 (p < 0.001), lower grading (p < 0.001), N ≠ 0 (p < 0.001), mucinous histology (p < 0.001), budding (p < 0.001), and PNI (p < 0.001).Within the LVI + patients, T3–4 (p = 0.009) and N ≠ 0 (p < 0.001) resulted as independent predictors of shortened OS. In particular, N-status impacted the prognosis of patients with T3–4 tumors (p = 0.020), whereas it did not impact the prognosis of patients with T1–2 tumors (p = 0.393). Three groups (T1–2anyN, T3–4N0, T3–4 N ≠ 0), with distinct outcome (approximately 70%-, 52%-, and 35%-5-year-OS, respectively), were identified.ConclusionsLVI is associated with more aggressive/more advanced CRC and is confirmed as predictor of poor outcome. By using T- and N-stage, a simple algorithm may easily allow re-assessing the expected survival of patients with LVI + tumors.
Highlights
Colorectal cancer (CRC) is the third most frequently diagnosed neoplasia and the third cause of cancer-related death in the USA and worldwide [1, 2].CRC long-term outcome has been associated to a variety of demographic, clinical, surgical, and histopathological criteria [3]
In 1252 (47.2%) patients, CRC was located in the right colon, 1041 (39.3%) in the left colon and 359 (13.5%) in the rectum
Complete follow-up data were available for 2237 patients, whose survival was studied for long-term analysis
Summary
Colorectal cancer (CRC) is the third most frequently diagnosed neoplasia and the third cause of cancer-related death in the USA and worldwide [1, 2].CRC long-term outcome has been associated to a variety of demographic, clinical, surgical, and histopathological criteria [3]. LVI is widely considered a major prognostic factor for CRC prognosis assessment, literature and recommendations on the subject are extremely heterogeneous and mostly based on large, heterogeneous registry-based surveys [9] or retrospective, small-sized series [10,11,12,13]. It is still unclear whether, within the group of patients affected by CRC presenting LVI, there are further predictors of good or poor outcome
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