Gibson Katherine M, Chan Charles, Chapuis Pierre H, Dent Owen F, Bokey Les
1Department of Surgery, Liverpool Hospital and School of Medicine, University of Western Sydney, New South Wales, Australia 2Department of Anatomical Pathology, Concord Hospital and Discipline of Pathology, University of Sydney, New South Wales, Australia 3Department of Colorectal Surgery, Concord Hospital and Discipline of Surgery, University of Sydney, and School of Medicine, University of Western Sydney, New South Wales, Australia.
Dis Colon Rectum. 2014 Aug;57(8):916-26. doi: 10.1097/DCR.0000000000000162.
Extramural venous invasion is a known independent predictor of poor prognosis after resection of colorectal adenocarcinoma, but the prognostic value of mural venous invasion alone and the association between venous invasion and prognosis within tumor stages has received little research attention.
This study aimed to determine whether associations between mural and extramural venous invasion and outcome differ among tumor stages after adjustment for other factors known to influence prognosis.
This study is a retrospective analysis of prospectively collected data.
Data were drawn from a registry of 3040 consecutive patients undergoing resection between 1980 and 2005 under the care of specialist surgeons in a tertiary referral public hospital and an affiliated private hospital. A standardized protocol was used for the pathological assessment of specimens.
The primary outcomes measured were overall survival, cancer-specific survival, and recurrence.
There was no significant association between venous invasion and survival in stages A (n = 544) or B (n = 1078). In stage C (n = 899), overall survival time was significantly shorter in patients with mural invasion alone or extramural invasion (both p < 0.001) than in those without invasion, and this persisted after adjustment for other prognostic variables. Equivalent bivariate associations were found in stage D, but only the effect of extramural invasion persisted after adjustment.
Our findings arise from the experience of a single surgical group and may not be generalizable to other settings. Only hematoxylin and eosin staining was used.
The association between venous invasion and prognosis was stage specific. Both mural venous invasion alone and extramural venous invasion independently predicted overall survival in patients with stage C tumors, but not in patients with stages A, B, or D tumors. Although mural invasion alone was rare, the separate reporting of both mural and extramural invasion in patients with stage C tumor is informative and desirable.
肠壁外静脉侵犯是已知的结直肠癌切除术后预后不良的独立预测因素，但单纯肠壁内静脉侵犯的预后价值以及肿瘤分期内静脉侵犯与预后之间的关联很少受到研究关注。
本研究旨在确定在调整其他已知影响预后的因素后，肠壁内和肠壁外静脉侵犯与结局之间的关联在不同肿瘤分期中是否存在差异。
本研究是对前瞻性收集的数据进行的回顾性分析。
数据来自于1980年至2005年间在一家三级转诊公立医院和一家附属私立医院接受专科外科医生治疗的连续3040例接受手术切除患者的登记册。采用标准化方案对标本进行病理评估。
测量的主要结局为总生存期、癌症特异性生存期和复发情况。
在A期（n = 544）或B期（n = 1078）患者中，静脉侵犯与生存期之间无显著关联。在C期（n = 899）患者中，单纯肠壁内侵犯或肠壁外侵犯患者的总生存时间显著短于无侵犯患者（均p < 0.001），在调整其他预后变量后这种情况仍然存在。在D期发现了类似的双变量关联，但调整后仅肠壁外侵犯的影响仍然存在。
我们的研究结果来自单一外科团队的经验，可能无法推广到其他情况。仅使用了苏木精和伊红染色。
静脉侵犯与预后之间的关联具有分期特异性。单纯肠壁内静脉侵犯和肠壁外静脉侵犯均独立预测C期肿瘤患者的总生存期，但对A、B或D期肿瘤患者则不然。虽然单纯肠壁内侵犯很少见，但在C期肿瘤患者中分别报告肠壁内和肠壁外侵犯情况是有意义且可取的。
