McClelland David, Murray Graeme I
Department of Pathology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom.
Pathology, Division of Applied Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.
PLoS One. 2015 Dec 15;10(12):e0144987. doi: 10.1371/journal.pone.0144987. eCollection 2015.
Colorectal cancer is a common malignancy and a leading cause of cancer related death. Cancer staging following resection is key to determining any adjuvant therapy in those patients with high risk disease. In colorectal cancer, tumour stage and lymph node stage are the main pathological factors which have been considered to influence outcome. Increasing emphasis is now being placed on other factors, especially the presence of extramural venous invasion (EMVI). It is important to understand the relationship of EMVI with other pathological factors and to confirm that in an individual centre that EMVI is being detected at an appropriate rate and is of prognostic significance. This comprehensive study assesses the reporting and prognostic significance of EMVI in a single centre, using prospectively collected data from histopathology reports of a cohort of 2405 patients who underwent surgery for colorectal cancer over a nine year period. Overall, EMVI was reported in 27.9% of colorectal cancer excision specimens. In tumours (n = 1928) that had not received neoadjuvant therapy, the presence of EMVI varied significantly depending on tumour site (χ2 = 12.03, p<0.005), tumour stage (χ2 = 268.188, p<0.001), lymph node stage (χ2 = 294.368, p<0.001) and Dukes' stage (χ2 = 253.753, p<0.001). Multivariate analysis confirmed EMVI as a significant independent prognostic indicator (p<0.001). In conclusion, the presence of EMVI as an independent prognostic indicator is shown and is related to other pathological and prognostic factors. This study emphasises the requirement for the accurate identification of EMVI in colorectal cancer excision specimens and also understanding the relationship of EMVI with other prognostic factors.
结直肠癌是一种常见的恶性肿瘤,也是癌症相关死亡的主要原因。切除术后的癌症分期是确定那些患有高危疾病患者辅助治疗的关键。在结直肠癌中,肿瘤分期和淋巴结分期是被认为影响预后的主要病理因素。现在越来越强调其他因素,尤其是壁外静脉侵犯(EMVI)的存在。了解EMVI与其他病理因素的关系,并确认在单个中心EMVI能以适当的比率被检测到且具有预后意义,这一点很重要。这项综合研究使用了前瞻性收集的来自一组2405例在九年期间接受结直肠癌手术患者的组织病理学报告数据,评估了单个中心EMVI的报告情况及其预后意义。总体而言,27.9%的结直肠癌切除标本报告有EMVI。在未接受新辅助治疗的肿瘤(n = 1928)中,EMVI的存在因肿瘤部位(χ2 = 12.03,p<0.005)、肿瘤分期(χ2 = 268.188,p<0.001)、淋巴结分期(χ2 = 294.368,p<0.001)和Dukes分期(χ2 = 253.753,p<0.001)而有显著差异。多变量分析证实EMVI是一个显著的独立预后指标(p<0.001)。总之,研究表明EMVI的存在是一个独立的预后指标,并且与其他病理和预后因素相关。这项研究强调了在结直肠癌切除标本中准确识别EMVI的必要性,以及了解EMVI与其他预后因素关系的重要性。