Skancke Matthew, Arnott Suzanne M, Amdur Richard L, Siegel Robert S, Obias Vincent J, Umapathi Bindu A
Department of General Surgery and Colorectal Surgery at the George Washington University Hospital.
Dis Colon Rectum. 2019 Feb;62(2):181-188. doi: 10.1097/DCR.0000000000001258.
Lymphovascular invasion and perineural invasion are histopathological features associated with higher-risk colon cancer.
The purpose of this study was to quantify the impact of lymphovascular and perineural invasion on overall survival after diagnosis and to determine the protective effect of adjuvant chemotherapy for early adenocarcinoma with high-risk factors.
This was a retrospective database review of the 2010-2014 National Cancer Database for colon cancer.
Individuals diagnosed with invasive adenocarcinoma of the colon (histology code 8140) with primary surgical resection with >12 nodes harvested and no positive nodes on pathological examination were included.
A total of 32,493 patients underwent surgical resection for stage II adenocarcinoma of the colon.
The study involved multivariate Cox regression analysis of the impact of lymphovascular and perineural invasion and adjuvant chemotherapy on overall survival after a diagnosis of stage II adenocarcinoma of the colon.
Survival after a diagnosis of stage II adenocarcinoma of the colon was measured.
Five-year survival after diagnosis and surgical resection without adjuvant chemotherapy was lower for patients with lymphovascular (60.0%), perineural (56.9%), and lymphovascular and perineural invasion (55.8%) compared with double-negative disease (66.1%). Log-rank testing confirmed that adjuvant chemotherapy improved 5-year survival after diagnosis for lymphovascular (85.5%), perineural (83.6%), and lymphovascular and perineural invasion (74.3%). After controlling for differences in cohorts, Cox regression analysis showed an increased HR for mortality of 14.0% for lymphovascular (HR = 1.141 (95% CI, 1.060-1.228)), 32.1% for perineural (HR = 1.321 (95% CI, 1.176-1.483)), and 41.0% for lymphovascular and perineural invasion (HR = 1.409 (95% CI, 1.231-1.612)) compared with having neither. Chemotherapy showed a 43% reduction in hazard for mortality (HR = 0.570 (95% CI, 0.513-0.633)).
The study was limited by its retrospective review and observational bias.
Lymphovascular and perineural invasion have a detrimental effect on survival after diagnosis of stage II adenocarcinoma of the colon. Chemotherapy may be protective specifically when lymphovascular and perineural invasion are present. See Video Abstract at http://links.lww.com/DCR/A786.
淋巴管浸润和神经周围浸润是与高危结肠癌相关的组织病理学特征。
本研究的目的是量化淋巴管和神经周围浸润对诊断后总生存期的影响，并确定辅助化疗对具有高危因素的早期腺癌的保护作用。
这是一项对2010 - 2014年国家癌症数据库中结肠癌的回顾性数据库分析。
纳入经手术切除且病理检查淋巴结清扫数>12枚且无阳性淋巴结的结肠浸润性腺癌（组织学编码8140）患者。
共有32493例患者接受了结肠II期腺癌的手术切除。
本研究对淋巴管和神经周围浸润以及辅助化疗对结肠II期腺癌诊断后总生存期的影响进行多因素Cox回归分析。
测量结肠II期腺癌诊断后的生存期。
与无淋巴管浸润、神经周围浸润的双阴性疾病患者（66.1%）相比，有淋巴管浸润（60.0%）、神经周围浸润（56.9%）以及淋巴管和神经周围均浸润（55.8%）的患者在未接受辅助化疗的情况下，诊断及手术切除后的5年生存率较低。对数秩检验证实，辅助化疗提高了有淋巴管浸润（85.5%）、神经周围浸润（83.6%）以及淋巴管和神经周围均浸润（74.3%）患者诊断后的5年生存率。在控制队列差异后，Cox回归分析显示，与两者均无的患者相比，淋巴管浸润患者的死亡风险比增加14.0%（风险比[HR]=1.141[95%可信区间（CI）,1.060 - 1.228]），神经周围浸润患者增加32.1%（HR = 1.321[95%CI,1.176 - 1.483]），淋巴管和神经周围均浸润患者增加41.0%（HR = 1.409[95%CI,1.231 - 1.612]）。化疗使死亡风险降低43%（HR = 0.570[95%CI,0.513 - 0.633]）。
本研究受回顾性分析及观察性偏倚的限制。
淋巴管和神经周围浸润对结肠II期腺癌诊断后的生存期有不利影响。当存在淋巴管和神经周围浸润时，化疗可能具有特异性保护作用。见视频摘要：http://links.lww.com/DCR/A786 。
