Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, 185 Juqian Street, Changzhou, 213000, Jiangsu, China.
Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China.
World J Surg Oncol. 2021 Apr 18;19(1):125. doi: 10.1186/s12957-021-02224-3.
Lymphovascular invasion (LVI) is defined as the presence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage II colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage II CRC patients with LVI positivity (LVI+).
In order to avoid the effects of different ACT regimens, among 409 stage II patients, we chose 121 patients who received FOLFOX regimen and the 144 patients who did not receive ACT as the object of study. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. Harrell's concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis.
The LVI+ status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI), tumor budding (TB), and KRAS status. The 5-year overall survival (OS) rate of stage II patients with < 12 ELNs and LVI+ was less than stage IIIA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI, TB, and KRAS status were significant prognostic factors for stage II patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI+, the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002).
LVI is an independent prognostic risk factor for stage II CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage II CRC patients with LVI+ is beneficial for survival.
脉管侵犯（LVI）定义为癌细胞存在于淋巴管或血管中。本研究旨在评估 LVI 在淋巴结检查不足（ELNs）的 II 期结直肠癌（CRC）患者中的预后价值，并进一步将 LVI 与 TNM 分期系统相结合，以确定对 CRC 预后的预测效果。然后评估 LVI 阳性（LVI+）的 II 期 CRC 患者的辅助化疗（ACT）。
为了避免不同 ACT 方案的影响，在 409 例 II 期患者中，我们选择了 121 例接受 FOLFOX 方案和 144 例未接受 ACT 的患者作为研究对象。通过苏木精-伊红（HE）染色检查 LVI。采用 Kaplan-Meier 分析和对数秩检验分析生存率。使用 Cox 比例风险模型进行单因素和多因素分析。Harrell 一致性指数（C 指数）用于评估不同系统预测预后的准确性。
LVI+状态与 pT 分期、分化程度、肿瘤分期、血清 CEA 和 CA19-9 水平、神经周围侵犯（PNI）、肿瘤芽生（TB）和 KRAS 状态显著相关。淋巴结检查不足且 LVI+的 II 期患者的 5 年总生存率（OS）低于 IIIA 期。多因素分析显示，LVI、pT 分期、血清 CEA 和 CA19-9 水平、PNI、TB 和 KRAS 状态是淋巴结检查不足的 II 期患者的显著预后因素。第 8 版 TNM 分期系统联合 LVI 比单独使用第 8 版 TNM 分期系统具有更高的 C 指数（C 指数，0.895 比 0.833）。在 LVI+的患者中，ACT 组的 5 年 OS 和 5 年无病生存率（DFS）显著高于单独手术（SA）组（5 年 OS，66.7%比 40.9%，P=0.004；5 年 DFS，64.1%比 36.3%，P=0.002）。
LVI 是 II 期 CRC 患者的独立预后危险因素。将 LVI 与第 8 版 TNM 分期系统相结合，提高了对 CRC 预后的预测准确性。在 LVI+的 II 期 CRC 患者中使用 ACT 有利于生存。
