van der Schee Lisa, Verbeeck Annabelle, Deckers Ivette A G, Kuijpers Chantal C H J, Offerhaus G Johan A, Seerden Tom C J, Vleggaar Frank P, Brosens Lodewijk A A, Moons Leon M G, Snaebjornsson Petur, Laclé Miangela M
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands.
United European Gastroenterol J. 2024 Dec;12(10):1429-1439. doi: 10.1002/ueg2.12670. Epub 2024 Oct 30.
Lymphovascular invasion (LVI) plays an important role in determining the risk of lymph node metastasis (LNM) in T1 colorectal cancer (CRC) patients and influencing treatment decisions and patient outcomes.
This study evaluated how the detection of LVI varies between Dutch laboratories and investigated its impact on the treatment and oncological outcomes of T1 CRC patients.
Pathology reports and clinical data of T1 CRC patients who underwent local resection between 2015 and 2019 were obtained from the Dutch nationwide pathology databank (Palga cohort, n = 5513). Data on the standard of LVI diagnosis (H&E/Immunohistochemistry) were not available. We categorized laboratories as low, average, or high detectors and evaluated the impact of LVI detection practice on the surgical resection rate and the proportion of LNM-negative (LNM-) surgeries. In the second part of the study, we used the Dutch T1 CRC Working Group cohort (n = 1268) to evaluate the impact of LVI detection practice on cancer recurrences during follow-up. Multivariable logistic regression analyses and Cox proportional hazard regression were used to study the association between LVI detection practice and the outcomes.
In the PALGA cohort, the proportion of surgical resections after local resection of a T1 CRC was significantly higher among patients diagnosed by laboratories with a high LVI detection rate (high vs. low: adjusted OR [aOR] 1.87; 95% confidence interval [CI] 1.52-2.31) as was the proportion of LNM-surgeries (aOR 1.73; 95% CI 1.39-2.15). In the second cohort, no significant difference was observed in cancer recurrences among patients diagnosed in laboratories with high detection rates compared with low detection rates (aHR 2.23; 95% CI 0.94-5.23).
These findings suggest that a high detection rate of LVI does not improve oncological outcomes and may expose more patients to unnecessary oncological surgery, emphasizing the need for standardization of LVI diagnosis.
淋巴管浸润（LVI）在确定T1期结直肠癌（CRC）患者的淋巴结转移（LNM）风险以及影响治疗决策和患者预后方面起着重要作用。
本研究评估了荷兰各实验室之间LVI检测的差异，并调查了其对T1期CRC患者治疗和肿瘤学结局的影响。
从荷兰全国病理数据库（Palga队列，n = 5513）中获取2015年至2019年间接受局部切除的T1期CRC患者的病理报告和临床数据。关于LVI诊断标准（苏木精-伊红染色/免疫组织化学）的数据不可用。我们将实验室分为低、中、高检测率组，并评估LVI检测实践对手术切除率和LNM阴性（LNM-）手术比例的影响。在研究的第二部分，我们使用荷兰T1期CRC工作组队列（n = 1268）来评估LVI检测实践对随访期间癌症复发的影响。采用多变量逻辑回归分析和Cox比例风险回归来研究LVI检测实践与结局之间的关联。
在PALGA队列中，LVI检测率高的实验室诊断的患者在T1期CRC局部切除术后的手术切除比例显著更高（高检测率组与低检测率组：调整后的比值比[aOR] 1.87；95%置信区间[CI] 1.52 - 2.31），LNM手术的比例也是如此（aOR 1.73；95% CI 1.39 - 2.15）。在第二个队列中，高检测率实验室诊断的患者与低检测率实验室诊断的患者相比，癌症复发率没有显著差异（调整后的风险比[aHR] 2.23；95% CI 0.94 - 5.23）。
这些发现表明，LVI的高检测率并不能改善肿瘤学结局，可能会使更多患者接受不必要的肿瘤手术，强调了LVI诊断标准化的必要性。
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