结肠癌中淋巴管侵犯与淋巴结转移之间的关联：一项美国国立癌症数据库分析。

Association between lymphovascular invasion and lymph node metastases in colon cancer: A National Cancer Database analysis.

作者信息

Emile Sameh Hany, Horesh Nir, Garoufalia Zoe, Wignakumar Anjelli, Boutros Marylise, Wexner Steven D

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Centre, Cleveland Clinic Florida, Weston, Florida, USA.

Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.

出版信息

Colorectal Dis. 2025 Jan;27(1):e17256. doi: 10.1111/codi.17256.

DOI:10.1111/codi.17256

PMID:39840903

Abstract

AIM

Lymphovascular invasion (LVI) is a well-known risk factor in colorectal cancer that is associated with a worse prognosis. The present study aimed to assess the characteristics of patients with LVI-positive colon cancer according to the status of nodal metastases and to study the association between LVI-nodal status and survival.

METHOD

This retrospective study assessed the association between LVI and lymph node metastases in colon cancer, using data from the National Cancer Database. Patients were classified according to the pathological N stage into pN0 and pN1-2. The risk factors for LVI were determined in each group using multivariable regression analyses. The primary outcome was LVI and the secondary outcome was 5-year overall survival (OS). A modification of the tumour, node, metastasis (TNM) staging system that incorporates LVI in each stage was proposed.

RESULTS

The study included 357 724 patients (51.1% female, median age 70 years). LVI was detected in 11.6% and 52.5% of patients with node-negative and node-positive disease, respectively. The independent predictors of LVI in pN0 stage were poorly differentiated carcinomas (OR: 3.6, p < 0.001), undifferentiated carcinomas (OR: 3.3, p < 0.001), mucinous carcinomas (OR: 0.61, p < 0.001), and perineural invasion (OR: 4.2, p < 0.001). The independent predictors of LVI in pN1-2 disease were poorly differentiated carcinomas (OR: 2.36, p < 0.001), undifferentiated carcinomas (OR: 3.23, p < 0.001), and perineural invasion (OR: 3.33, p < 0.001). LVI was significantly associated with worse 5-year OS and the adverse survival impact of LVI was higher in pN1-2 disease (HR: 1.47, p < 0.001) than in pN0 disease (HR: 1.28, p < 0.001). When LVI was present, the 5-year OS was reduced by 1.5% in stage I, 5.6% in stage II, and 11.5% in stage III.

CONCLUSION

LVI was more prevalent in patients with colon cancer with lymph node metastases than in patients with node-negative disease. However, LVI was not detected in approximately half of patients with nodal disease. The adverse survival effect of LVI was proportional to the stage of colon cancer.

摘要

目的

淋巴管侵犯（LVI）是结直肠癌中一个众所周知的危险因素，与较差的预后相关。本研究旨在根据淋巴结转移情况评估LVI阳性结肠癌患者的特征，并研究LVI-淋巴结状态与生存之间的关联。

方法

这项回顾性研究利用国家癌症数据库的数据评估了LVI与结肠癌淋巴结转移之间的关联。患者根据病理N分期分为pN0和pN1-2。使用多变量回归分析确定每组中LVI的危险因素。主要结局是LVI，次要结局是5年总生存期（OS）。提出了一种在每个阶段纳入LVI的肿瘤、淋巴结、转移（TNM）分期系统的改良版。

结果

该研究纳入了357724例患者（51.1%为女性，中位年龄70岁）。在淋巴结阴性和阳性疾病患者中，LVI的检出率分别为11.6%和52.5%。pN0期LVI的独立预测因素为低分化癌（OR：3.6，p<0.001）、未分化癌（OR：3.3，p<0.001）、黏液癌（OR：0.61，p<0.001）和神经周围侵犯（OR：4.2，p<0.001）。pN1-2期疾病中LVI的独立预测因素为低分化癌（OR：2.36，p<0.001）、未分化癌（OR：3.23，p<0.001）和神经周围侵犯（OR：3.33，p<0.001）。LVI与较差的5年OS显著相关，且LVI对生存的不良影响在pN1-2期疾病（HR：1.47，p<0.001）中高于pN0期疾病（HR：1.28，p<0.001）。当存在LVI时，I期的5年OS降低1.5%，II期降低5.6%，III期降低11.5%。