Li Wei, Liu Bo, Xiang Xingxing, Zhang Qun, Yang Qinglin, Cao Yinghao, Liu Tao
Department of Digestive Surgical Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
BMC Cancer. 2025 Apr 28;25(1):793. doi: 10.1186/s12885-025-14083-2.
Lymphovascular invasion (LVI) is associated with poor prognosis in a variety of malignancies; however, its prognostic value has not been fully defined in patients with colorectal cancer with liver metastases (CRCLM). The aim of this study was to investigate the impact of LVI on long-term postoperative recurrence and survival in patients with CRCLM.
Clinicopathologic data were retrospectively collected from patients who underwent primary resection for CRCLM at Wuhan Union Hospital from 2013 to 2018. To reduce potential confounders and selection bias, we used propensity score matching (PSM) to compare the clinicopathologic characteristics and long-term prognostic outcomes of patients in the LVI (+) and LVI (-) groups. Cox unifactorial and multifactorial analyses were used to screen relevant factors affecting patient prognosis, and Kaplan-Meier curves were plotted to compare differences in patient overall survival (OS) and disease-free survival (DFS). The predictive power of independent factors on patients' long-term prognosis was assessed using receiver operating characteristic ROC) curves and area under the curve (AUC).
After PSM, 230 patients were enrolled in the study (n = 115 per group). Multifactorial analysis revealed that LVI was an independent prognostic factor for OS and DFS (hazard ratio [HR], 1.424; 95% confidence interval [CI], 1.004-2.022; P = 0.048 and HR, 1.452; 95% CI, 1.020-2.069; p = 0.039, respectively). In the LVI (-) group, postoperative chemotherapy did not significantly improve OS or DFS; however, in the LVI (+) group, those who received chemotherapy had significantly improved OS (HR: 1.593, 95% CI: 1.187 - 2.571; P = 0.044) and DFS (HR: 1.503, 95% CI. 1.033 - 2.422; P = 0.045) compared with patients not treated with chemotherapy. In the LVI (+) group, the AUC for the OS AUROC curves was more favorable compared with after PSM (AUC at 3 years: 0.786 vs. 0.903; AUC at 5 years: 0.744 vs. 0.889). For DFS, the area under the AUROC curve was also better in the LVI (+) subgroup compared with after PSM (AUC at 3 years: 0.825 vs. 0.874; AUC at 5 years: 0.839 vs. 0.863).
LVI may significantly impact long-term survival and prognosis in patients with CRCLM undergoing primary resection, potentially serving as an independent prognostic factor for OS and DFS. Additionally, postoperative chemotherapy appears to significantly improve the long-term prognosis of patients with LVI (+).
淋巴管侵犯（LVI）与多种恶性肿瘤的不良预后相关；然而，其在伴有肝转移的结直肠癌（CRCLM）患者中的预后价值尚未完全明确。本研究旨在探讨LVI对CRCLM患者术后长期复发和生存的影响。
回顾性收集2013年至2018年在武汉协和医院接受CRCLM初次切除患者的临床病理资料。为减少潜在混杂因素和选择偏倚，我们采用倾向评分匹配（PSM）来比较LVI（+）组和LVI（-）组患者的临床病理特征和长期预后结果。采用Cox单因素和多因素分析筛选影响患者预后的相关因素，并绘制Kaplan-Meier曲线比较患者总生存（OS）和无病生存（DFS）的差异。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估独立因素对患者长期预后的预测能力。
PSM后，230例患者纳入研究（每组n = 115）。多因素分析显示，LVI是OS和DFS的独立预后因素（风险比[HR]，1.424；95%置信区间[CI]，1.004 - 2.022；P = 0.048；HR，1.452；95% CI，1.020 - 2.069；P = 0.039）。在LVI（-）组中，术后化疗未显著改善OS或DFS；然而，在LVI（+）组中，接受化疗的患者与未接受化疗的患者相比，OS（HR：1.593，95% CI：1.187 - 2.571；P = 0.044）和DFS（HR：1.503，95% CI. 1.033 - 2.422；P = 0.045）显著改善。在LVI（+）组中，OS的AUC与PSM后相比，OS AUROC曲线更优（3年时AUC：0.786 vs. 0.903；5年时AUC：0.744 vs. 0.889）。对于DFS，LVI（+）亚组的AUROC曲线下面积与PSM后相比也更好（3年时AUC：0.825 vs. 0.874；5年时AUC：0.839 vs. 0.863）。
LVI可能对接受初次切除的CRCLM患者的长期生存和预后产生显著影响，可能作为OS和DFS的独立预后因素。此外，术后化疗似乎能显著改善LVI（+）患者的长期预后。
