Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: A retrospective cohort study

Al-Sukhni, Eisar; Attwood, Kristopher; Gabriel, Emmanuel; LeVea, Charles; Kanehira, Kazunori; Nurkin, Steven

doi:10.1016/j.ijsu.2016.08.528

Cited by 92 publications

(79 citation statements)

References 21 publications

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“…[197][198][199][200][201][202] Multivariate analyses have shown that poor histologic types (poorly differentiated adenocarcinoma, signet ring cell carcinoma, mucinous carcinoma) have increased ORs (2.93-45.9) for lymph node metastasis compared with well differentiated adenocarcinomas. [203][204][205] Four meta-analyses also showed early colorectal cancers with poor histologic types to have an increased risk of lymph node metastasis with ORs ranging between 4.78 and 8.27. 8,[206][207][208] Well differentiated intramucosal colorectal cancer does not metastasize to the lymph nodes, whereas 6%-20% of early colorectal cancers that invade the submucosa metastasize to the lymph nodes.…”

Section: Statement G13mentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Section: Statement G13mentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

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“…It is not only associated with higher T stage and poor differentiation, but also a key link of distant metastasis, and an important risk factor for cancer recurrence and shortened survival (50)(51)(52). In this meta-analysis, we observed a higher rate of lymphovascular invasion in the SEMS group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

Fan

et al. 2020

Preprint

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Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS. Methods: Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model. Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence ofperineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.

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“…The National Comprehensive Cancer Network (NCCN) Guidelines consider lymphovascular invasion (LVI), which is defined as the presence of tumor cells in the lymphatic vessels or blood vessels or both, as a significant negative factor in treatment options and prognostication in rectal cancer [4,5]. Several investigations have revealed that patients with LVI may associate with lymph-node metastasis and benefit from adjuvant systemic therapy [6][7][8][9]. Hence, it becomes increasingly important to evaluate LVI status preoperatively, so that patients with LVI might benefit from radical surgery and adjuvant treatments [4,6,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Several investigations have revealed that patients with LVI may associate with lymph-node metastasis and benefit from adjuvant systemic therapy [6][7][8][9]. Hence, it becomes increasingly important to evaluate LVI status preoperatively, so that patients with LVI might benefit from radical surgery and adjuvant treatments [4,6,10,11].…”

Section: Introductionmentioning

confidence: 99%

Radiomic features based on MRI for prediction of lymphovascular invasion in rectal cancer

Liu

Yang

et al. 2019

Chin J Acad Radiol

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Purpose To investigate the value of radiomics in predicting lymphovascular invasion (LVI) status of rectal cancer based on MRI. Materials and methods The retrospective study included 188 patients based on MRI with histologically confirmed rectal cancer and evaluated LVI status. Clinical factors and image data were collected, and radiomics features were extracted from multi-region (tumor and mesorectum) and single region (tumor), respectively, on T2WI and DWI. Spearman correlation analysis and the LASSO algorithm were used for radiomic feature extraction and selection; preliminarily selection of an optimal classifier by the results of the fivefold cross-validation performance in the six preselected specific machine learning classifier. Multi-regional and single-regional predictive models were both built and evaluated by calculating the area under the ROC curve (AUC) and corresponding accuracy, specificity, sensitivity, etc.Results A Ridge Classification model was constructed with 21 features (2 clinical features, 10 radiomics features from mesorectum region, and 9 radiomics features from tumor region) selected by Spearman correlation and LASSO analysis. The multi-regional model shows a good performance in the differentiation of the status of LVI in training data sets (AUC = 0.87, accuracy = 0.79). The model was further validated in the testing data sets, giving an AUC and an accuracy of 0.74 and 0.68, respectively. Furthermore, the performance of single-regional model (AUC = 0.72, accuracy = 0.67) is lower compared to the values given by the multi-regional model. Conclusion The radiomics model which we developed demonstrates that multi-regional radiomics features based on multiparametric MRI are useful for preoperatively predicting lymphovascular invasion in patients with rectal cancer. KeywordsRectal cancer · Machine learning · Radiomics · Lymphovascular · MRI Abbreviations AUC Area under the ROC curve EMVI Extramural venous invasion LASSO Least absolute shrinkage and selection operator LVI Lymphovascular invasion MRF Mesorectal fascia ROC Receiver-operating characteristic

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Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: A retrospective cohort study

Cited by 92 publications

References 21 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

Radiomic features based on MRI for prediction of lymphovascular invasion in rectal cancer

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