Lymphovascular Invasion is a Significant Prognosticator in Rectal Cancer Patients Who Receive Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

Lee, Jong Hoon; Jang, Hong Seok; Kim, Jun-Gi; Cho, Hyun Min; Shim, Byoung Yong; Oh, Seong Taek; Yoon, Seung Bae; Kim, Yeon‐Sil; Choi, Byung Ock; Kim, Sung Hwan

doi:10.1245/s10434-011-2062-z

Cited by 43 publications

(30 citation statements)

References 28 publications

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“…The majority of researchers tend to consider angioinvasion as an adverse risk factor for LR (18). However, this is inconsistent with the follow-up data recorded by Lee et al , although a significant difference was observed between distant metastasis and overall survival (19). …”

Section: Recurrent Risk Factors Following Primary Tumor Resectioncontrasting

confidence: 82%

Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)

Cai

et al. 2013

Oncology Letters

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Locally recurrent rectal cancer (LRRC) is defined as an intrapelvic recurrence following a primary rectal cancer resection, with or without distal metastasis. The treatment of LRRC remains a clinical challenge. LRRC has been regarded as an incurable disease state leading to a poor quality of life and a limited survival time. However, curative reoperations have proved beneficial for treating LRRC. A complete resection of recurrent tumors (R0 resection) allows the treatment to be curative rather than palliative, which is a milestone in medicine. In LRRC cases, the difficulty of achieving an R0 resection is associated with the post-operative prognosis and is affected by several clinical factors, including the staging of the local recurrence (LR), accompanying symptoms, patterns of tumors and combined therapy. The risk factors following primary surgery that lead to an increased rate of LR are summarized in this study, including the surgical, pathological and therapeutic factors.

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Section: Recurrent Risk Factors Following Primary Tumor Resectioncontrasting

confidence: 82%

Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)

Cai

et al. 2013

Oncology Letters

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“…11,26 Two studies found no impact of PNI on OS in multivariate analysis, although both found an impact of PNI on OS in univariate analysis, and both studies evaluated PNI as a single variable not combined with LVI. 24,25 In our study, we may not have been able to fully evaluate the impact of PNI on OS due to censoring of patients, limited follow-up, and few observed events ( P = 0.15).…”

Section: Discussionmentioning

confidence: 89%

“…Six studies in addition to ours found PNI to be significant for DFS on multivariate analysis. 11–13,23,24,26 Of note, PNI was combined with lymphovascular invasion (LVI) as a single variable in the multivariate analysis in 2 studies. 11,26 Also, 2 studies did not find PNI to be correlated with DFS on multivariate analysis 22,25 ; however, in one of these studies, 25 PNI was correlated with DFS on univariate analysis ( P < 0.001), and the P -value was close to being significant ( P = 0.051) on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation and Surgery

Chablani¹,

Nguyen²,

Pan³

et al. 2017

American Journal of Clinical Oncology

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Objectives The benefit of adjuvant chemotherapy in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and surgery is controversial. We examined the association of perineural invasion (PNI) with outcomes to determine whether PNI could be used to risk-stratify patients. Materials and Methods We performed a retrospective study of 110 patients treated with nCRT and surgery for LARC at our institution from 2004 to 2011. Eighty-seven patients were identified in our final analysis. We evaluated the association of PNI with locoregional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival, using log-rank and Cox proportional hazard modeling. Results Fourteen patients (16%) were PNI + and 73 patients (84%) were PNI−. The median follow-up was 27 months (range, 0.9 to 84 mo). The median DMFS was 13.5 months for PNI + and median not reached (> 40 mo) for PNI− (P < 0.0001). The median DFS was 13.5 months for PNI + and 39.8 months for PNI− (P < 0.0001). In a multivariate model including 7 pathologic variables, type of surgery, time to surgery from end of nCRT, and use of adjuvant chemotherapy, PNI remained a significant independent predictor of DMFS (hazard ratio 9.79; 95% confidence interval, 3.48–27.53; P < 0.0001) and DFS (hazard ratio 5.72; 95% confidence interval, 2.2–14.9; P = 0.0001). Conclusions For patients with LARC treated with nCRT, PNI found at the time of surgery is significantly associated with worse DMFS and DFS. Our data support testing the role of adjuvant chemotherapy in patients with PNI and perhaps other high-risk features.

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“…Age, gender, TNM stage, venous invasion, tumour necrosis, peri-tumoural lymphocytic infiltration, tumour budding and CEA levels were also independently associated with poor survival in at least some studies [17,18,21,22,26,30,32,33,39].…”

Section: Discussionmentioning

confidence: 96%

The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: A systematic review

Wyk

Going

Horgan

et al. 2017

Critical Reviews in Oncology/Hematology

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. (2017) The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: a systematic review. Critical Reviews in Oncology/Hematology, 112, pp. 11-20. (doi:10.1016/j.critrevonc.2017 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/139181/ Therefore, the aim of the present study was to systematically review the identification and associations of perineural invasion and survival in patients with primary operable colorectal cancer. From initial search results of 912 articles, 38 studies were selected. Using H&E stains; five studies including 1835 patients reported on survival stratified by perineural invasion in colon cancer with weighted average detection rates of 26%; eleven studies including 3837 patients reported on rectal cancer with weighted average detection rates of 25% and; sixteen studies including 9145 patients reported on survival stratified by perineural invasion in colorectal cancer with weighted average detection rates of 17%. Using special techniques (S100), six studies including 1458 patients reported on the identification of perineural invasion in colorectal cancer.In comparison to H&E staining alone, the use of immunohistochemistry with S100 increased the detection of perineural invasion to approximately 70%.However, those studies did not examine the relationship with outcomes, so further research is required to establish the clinical significance of perineural invasion detected by immunohistochemistry. In conclusion, perineural invasion deserves special attention for improved prognostic stratification in patients with colorectal cancer. Further work is required to standardise pathology assessment and reporting of perineural invasion, in particular its definition, use of special stains and routine inclusion in pathology practice. Reliable assessment is required for investigations into mechanisms of perineural invasion, its role tumour spread and prognostic value.

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Lymphovascular Invasion is a Significant Prognosticator in Rectal Cancer Patients Who Receive Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

Cited by 43 publications

References 28 publications

Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)

Prognostic factors associated with locally recurrent rectal cancer following primary surgery (Review)

Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation and Surgery

The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: A systematic review

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