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Impact of intramural and extramural vascular invasion on stage II‐III colon cancer outcomes
Author(s) -
Leijssen Lieve G. J.,
Dinaux Anne M.,
Amri Ramzi,
Taylor Martin S.,
Deshpande Vikram,
Bordeianou Liliana G.,
Kunitake Hiroko,
Berger David L.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25367
Subject(s) - medicine , stage (stratigraphy) , perineural invasion , colorectal cancer , lymphovascular invasion , cancer , t stage , adjuvant therapy , odds ratio , vascular invasion , pathology , oncology , metastasis , paleontology , biology
Background and Objectives Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II‐III colon cancer. Methods All stage II‐III colon cancer patients who underwent surgery between 2004 and 2015 were reviewed. We compared patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n = 923). Results EMVI was associated with other high‐risk features, including T4, N+ disease, lymphatic, and perineural invasion ( P < 0.001). EMVI+ patients had higher rates of locoregional and distant recurrence and subsequently disease‐specific mortality (stage‐II, odds ratio [OR] 3.64; P = 0.001; stage‐III OR, 1.94; P = 0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR, 1.21; P = 0.764; OR, 1.28, P = 0.607, respectively). The adjusted HRs for EMVI+ patients on disease‐free survival, and disease‐specific survival were 2.07 ( P < 0.001) and 1.67 ( P = 0.027), respectively. Moreover, EMVI+ stage‐II patients fared worse than EMVI– stage‐III patients, even after adjusting for adjuvant chemotherapy. Conclusion EMVI is a strong predictor for worse oncologic outcomes in stage II‐III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.