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International Journal of Colorectal Disease

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01-07-2007 | Original Article

No prognostic impact of isolated lymphovascular invasion after radical resection of rectal cancer—results of a multicenter observational study

Authors: Henry Ptok, Frank Meyer, Ralf Steinert, Michael Vieth, Karsten Ridwelski, Hans Lippert, Ingo Gastinger, Study Group “Colon/Rectum Carcinoma (Primary Tumor Lesion)”

Published in: International Journal of Colorectal Disease | Issue 7/2007

Abstract

Background

The prognostic impact of isolated lymphovascular invasion (LVI) after radical resection of rectal cancer is controversially discussed. However, it could be relevant to decide for an adjuvant treatment.

Aim

The aim of the analysis was, based on the data of an observational study, to determine the prognostic relevance of the isolated LVI.

Materials and methods

Patients after radical resection of rectal cancer with no hemangioinvasion were subdivided in three groups: I—no LVI, no lymph node metastases (LNM); II—positive LVI, no LNM; III—positive LNM. Five-year local recurrence rate, distant metastases-free and disease-free survival were determined uni- and multivariate.

Results

Patients, n = 846, were studied (I, n = 471; II, n = 75; III, n = 300). The univariate comparison between the groups revealed the following 5-year results: local recurrence rate: 9.4 vs 10.0 vs 14.0%; distant metastases-free survival: 84.1 vs 82.5 vs 49.3%; disease-free survival: 83.2 vs 80.7 vs 45.5%. The differences between groups I and III were significant, but not between groups I and II. The determined higher disease-free survival rate in group II vs group III was significant (P = 0.041), but the differences in local recurrence rate and rate of distant metastases did not reach statistical significance. The multivariate analysis revealed no impact of the isolated LVI on the oncological outcome.

Conclusion

The isolated LVI has no independent prognostic impact on the local recurrence rate and long-term survival after radical resection of rectal cancer. Based on this finding, no indication for an adjuvant treatment in these patients can be derived.

Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Soreide O; on behalf of the Norwegian Rectal Cancer Group (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47:48–58PubMedCrossRef

Cecil TD, Sexton R, Moran BJ, Heald RJ (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 45:1145–1150

Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482PubMedCrossRef

Park YJ, Park KJ, Park J, Lee KU, Choe KJ, Kim J (1999) Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated patients. World J Surg 23:721–726PubMedCrossRef

Greene FL, Stewart AK, Norton HJ (2004) New tumor-node-metastasis staging strategy for node-positive (stage III) rectal cancer: an analysis. J Clin Oncol 22:1778–1784PubMedCrossRef

Wang HS, Liang WY, Lin TC, Chen WS, Jiang JK, Yang SH, Chang SC, Lin JK (2005) Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis. Dis Colon Rectum 48:1182–1192PubMedCrossRef

Meyer W, Awad-Allah A, Steinhäuser BB, Jurowich C, Kaiser A, Gebhardt C (2001) Prognostic importance of isolated peritumoral lymphangiosis carcinomatosa in lymph-node-negative colorectal carcinoma. Langenbecks Arch Surg 386:124–131PubMedCrossRef

Meguerditchian AN, Bairati I, Lagace R, Harel F, Kibrite A (2005) Prognostic significance of lymphovascular invasion in surgically cured rectal carcinoma. Am J Surg 189:707–713PubMedCrossRef

Heide J, Krull A, Berger J (2004) Extracapsular spread of nodal metastasis as a prognostic factor in rectal cancer. Int J Radiat Oncol Biol Phys 58:773–778PubMedCrossRef

10.

Law WL, Chu KW (2002) Local recurrence following total mesorectal excision with double-stapling anastomosis for rectal cancers: analysis of risk factors. World J Surg 26:1272–1276PubMedCrossRef

11.

Law WL, Ho JWC, Chan R, Au G, Chu KW (2005) Outcome of anterior resection for stage II rectal cancer without radiation: the role of adjuvant chemotherapy. Dis Colon Rectum 48:218–226PubMedCrossRef

12.

Tang R, Wang JY, Tsao KC, Ho YS (1999) Lymphangiosis as a predictor of outcome in patients with primary diffusely infiltrative adenocarcinoma of the colon and rectum. Arch Surg 134:157–160PubMedCrossRef

13.

Celen O, Yildirim E, Berberoglu U (2004) Factors influencing outcome of surgery for stage I rectal cancer. Neoplasm 51:487–490

14.

Marusch F, Koch A, Schmidt U, Meyer L, Steinert R, Pross M, Köckerling F, Bauer H, Schönleben K, Halbfass HJ, Scheele J, Gastinger I, Lippert H; Studiengruppe “Kolon/Rektum Karzinome (Primärtumor)” (2003) Importance of rectal extirpation for the therapy concept of low rectal cancers. Chirurg 74:341–352PubMedCrossRef

15.

Marusch F, Koch A, Schmidt U, Zippel R, Geissler S, Pross M, Roessner A, Köckerling I, Lippert H (2002) “Colon-/rectal carcinoma” prospective studies as comprehensive surgical quality assurance. Chirurg 73:138–146PubMedCrossRef

16.

Deinlein P, Reulbach U, Stolte M, Vieth M (2003) Risk factors for lymphatic metastasis from pT1 colorectal adenocarcinoma. Pathologe 24:387–393PubMedCrossRef

17.

Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision. A prospective evaluation of 622 patients. Ann Surg 240:260–268PubMedCrossRef

18.

Rosenberg R, Friederichs J, Gertler R, Hoos A, Mueller J, Nahrig J, Nekarda H, Siewert JR (2004) Prognostic evaluation and review of immunohistochemically detected disseminated tumor cells in peritumoral lymph nodes of patients with pN0 colorectal cancer. Int J Colorectal Dis 19:430–437PubMedCrossRef

19.

Isaka N, Nozue M, Doy M, Fukao K (1999) Prognostic significance of perirectal lymph node micrometastasis in Dukes’ B rectal carcinoma: an immunohistochemical study by CAM5.2. Clin Cancer Res 5:2065–2068PubMed

20.

Charbit L, Peschaud F, Penna C (2005) Lymph nodes in rectal cancer. J Chir (Paris) 142:85–92

21.

Wang C, Zhou ZG, Wang Z, Chen DY, Zheng YC, Zhao PG (2005) Nodal spread and micrometastasis within the mesorectum. World J Gastroenterol 11:3586–3590PubMed

22.

Hassan C, Zullo A, Risio M, Rossini FP, Morini S (2005) Histologic risk factors and clinical outcome in colorectal malignant polyp: a pooled-data analysis. Dis Colon Rectum 48:1588–1596PubMedCrossRef

23.

Okabe S, Shia J, Nash G, Wong WD, Guillem JG, Weiser MR, Temple L, Sugihara K, Paty PB (2004) Lymph node metastasis in T1 adenocarcinoma of the colon and rectum. J Gastrointest Surg 8:1032–1039PubMedCrossRef

24.

Mouta Carriera C, Nasser SM, di Tomaso E, Padera TP, Boucher Y, Tomarev SI, Jain RK (2001) LYVE-1 is not restricted to the lymph vessels: expression in normal liver blood sinusoids and down-regulation in human liver cancer and cirrhosis. Cancer Res 61:8079–8084

25.

Jackson DG (2003) The lymphatics revisited: new perspectives from the hyaluronan receptor LYVE-1. Trends Cardiovasc Med 13:1–7PubMedCrossRef

26.

Sleeman JP, Krishnan J, Kirkin V, Baumann P (2001) Markers for the lymphatic endothelium: in search of the holy grail? Microsc Res Tech 55:61–69PubMedCrossRef

27.

Rodriguez-Niedenfuhr M, Papoutsi M, Christ B, Nicolaides KH, von Kaisenberg CS, Tomarev SI, Wilting J (2001) Prox1 is a marker of ectodermal placodes, endodermal compartments, lymphatic endothelium and lymphangioblasts. Anat Embryol 204:399–406PubMedCrossRef

28.

Wilting J, Papoutsi M, Christ B, Nicolaides KH, von Kaisenberg CS, Borges J, Stark GB, Alitalo K, Tomarev SI, Niemeyer C, Rossler J (2002) The transcription factor Prox1 is a marker for lymphatic endothelial cells in normal and diseased human tissues. FASEB J 16:1271–1273PubMed

Title: No prognostic impact of isolated lymphovascular invasion after radical resection of rectal cancer—results of a multicenter observational study
Authors: Henry Ptok
Frank Meyer
Ralf Steinert
Michael Vieth
Karsten Ridwelski
Hans Lippert
Ingo Gastinger
Study Group “Colon/Rectum Carcinoma (Primary Tumor Lesion)”
Publication date: 01-07-2007
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 7/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-006-0220-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

No prognostic impact of isolated lymphovascular invasion after radical resection of rectal cancer—results of a multicenter observational study

Abstract

Background

Aim

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Materials and methods

Results

Conclusion

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