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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2012

01-04-2012 | Colorectal Cancer

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

Authors: Jong Hoon Lee, MD, Hong Seok Jang, MD, Jun-Gi Kim, MD, Hyun Min Cho, MD, Byoung Yong Shim, MD, Seong Taek Oh, MD, Sei-Chul Yoon, MD, Yeon-Sil Kim, MD, Byung Ock Choi, MD, Sung Hwan Kim, MD

Published in: Annals of Surgical Oncology | Issue 4/2012

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Abstract

Purpose

This study was designed to identify the significance of lymphovascular invasion as a prognosticator for tumor recurrence and survival in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME).

Methods

Between January 2003 and October 2010, the study included 328 patients with primary rectal cancer who had received preoperative CRT followed by TME. We analyzed the clinicopathologic factors that may be associated with survival, such as age, gender, carcinoembryonic antigen (CEA) value, pathologic T and N stage, tumor response, histologic grade, lymphovascular invasion (LVI), and perineural invasion.

Results

Higher pathologic T and N stage, poor tumor response, high-grade histology, and positive LVI were adverse prognostic factors for both disease-free survival (DFS) and overall survival (OS) on the multivariate analysis. Perineural invasion was a significant adverse prognostic factor affecting DFS (P = 0.046) but not OS (P = 0.08). Increased T and N stage and distant recurrence, but not local recurrence, were significant factors associated with LVI. The LVI-negative group had a higher DFS (71.4 vs. 56.2%, P = 0.012) and OS rate (86.7 vs. 63.4%, P = 0.020) at 5 years than the LVI-positive group did.

Conclusions

Positive LVI had a negative impact on survival in patients with rectal cancer who received preoperative CRT and TME and is significantly associated with an increased chance of distant recurrence. Based on this finding, more tailored adjuvant chemotherapy is warranted for advanced rectal cancer patients with LVI to reduce the distant dissemination of tumor.
Literature
1.
Kim DW, Jeong SY, Kim DY. Treatment patterns for colorectal cancer patients at the national cancer center Korea in 2003. J Korean Soc Coloproctol. 2007;23:245–9.CrossRef
2.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351:1731–40.PubMedCrossRef
3.
Gerard J, Conroy T, Bonnetain F, Bouché O, Chapet O, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.PubMedCrossRef
4.
Lee JH, Kim SH, Kim JG, Cho HM, Shim BY. Preoperative Chemoradiotherapy (CRT) followed by laparoscopic surgery for rectal cancer: predictors of the tumor response and the long-term oncologic outcomes. Int J Radiat Oncol Biol Phys. 2011;82:431–8.CrossRef
5.
Wolthuis AM, Penninckx F, Haustermans K, Ectors N, Van Cutsem E, et al. Outcome standards for an organ preservation strategy in stage II and III rectal adenocarcinoma after neoadjuvant chemoradiation. Ann Surg Oncol. 2011;18:684–90.PubMedCrossRef
6.
de Campos-Lobato LF, Stocchi L, da Luz MA, Geisler D, Dietz DW, et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. Ann Surg Oncol. 2011;18:1590–8.PubMedCrossRef
7.
Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol. 2008;15:729–37.PubMedCrossRef
8.
Croog VJ, Abu-Rustum NR, Barakat RR, Alektiar KM. Adjuvant radiation for early stage endometrial cancer with lymphovascular invasion. Gynecol Oncol. 2008;111:49–54.PubMedCrossRef
9.
Lotan Y, Gupta A, Shariat SF, Palapattu GS, Vazina A, et al. Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. J Clin Oncol. 2005;23:6533–9.PubMedCrossRef
10.
Koukourakis MI, Giatromanolaki A, Sivridis E, Gatter KC, Harris AL. Inclusion of vasculature-related variables in the Dukes staging system of colon cancer. Clin Cancer Res. 2005;11:8653–60.PubMedCrossRef
11.
National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology: colon cancer, Washington. 2011:COL-3.
12.
Heide J, Krull A, Berger J. Extracapsular spread of nodal metastasis as a prognostic factor in rectal cancer. Int J Radiat Oncol Biol Phys. 2004;58:773–8.PubMedCrossRef
13.
Law WL, Chu KW. Local recurrence following total mesorectal excision with double-stapling anastomosis for rectal cancers: analysis of risk factors. World J Surg. 2002;26:1272–6.PubMedCrossRef
14.
Ptok H, Meyer F, Steinert R, Vieth M, Ridwelski K, et al. No prognostic impact of isolated lymphovascular invasion after radical resection of rectal cancer–results of a multicenter observational study. Int J Colorectal Dis. 2007;22:749–56.PubMedCrossRef
15.
Minsky BD, Mies C, Recht A, Rich TA, Chaffey JT. Resectable adenocarcinoma of the rectosigmoid and rectum: II. The influence of blood vessel invasion. Cancer. 1988;61:1417–24.PubMedCrossRef
16.
Yoon SM, Kim DY, Kim TH, Jung KH, Chang HJ, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007;69:1167–72.PubMedCrossRef
17.
Tuchiya A, Ando Y, Kikuchi Y, Kanazawa M, Sato H, et al. Venous invasion as a prognostic factor in colorectal cancer. Surg Today. 1995;25:950–3.CrossRef
18.
Tominaga T, Sakabe T, Koyama Y, Hamano K, Yasutomi M, et al. Prognostic factors for patients with colon or rectal carcinoma treated with resection only. Cancer. 1996;78:403–8.PubMedCrossRef
19.
Kapiteijn E, Liefers GJ, Los LC, Kranenbarg EK, Hermans J, et al. Mechanisms of oncogenesis in colon versus rectal cancer. J Pathol. 2001;195:171–8.PubMedCrossRef
20.
American Joint Committee on Cancer (AJCC). Cancer staging manual, 7th edn. New York: Springer-Verlag; 2009. p. 143–64.
21.
Hoda SA, Hoda RS, Merlin S, Shamonki J, Rivera M. Issues relating to lymphovascular invasion in breast carcinoma. Adv Anat Pathol. 2006;13:308–15.PubMedCrossRef
22.
Walgenbach-Bruenagel G, Tolba RH, Varnai AD, Bollmann M, Hirner A, et al. Detection of lymphatic invasion in early stage primary colorectal cancer with the monoclonal antibody D2-40. Eur Surg Res. 2006;38:438–44.PubMedCrossRef
23.
Dresen RC, Peters EE, Rutten HJ, Nieuwenhuijzen GA, Demeyere TB, et al. Local recurrence in rectal cancer can be predicted by histopathological factors. Eur J Surg Oncol. 2009;35:1071–7.PubMedCrossRef
24.
Rodel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005; 23:8688–96.PubMedCrossRef
25.
Szynglarewicz B, Matkowski R, Halon A, Lacko A, Stepien M, et al. Association between histological type of tumour growth and patient survival in t2–t3 lymph node-negative rectal cancer treated with sphincter-preserving total mesorectal excision. Pathol Oncol Res. 2010;16:201–6.PubMedCrossRef
26.
Silberfein EJ, Kattepogu KM, Hu CY, Skibber JM, Rodriguez-Bigas MA, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol. 2010;17:2863–9.PubMedCrossRef
27.
Collette L, Bosset JF, den Dulk M, Nguyen F, Mineur L, et al. Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European organisation for research and treatment of cancer radiation oncology group. J Clin Oncol. 2007;25:4379–86.PubMedCrossRef
28.
Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, et al. Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis. Cancer. 1996;78:2313–7.PubMedCrossRef
29.
Vass DG, Ainsworth R, Anderson JH, Murray D, Foulis AK, et al. The value of an elastic tissue stain in detecting venous invasion in colorectal cancer. J Clin Pathol. 2004;57:769–72.PubMedCrossRef
30.
Uemura M, Ikeda M, Yamamoto H, Kitani K, Tokuoka M, et al. Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. Ann Surg Oncol. 2011;18:1015–22.PubMedCrossRef
Metadata
Title
Lymphovascular Invasion is a Significant Prognosticator in Rectal Cancer Patients Who Receive Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision
Authors
Jong Hoon Lee, MD
Hong Seok Jang, MD
Jun-Gi Kim, MD
Hyun Min Cho, MD
Byoung Yong Shim, MD
Seong Taek Oh, MD
Sei-Chul Yoon, MD
Yeon-Sil Kim, MD
Byung Ock Choi, MD
Sung Hwan Kim, MD
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2062-z

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