Abstract
Abstract
Background
Colorectal cancer (CRC) consists of several histological subtypes that greatly affect prognosis. Venous invasion (VI) has been implicated in the postoperative recurrence of CRC, but the relationship between the VI grade and postoperative recurrence in each histological subtype has not been clarified thus far.
Methods
A total of 323 CRCs without distant metastasis at surgery (pathologic stage III or lower), including 152 well-to-moderately differentiated adenocarcinomas (WMDAs), 98 poorly differentiated adenocarcinomas (PDAs), and 64 mucinous adenocarcinomas (MUAs), were analyzed. They were routinely processed pathologically, and VI was graded as follows irrespective of location by elastica van Gieson staining: v0 (none), no venous invasion; v1 (mild), 1–3 invasions per glass slide; v2 (moderate), 4–6 invasions per glass slide; and v3 (severe), ≥ 7 invasions per glass slide. Filling-type invasion in veins with a minor axis of ≥ 1 mm increased the grade by 1. The association of VI grade with prognosis was statistically analyzed.
Results
All recurrences occurred as distant metastases. Recurrence increased with VI grade in WMDA (v0 11.8%, v1 15.8%, v2 73.9%, v3 75.0%) and MUA (v0 15.2%, v1 30.8%, v2 40.0%). The recurrence rate was relatively high in PDA even with v0 and increased with VI grade (v0 27.8%, v1 32.7%, v2 33.3%, v3 60.0%). VI grade was a significant predictor of recurrence in WMDA but not in PDA and MUA by multivariate analysis. In node-negative (stage II or lower) CRC, the recurrence-free survival (RFS) rate exceeded 90% in v0 and v1 WMDA until postoperative day (POD) 2100 and v0 MUA until POD 1600 but fell below 80% in the other settings by POD 1000. In node-positive (stage III) CRC, the RFS rate fell below 80% in all histological subtypes by POD 1000.
Conclusions
VI grade v1 had a similar recurrence rate and RFS as grade v0 and may not warrant adjuvant chemotherapy in node-negative (stage II or lower) WMDA. In addition to node-positive (stage III) CRC, adjuvant chemotherapy may be indicated for node-negative (stage II or lower) CRC when it is WMDA with VI grade v2 or v3, MUA with VI, or PDA.
Publisher
Springer Science and Business Media LLC
Subject
Gastroenterology,General Medicine
Reference30 articles.
1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics. CA Cancer J Clin. 2020;71(3):209–49. https://doi.org/10.3322/caac.21660.
2. American Cancer Society. Survival rates for colorectal cancer. https://www.cancer.org/cancer/colorectal-cancer/detection-diagnosis-staging/survival-rates.html. Accessed 18 May 2021.
3. Sato T, Ueno H, Mochizuki H, Shinto E, Hashiguchi Y, Kajiwara Y, Shimazaki H, Hase K. Objective criteria for the grading of venous invasion in colorectal cancer. Am J Surg Pathol. 2010;34(4):454–62. https://doi.org/10.1097/PAS.0b013e3181d296ef.
4. Union for International Cancer Control (UICC). Introduction. In: Brierley JD, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours. 8th ed. Oxford: Wiley Blackwell; 2017. p. 102–4.
5. American Joint Committee on Cancer (AJCC). Colon and rectum cancer staging, 7th edn. http://cancerstaging.org/references-tools/quickreferences/Documents/ColonMedium.pdf. Accessed 22 July 2011.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献