Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection.
OBJECTIVE
Streak type, defined by the presence of white streaks at the advancing margin of tumor invasion; focal dedifferentiation, seen as undifferentiated cancer cells with an infiltrative pattern at the invasive front; and perineural invasion have been demonstrated to be prognostic factors in patients with colorectal cancer. We performed a prospective study to examine the usefulness of these features as prognostic factors.


METHODS
We reviewed a total of 391 patients who underwent curative surgery for colorectal cancer between May 1997 and June 1999. Of these, 50 patients with multiple cancers were excluded, and a total of 341 patients were finally entered into the study.


RESULTS
Of the prognostic factors investigated, depth of invasion, lymph node status, lymphatic invasion, venous invasion, growth type, streak type, focal dedifferentiation, and perineural invasion were significant prognostic factors in univariate analysis. In multivariate analysis, lymph node status, depth of invasion, and perineural invasion were significant prognostic factors. The survival of patients with perineural invasion was significantly poorer than that of patients without perineural invasion in both stage II and III cancer.


CONCLUSIONS
Perineural invasion status can be used to facilitate the selection of colorectal cancer patients for adjuvant chemotherapy and should be described in routine pathology reports.
Fujita
Shin
S
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. sfujia@ncc.go.jp
Shimoda
Tadakazu
T
Yoshimura
Kimio
K
Yamamoto
Seiichiro
S
Akasu
Takayuki
T
Moriya
Yoshihiro
Y
D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate