title: Is there a rationale to record lymphatic invasion in node-positive colorectal cancer?
abstract: This study aimed to evaluate the prognostic significance of lymphatic invasion in colorectal cancers that have already spread to regional lymph nodes. 168 patients with node-positive tumours (colon, n=98; rectum, n=70) were retrospectively evaluated. Lymphatic invasion was assessed on H&E stained slides and univariable and multivariable analyses were applied. Lymphatic invasion was detected in 95 (57%) cases and was significantly associated with tumour and node classification and tumour differentiation. Patients with tumours showing lymphatic invasion had decreased progression-free survival (p=0.025) and cancer-specific survival (p=0.082). Stratified by location, lymphatic invasion was significantly associated with decreased progression-free (p=0.010) and cancer-specific (p=0.023) survival in colon cancers, yet not in rectal cancers. Multivariable analysis proved T4 (HR 2.18, 95% CI 1.40 to 3.39; p<0.001) and N2 (HR 1.68, 95% CI 1.07 to 2.66; p=0.03) as independent predictors of progression-free survival and T4 (HR 1.90, 95% CI 1.17 to 3.07; p=0.009), N2 (HR 2.27, 95% CI 1.38 to 3.73; p=0.001) and poor tumour differentiation (HR 2.18, 95% CI 1.39 to 3.43; p<0.001) as independent predictors of cancer-specific survival, while for lymphatic invasion no influence on outcome was noted. In conclusion, only tumour and node classification, and tumour differentiation proved to be independent prognostic variables in node-positive colorectal cancer and merit special attention in clinical decision-making.
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, Graz, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Betge
authors.forename: Nora I
authors.initials: NI
authors.lastname: Schneider
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Pollheimer
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lindtner
authors.forename: Peter
authors.initials: P
authors.lastname: Kornprat
authors.forename: Andrea
authors.initials: A
authors.lastname: Schlemmer
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors