title: Mural and extramural venous invasion and prognosis in colorectal cancer.
abstract: BACKGROUND
  Extramural venous invasion is a known independent predictor of poor prognosis after resection of colorectal adenocarcinoma, but the prognostic value of mural venous invasion alone and the association between venous invasion and prognosis within tumor stages has received little research attention.
  
  
  OBJECTIVE
  This study aimed to determine whether associations between mural and extramural venous invasion and outcome differ among tumor stages after adjustment for other factors known to influence prognosis.
  
  
  METHODS
  This study is a retrospective analysis of prospectively collected data.
  
  
  METHODS
  Data were drawn from a registry of 3040 consecutive patients undergoing resection between 1980 and 2005 under the care of specialist surgeons in a tertiary referral public hospital and an affiliated private hospital. A standardized protocol was used for the pathological assessment of specimens.
  
  
  METHODS
  The primary outcomes measured were overall survival, cancer-specific survival, and recurrence.
  
  
  RESULTS
  There was no significant association between venous invasion and survival in stages A (n = 544) or B (n = 1078). In stage C (n = 899), overall survival time was significantly shorter in patients with mural invasion alone or extramural invasion (both p < 0.001) than in those without invasion, and this persisted after adjustment for other prognostic variables. Equivalent bivariate associations were found in stage D, but only the effect of extramural invasion persisted after adjustment.
  
  
  CONCLUSIONS
  Our findings arise from the experience of a single surgical group and may not be generalizable to other settings. Only hematoxylin and eosin staining was used.
  
  
  CONCLUSIONS
  The association between venous invasion and prognosis was stage specific. Both mural venous invasion alone and extramural venous invasion independently predicted overall survival in patients with stage C tumors, but not in patients with stages A, B, or D tumors. Although mural invasion alone was rare, the separate reporting of both mural and extramural invasion in patients with stage C tumor is informative and desirable.
authors.affiliation: 1Department of Surgery, Liverpool Hospital and School of Medicine, University of Western Sydney, New South Wales, Australia 2Department of Anatomical Pathology, Concord Hospital and Discipline of Pathology, University of Sydney, New South Wales, Australia 3Department of Colorectal Surgery, Concord Hospital and Discipline of Surgery, University of Sydney, and School of Medicine, University of Western Sydney, New South Wales, Australia.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Gibson
authors.forename: Charles
authors.initials: C
authors.lastname: Chan
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Chapuis
authors.forename: Owen F
authors.initials: OF
authors.lastname: Dent
authors.forename: Les
authors.initials: L
authors.lastname: Bokey
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000473:pathology*