title: Impact of perineural and lymphovascular invasion on oncological outcomes in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery.
abstract: BACKGROUND
  The prognostic significance of perineural and/or lymphovascular invasion (PLVI) and its relationship with tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT) and surgery.
  
  
  METHODS
  A total of 324 patients with LARC were treated with CRT and operated on between January 1992 and June 2007. Tumors were graded using a quantitative 5-grade TRG classification and the presence of PLVI was histologically studied.
  
  
  RESULTS
  At a median follow-up of 79.0 months (range 3-250 months), a total of 80 patients (24.7%) relapsed. The observed 5- and 10-year overall survival (OS) was 83.2 and 74.9 %, respectively. The 5- and 10-year disease-free survival (DFS) was 75.1 and 71.4%, respectively. A significant correlation was found between the TRG and survival (log rank, p < 0.001). The 10-year OS was 32.7% for grade 1, 63.8% for grade 2, 75.0% for grade 3, 90.4% for grade 3+, and 96.0%,for grade 4. The 10-year DFS was 31.8% for grade 1, 58.6% for grade 2, 70.4% for grade 3, 88.4% for grade 3+, and 97.1% for grade 4. In patients with PLVI, the TRG had no impact on survival. When excluding patients with PLVI, the TRG was an independent prognostic factor for OS and DFS.
  
  
  CONCLUSIONS
  The presence of PLVI is a more powerful prognostic factor than TRG in LARC patients treated with neoadjuvant CRT followed by surgery. PLVI denotes an aggressive phenotype, suggesting that these patients may benefit from adjuvant systemic therapy.
authors.affiliation: Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain, fjacien@unav.es.
authors.forename: J A
authors.initials: JA
authors.lastname: Cienfuegos
authors.forename: F
authors.initials: F
authors.lastname: Rotellar
authors.forename: J
authors.initials: J
authors.lastname: Baixauli
authors.forename: C
authors.initials: C
authors.lastname: Beorlegui
authors.forename: J J
authors.initials: JJ
authors.lastname: Sola
authors.forename: L
authors.initials: L
authors.lastname: Arbea
authors.forename: C
authors.initials: C
authors.lastname: Pastor
authors.forename: J
authors.initials: J
authors.lastname: Arredondo
authors.forename: J L
authors.initials: JL
authors.lastname: Hernández-Lizoáin
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010524:Peripheral Nervous System Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D011184:Postoperative Period; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016190:Carboplatin; D002955:Leucovorin; D005472:Fluorouracil