Prognostic significance of computed tomography-detected extramural vascular invasion in colon cancer.
OBJECTIVE
To compare disease-free survival (DFS) between extramural vascular invasion (EMVI)-positive and -negative colon cancer patients evaluated by computed tomography (CT).


METHODS
Colon cancer patients (n = 194) undergoing curative surgery between January 2009 and December 2013 were included. Each patient's demographics, cancer characteristics, EMVI status, pathological status and survival outcomes were recorded. All included patients had been routinely monitored until December 2015. EMVI was defined as tumor tissue within adjacent vessels beyond the colon wall as seen on enhanced CT. Disease recurrence was defined as metachronous metastases, local recurrence, or death due to colon cancer. Kaplan-Meier analyses were used to compare DFS between the EMVI-positive and -negative groups. Cox's proportional hazards models were used to measure the impact of confounding variables on survival rates.


RESULTS
EMVI was observed on CT (ctEMVI) in 60 patients (30.9%, 60/194). One year after surgery, there was no statistically significant difference regarding the rates of progressive events between EMVI-positive and -negative patients [11.7% (7/60) and 6.7% (9/134), respectively; P = 0.266]. At the study endpoint, the EMVI-positive patients had significantly more progressive events than the EMVI-negative patients [43.3% (26/60) and 14.9% (20/134), respectively; odds ratio = 4.4, P < 0.001]. Based on the Kaplan-Meier method, the cumulative 1-year DFS rates were 86.7% (95%CI: 82.3-91.1) and 92.4% (95%CI: 90.1-94.7) for EMVI-positive and EMVI-negative patients, respectively. The cumulative 3-year DFS rates were 49.5% (95%CI: 42.1-56.9) and 85.8% (95%CI: 82.6-89.0), respectively. Cox proportional hazards regression analysis revealed that ctEMVI was an independent predictor of DFS with a hazard ratio of 2.15 (95%CI: 1.12-4.14, P = 0.023).


CONCLUSIONS
ctEMVI may be helpful when evaluating disease progression in colon cancer patients.
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Xun
X
Yao
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Su-Xing
SX
Yang
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Xing-He
XH
Song
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Yan-Cheng
YC
Cui
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Ying-Jiang
YJ
Ye
Xun Yao, Su-Xing Yang, Xing-He Song, Yi Wang, Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Yi
Y
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
Colon cancer; Disease-free survival; Extramural vascular invasion; Neoplasm invasion; Risk assessment