title: Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry.
abstract: BACKGROUND
  Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level.
  
  
  METHODS
  Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012.
  
  
  RESULTS
  Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p = .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence.
  
  
  CONCLUSIONS
  Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.
authors.affiliation: a Department of Surgery , Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , Västerås , Sweden.
authors.forename: Maziar
authors.initials: M
authors.lastname: Nikberg
authors.affiliation: a Department of Surgery , Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , Västerås , Sweden.
authors.forename: Abbas
authors.initials: A
authors.lastname: Chabok
authors.affiliation: b Department of Oncology , Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , Västerås , Sweden.
authors.forename: Henry
authors.initials: H
authors.lastname: Letocha
authors.affiliation: c Department of Pathology , Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , Västerås , Sweden.
authors.forename: Csaba
authors.initials: C
authors.lastname: Kindler
authors.affiliation: d Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.affiliation: a Department of Surgery , Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås , Västerås , Sweden.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Smedh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D010502:Perineum / Q000473:pathology*; D010525:Peripheral Nerves / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy; D012042:Registries; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult