TD-count, perineural invasion and extramural venous invasion are important independent high-risk features in colorectal cancer
Tage Gantelius, Simon Lundström, Pamela BuchwaldAbstract
Introduction
Tumour deposits (TDs) are the only histological factor beyond lymph node metastases (LNMs) to be given prognostic effect in nodal staging of colorectal cancer (CRC). However, other histological factors such as perineural invasion (PNI), vascular invasion, lymphovascular invasion (LVI) and extramural venous invasion (EMVI) has been suggested as ‘high-risk features’. This study aimed to explore the prognostic impact of histological co-occurrent high-risk features in CRC.
Methods
Using data from the Swedish Colorectal Cancer Registry, this study included CRC patients who underwent radical surgery with curative intention between 2017 and 2019. Exclusion criteria were metastatic disease at diagnosis, appendiceal tumours, non-radical surgery or death within 30 days of surgery. Uni- and multivariable cox-regression analyses were performed to assess the impact on study outcomes overall survival (OS), distant metastasis (DM) and local recurrence (LR) and adjusted for age, sex, neoadjuvant treatment and number of LNMs.
Results
Of 14 357 patients assessed for eligibility, 11 683 patients were analysed. After five years, 3140 (27%) patients were deceased whereas 1563 (13%) had DM and 317 (3%) LR. PNI and EMVI were associated with all study outcomes in the sensitivity-analysis. In subgroup analysis of N1c-patients, PNI-positivity was associated with DM in Cox-regression analysis.
Discussion
Co-occurrent high-risk features are prognostically and predictably important in CRC. Among these features, TD-count, PNI and EMVI appears to have the greatest prognostic potential and may improve risk stratification.