结肠癌中淋巴血管侵袭与淋巴结转移的关系：国家癌症数据库分析。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-01-22 DOI:10.1111/codi.17256

Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Anjelli Wignakumar, Marylise Boutros, Steven D. Wexner

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引用次数: 0

摘要

目的：淋巴血管侵袭（LVI）是众所周知的结直肠癌预后不良的危险因素。本研究旨在根据淋巴结转移状态评估lvi阳性结肠癌患者的特征，并研究lvi -淋巴结状态与生存的关系。方法：本回顾性研究评估LVI与结肠癌淋巴结转移之间的关系，使用来自国家癌症数据库的数据。根据病理N分期分为pN0和pN1-2。采用多变量回归分析确定各组LVI的危险因素。主要终点是LVI，次要终点是5年总生存期（OS）。提出了一种肿瘤、淋巴结、转移（TNM）分期系统的改进，该分期系统将LVI纳入每个阶段。结果：纳入357 724例患者，其中女性51.1%，中位年龄70岁。淋巴结阴性和淋巴结阳性患者中分别有11.6%和52.5%检测到LVI。pN0期LVI的独立预测因子为低分化癌（OR: 3.6, p）。结论：LVI在伴有淋巴结转移的结肠癌患者中比在淋巴结阴性患者中更为普遍。然而，在大约一半的淋巴结疾病患者中未检测到LVI。LVI的不良生存效应与结肠癌分期成正比。

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Association between lymphovascular invasion and lymph node metastases in colon cancer: A National Cancer Database analysis

Aim

Lymphovascular invasion (LVI) is a well-known risk factor in colorectal cancer that is associated with a worse prognosis. The present study aimed to assess the characteristics of patients with LVI-positive colon cancer according to the status of nodal metastases and to study the association between LVI-nodal status and survival.

Method

This retrospective study assessed the association between LVI and lymph node metastases in colon cancer, using data from the National Cancer Database. Patients were classified according to the pathological N stage into pN0 and pN1-2. The risk factors for LVI were determined in each group using multivariable regression analyses. The primary outcome was LVI and the secondary outcome was 5-year overall survival (OS). A modification of the tumour, node, metastasis (TNM) staging system that incorporates LVI in each stage was proposed.

Results

The study included 357 724 patients (51.1% female, median age 70 years). LVI was detected in 11.6% and 52.5% of patients with node-negative and node-positive disease, respectively. The independent predictors of LVI in pN0 stage were poorly differentiated carcinomas (OR: 3.6, p < 0.001), undifferentiated carcinomas (OR: 3.3, p < 0.001), mucinous carcinomas (OR: 0.61, p < 0.001), and perineural invasion (OR: 4.2, p < 0.001). The independent predictors of LVI in pN1-2 disease were poorly differentiated carcinomas (OR: 2.36, p < 0.001), undifferentiated carcinomas (OR: 3.23, p < 0.001), and perineural invasion (OR: 3.33, p < 0.001). LVI was significantly associated with worse 5-year OS and the adverse survival impact of LVI was higher in pN1-2 disease (HR: 1.47, p < 0.001) than in pN0 disease (HR: 1.28, p < 0.001). When LVI was present, the 5-year OS was reduced by 1.5% in stage I, 5.6% in stage II, and 11.5% in stage III.

Conclusion

LVI was more prevalent in patients with colon cancer with lymph node metastases than in patients with node-negative disease. However, LVI was not detected in approximately half of patients with nodal disease. The adverse survival effect of LVI was proportional to the stage of colon cancer.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.