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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Important role of lymphovascular and perineural invasion in prognosis of colorectal cancer patients with N1c disease
Zhi-Gang Sun, Shao-Xuan Chen, Bai-Long Sun, Da-Kui Zhang, Hong-Liang Sun, Huang Chen, Yu-Wan Hu, Tong-Yin Zhang, Zi-Han Han, Wen-Xiao Wu, Zhi-Yong Hou, Li Yao, Jian-Zheng Jie
Zhi-Gang Sun, Shao-Xuan Chen, Bai-Long Sun, Da-Kui Zhang, Zi-Han Han, Zhi-Yong Hou, Li Yao, Jian-Zheng Jie, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Hong-Liang Sun, Yu-Wan Hu, Tong-Yin Zhang, Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
Huang Chen, Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Yu-Wan Hu, Tong-Yin Zhang, Wen-Xiao Wu, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Wen-Xiao Wu, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Sun ZG, Chen SX, Jie JZ designed the research; Sun BL, Zhang DK, Han ZH, Wu WX, Hou ZY, Yao L assisted in data collection; Sun HL, Hu YW, Zhang TY verified imaging data; Chen H verified pathological data; Sun ZG, Chen SX, Jie JZ performed the research; All authors have read and approve the final manuscript.
Supported by the National High Level Hospital Clinical Research Funding, No. 2023-NHLHCRF-BQ-32 and No. 2023-NHLHCRF-YYPPLC-ZR-13; and the Elite Medical Professionals Project of China-Japan Friendship Hospital, No. ZRJY2024-GG01.
Institutional review board statement: This study was a retrospective research, using anonymous cases and did not involve ethical issues. According to relevant policies of the China-Japan Friendship Hospital Review Board, ethical review was exempted.
Informed consent statement: The requirement to obtain the informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jian-Zheng Jie, Chief Physician, MD, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China.
jianzhengjie@sohu.com
Received: October 23, 2024
Revised: December 4, 2024
Accepted: December 16, 2024
Published online: February 7, 2025
Processing time: 68 Days and 0.3 Hours
BACKGROUND
Lymphovascular invasion (LVI) and perineural invasion (PNI) are associated with decreased survival in colorectal cancer (CRC), but its significance in N1c stage remains to be clearly defined.
AIM
To evaluate LVI and PNI as potential prognostic indicators in N1c CRC.
METHODS
We retrospectively identified 107 consecutive patients who had CRC with N1c disease radically resected at our hospital. Tumors were reviewed for LVI and PNI by one pathologist blinded to the patients’ outcomes. Disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier method, with LVI and PNI prognosis differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using log-rank test. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic predictive ability.
RESULTS
The median follow-up time was 63.17 (45.33-81.37) months for DFS, with 33.64% (36/107) of patients experiencing recurrence; 21.5% of tumors were found to be LVI positive and 44.9% PNI positive. The 5-year DFS rate was greater for patients with LVI-negative tumors compared with LVI-positive tumors (74.0% vs 35.6%), and PNI was similar (82.5% vs 45.1%). On multivariate analysis, LVI [hazard ratio (HR) = 3.368, 95% confidence interval (CI): 1.628-6.966, P = 0.001] and PNI (HR = 3.055, 95%CI: 1.478-6.313, P = 0.002) were independent prognostic factors for DFS. All patients could be divided into three groups of patients with different prognosis according to LVI and PNI. The 5-year ROC curve for LVI, PNI and their combination prediction of DFS was 0.646, 0.709 and 0.759, respectively. Similar results were seen for OS and CSS.
CONCLUSION
LVI and PNI could serve as independent prognostic factors of outcomes in N1c CRC patients. Patients with LVI or PNI should be given more attention during treatment.
Core Tip: This study evaluated lymphovascular invasion (LVI) and perineural invasion (PNI) as prognostic indicators in N1c colorectal cancer. Among 107 N1c patients, 21.5% were LVI-positive and 44.9% were PNI-positive. Five-year disease-free survival (DFS) rates were higher for LVI-negative (74.0%) and PNI-negative (82.5%) patients than LVI-positive (35.6%) and PNI-positive (45.1%) patients. On multivariate analysis, both LVI and PNI were independent prognostic factors. Receiver operating characteristic curve analysis showed good predictive ability for DFS, overall survival and cancer-specific survival. Patients with LVI or PNI should be closely monitored during treatment.
