The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer

Roxburgh, C. S. D. , McMillan, D. C. , Richards, C. H., Atwan, M., Anderson, J., Harvey, T., Horgan, P. G. and Foulis, A. K. (2014) The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer. Annals of Surgery, 259(6), pp. 1156-1165. (doi: 10.1097/SLA.0000000000000229)

Abstract

<b>Objective:</b> To examine the clinical utility of improved detection of venous invasion (VI) in patients undergoing potentially curative resection of colorectal cancer.<p></p> <b>Background:</b> VI is a feature of colorectal cancer (CRC) progression. Elastica staining can be used to improve detection of VI and correspondingly its prediction of patient survival.<p></p> <b>Methods:</b> A single-center, observational study of pathology variables, including detection of VI by staining for elastica, using 631 stage I to III CRC specimens, collected from 1997 to 2009 (176 analyzed retrospectively and 455 analyzed prospectively), was performed.<p></p> <b>Results:</b> VI was detected in 56% of patients with CRC. Over a median follow-up period of 73 months, 238 patients died (134 from cancer). On multivariate analysis, VI by elastica staining was associated with a shorter survival duration, independent of other pathology features, in all cases [hazard ratio (HR) = 3.94, 95% confidence interval (CI): 2.33-6.65, P < 0.001] and in node-negative cases (HR = 3.55, 95% CI: 1.81-6.97; P < 0.001). In the absence of elastica-detected VI, with the exception of T stage, no other pathology features were associated with survival time. Therefore, the combination of T stage and VI (TVI) on survival was examined. Five-year cancer mortality could be stratified between 100% and 54% for patients with node-negative tumors and between 100% and 33% for patients with node-positive tumors. In all cases, the TVI had similar predictive value as that of T stage and node status (TNM). In node-negative disease, TVI had superior predictive value.<p></p> <b>Conclusions:</b> The results of the present study have prompted the development of a novel tumor staging system based on TVI. The TVI has clinical utility, especially in node-negative disease, in predicting outcome following curative resection for CRC.<p></p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and McMillan, Professor Donald and Foulis, Dr Alan and Roxburgh, Professor Campbell and Harvey, Mr Tim and Anderson, Mr John and Richards, Mr Colin
• Authors: Roxburgh, C. S. D., McMillan, D. C., Richards, C. H., Atwan, M., Anderson, J., Harvey, T., Horgan, P. G., and Foulis, A. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgery
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0003-4932
• ISSN (Online): 1528-1140