Lymphovascular Invasion as a Superior Prognostic Factor for Stage III Colon Cancer: Implications for Adjuvant Chemotherapy Duration

{/'title/': /'翻译：//nLymphovascular invasion represents//na superior prognostic and predictive//npathological factor of the duration of adjuvant//nchemotherapy for stage III colon cancer patients/', /'abstract/': /'//nBackground: Lymphovascular invasion (LVI) and perineural invasion (PNI) can indicate poor survival outcomes in//ncolorectal cancer, but few studies have focused on stage III colon cancer. The current study aimed to confirm the//nprognostic value of LVI and PNI and identify patients who could benefit from a complete duration of adjuvant chemotherapy//nbased on the two pathological factors.//nMethods: We enrolled 402 consecutive patients with stage III colon cancer who received colon tumor resection from//nNovember 2007 to June 2016 at Sun Yat-sen University Cancer Center. Survival analyses were performed by using//nKaplan–Meier method with log-rank tests. Risk factors related to disease-free survival (DFS) and overall survival (OS)//nwere identified through Cox proportional hazards analysis.//nResults: 141 (35.1%) patients presented with LVI, and 108 (26.9%) patients with PNI. The LVI-positive group was associated//nwith poorer 3-year DFS (86.5% vs. 76.3%, P = 0.001) and OS (96.0% vs. 89.1%, P = 0.003) rates compared with//nthe LVI-negative group. The PNI-positive group showed a worse outcome compared with the PNI-negative group//nin 3-year DFS rate (72.5% vs. 86.7%, P < 0.001). Moreover, LVI-positive group present better 3-year DFS and OS rate in//npatients completing 6–8 cycles of adjuvant chemotherapy than those less than 6 cycles (3-year DFS: 80.0% vs. 64.9%,//nP = 0.019; 3-year OS: 93.2% vs. 76.3%, P = 0.002).//nConclusions: LVI is a superior prognostic factor to PNI in stage III colon cancer patients undergoing curative treatment.//nPNI status can noly predict the 3-year DFS wihout affecting the 3-year OS. Furthermore, LVI also represents an//neffective indicator for adjuvant chemotherapy duration.//nKeywords: Lymphovascular invasion, Perineural invasion, Adjuvant chemotherapy, Stage III colon cancer, Prognosis//n//nPatients//nA total of 402 consecutive patients with stage III colon//ncancer who underwent primary tumor resection between//nNovember 2007 and June 2016 at Sun Yat-sen University//nCancer Center were included in this retrospective study.//nThe patients were enrolled according to the following//ncriteria: (1) pathologically diagnosed as colon adenocarcinoma;//n(2) colon tumor curative resection; (3) adjuvant//nchemotherapy with the XELOX regimen (oxaliplatin//nplus capecitabine); (4) complete pathological data with//ndefinite LVI and PNI statuses; (5) no preoperative anticancer//ntreatment; (6) American Society of Anesthesiologists//nclass I–II; and (7) postoperative follow-up at least 3//nmonths after delivery of the first cycle of chemotherapy.//nThe clinical information, including demographics, tumor//ncharacteristics, treatment details, and follow-up data,//nwere carefully collected from the electronic medical//nrecord system. Right-sided colon cancer was defined as//nthe tumor located in cecum, ascending, hepatic flexure,//nand transverse colon, whereas left-sided colon cancer//nwas recognized as the tumor in splenic flexure, descending,//nand sigmoid colon. The current study was conducted//nbased on the ethical standards of the World Medical//nAssociation Declaration of Helsinki. This study was//napproved by the Institutional Research Ethics Committee//nof Sun Yat-sen University Cancer Center (approval number://nB2022-790-01). All patient data were documented//nconfidentially.//nTreatments//nAll the patients underwent curative resection of the//ncolon tumor by performing standard complete mesocolic//nexcision and regional lymphadenectomy. The initial adjuvant//nchemotherapy was performed 3–8 weeks for all the//npatients after colon tumor resection. The XELOX regimen//nwas administered as 3-week cycle chemotherapy as//n130 mg/m2 oxaliplatin on day 1 combined with 1000 mg///nm2 capecitabine twice daily on days 1–14 at an interval//nof 7 days. The continued administration of the XELOX//nregimen of adjuvant chemotherapy depended on the//npatient’s general status, the toxicity of the chemotherapy,//nor the patient’s tolerance to the subsequent cycle of//nchemotherapy.//nPathologic analysis//nEach tumor resection specimen was reviewed by two//nindependent pathologists (Songran Liu and Shixun Lu).//nAll cases were pathologically staged referring to the 8thedition of the American Joint Committee on Cancer//n(AJCC) staging system. Hematoxylin and eosin staining//nwas used to evaluate the LVI status without other special//nstains. LVI was diagnosed as the presence of tumor cells//nwithin the small endothelium-lined lymphatic or vascular//nchannels [14]. PNI was diagnosed as tumor invasion//nin, around, and through nerves and nerve sheaths (Fig. 1)//n[15]. In addition, the statuses of proximal and distal margins,//nlymph node metastasis, and tumor differentiation//nwere assessed in line with current guidelines [3, 12]./