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ORIGINAL ARTICLE
Year : 2020  |  Volume : 39  |  Issue : 3  |  Page : 745-747

Reporting of lymphovascular invasion and non-nodal tumor deposits as prognostic risk factors in colorectal cancer patients


Department of General Surgery, Cairo University, Cairo, Egypt

Date of Submission18-Mar-2020
Date of Decision09-Apr-2020
Date of Acceptance12-Apr-2020
Date of Web Publication28-Aug-2020

Correspondence Address:
MD Abdrabou N Mashhour
Department of General Surgery, Cairo University, Cairo, 2287
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_65_20

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  Abstract 


Background and purpose Both lymphovascular invasion (LVI) and non-nodal tumor deposits (TDs) are essential prognostic risk factors for colorectal cancer that many oncologists may not be aware of. This study aimed to detect the incidence of reporting of the state of the LVI and non-nodal TDs with operable colorectal malignancy, which are very important prognostic risk factors.
Patients and methods Reporting of LVI and non-nodal TDs were traced in 900 patients (818 retrospective and 82 prospective individuals) with cancer of the colon and the rectum. The ability of improving the incidence of reporting was estimated by comparison of incidence of reporting in both groups.
Results Percentage of reporting of LVI was 39% in the retrospective group and 49.9% in the prospective group, while reporting of non-nodal TDs was 7.228% in the retrospective group and 24.24% in the prospective group. There was a statistically significant difference between reporting of non-nodal TDs, prospective patients over retrospective patients (P<0.0001); while there was no statistically significant difference between reporting in retrospective and prospective patients in the LVI with P value of 0.865.
Conclusion There were inadequate reporting of both non-nodal TDs and LVI in retrospective patients with improvement in prospective patients although statistically nonsignificant in the LVI, which may necessitate a new staging system that could accommodate all this prognostic risk factors.

Keywords: colorectal cancer, lymphovascular invasion, non-nodal tumor deposits, prognosis, staging


How to cite this article:
Elbarmelgi MY, Mashhour AN. Reporting of lymphovascular invasion and non-nodal tumor deposits as prognostic risk factors in colorectal cancer patients. Egypt J Surg 2020;39:745-7

How to cite this URL:
Elbarmelgi MY, Mashhour AN. Reporting of lymphovascular invasion and non-nodal tumor deposits as prognostic risk factors in colorectal cancer patients. Egypt J Surg [serial online] 2020 [cited 2020 Sep 21];39:745-7. Available from: http://www.ejs.eg.net/text.asp?2020/39/3/745/293685




  Introduction Top


Colorectal carcinoma is one of the most common malignancies worldwide and the most common cancer of the alimentary tract [1]. Several risk factors may be involved in the development of colorectal cancer including age, high-fat diet, and excessive alcohol consumption [2]. Also, many gene mutations have been described in the development of such cancer as the K-ras gene [3]. Other risk factors include polyps, familial adenomatous polyposis, and inflammatory bowel disease [4].

Different staging systems of cancers are used to predict the prognosis and plan the management. TNM staging system is now the most used staging system in colorectal cancer worldwide, which can be detected preoperatively by computed tomographic scan, MRI, or by endorectal ultrasound [5]. However, it has no place to accommodate all prognostic risk factors such as preoperative carcinoembryonic antigen and circumferential tumor margins [6]. From the first staging systems used in the management and prediction of prognosis of colorectal cancer is the Dukes system, which is widely used throughout the world till nowadays [7].

There are many prognostic risk factors which are very important in putting the plan of management and predicting the prognosis after surgery. Tumor grade and differentiation, histological tumor type [8],[9], circumferential margins status, and lymphovascular invasion (LVI) [10],[11] are examples of those factors.

One of the most important factors in determining the prognosis and management of colorectal cancer is the status of resected lymph nodes as in Al Sahaf et al. [12]. The extramural nodules in the T-category was classified in the sixth edition of the TNM and then considered as tumor deposits (TDs) in the seventh edition. Extracapsular lymph node metastasis is an established poor prognostic indicator in many cancers including colorectal cancer [12].


  Aim Top


The first end point is to detect the incidence of reporting of the state of the LVI and non-nodal TDs with operable colorectal malignancy, which are very important prognostic risk factors. The second end point is the ability of improving the incidence of reporting in both.


  Patients and methods Top


Population of study

Both men and women from any age group presenting with colon or rectal cancer were included in the study. This study was approved from the scientific committee of General surgery department faculty of medicine Cairo University. A written consent was signed by the prospective group of patients.

Inclusion criteria

  1. Patients with respectable colon and rectal cancer.
  2. Adenocarcinoma pathology with all its variants.


Exclusion criteria

  1. Primary anal canal carcinoma.
  2. Melanoma or squamous cell carcinoma pathology.
  3. Patients who were not subjected to primary resection.


Interventions

Reporting of the state of the LVI and non-nodal TDs was traced in the postoperative pathology reports of resected colorectal cancer.

This took place in both groups of patients:
  1. Retrospective patients (n=818) from the registry of colorectal cancer patients from January 2010 to January 2019 at Cairo University Hospitals.
  2. Prospective group of colorectal cancer patients (n=82) presenting to our colorectal unit in the period between June 2015 and March 2019. This group represented an intervention group to detect the difference in reporting between both groups.


Total number of patients was 900: retrospective group (n=818) and prospective group (n=82).

Statistical analysis

Statistically, the information obtained were described as number of patients and percentages when appropriate. χ2 test were used for comparison between both groups. P value less than 0.05 was considered statistically significant. All statistical calculations were done using computer program SPSS (Statistical analysis was done using IBM SPSS statistics for windows, Armonk, NY: IBM Corp).


  Results Top


Reporting of the lymphovascular invasion

Reporting of LVI in both retrospective and prospective groups is shown in [Table 1].
Table 1 Number and percentage of reporting of lymphovascular invasion

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Reporting of the non-nodal tumor deposits

[Table 2] shows the reporting in both retrospective and prospective groups.
Table 2 Number and percentage of reporting of non-nodal tumor deposits

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Comparison between both groups

There was a statistically significant difference in reporting of non-nodal TDs between both groups to the benefit of prospective one in which the P value was less than 0.0001. This is shown in [Table 3].
Table 3 Statistical analysis of reporting of lymphovascular invasion between both groups

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On the other hand, there was insignificant statistical difference in reporting of LVI between both groups in which the P value was 0.865. This is shown in [Table 4].
Table 4 Statistical analysis of reporting of non-nodal tumor deposits between both groups

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  Discussion Top


Data gathered from the registry of retrospective group of patients shows that the reporting of LVI increased in the prospective group although there was statistically insignificant difference (P=0.865). On the other hand, reporting of the non-nodal TDs dramatically improved in the prospective group of patients which was statistically significant (P<0.0001). This occurs usually due to the fact that many of the oncologists, colorectal surgeons, and pathologists are unaware of the way those risk factors may affect the course of the disease as it is not included in the staging systems used, either the TNM or the Dukes staging systems [13].

In some countries, it is recommended to combine the Dukes staging system and TNM staging system in planning management and predicting prognosis. TNM staging module can be applied to all types of cancers and has been frequently subjected to different modifications [7].

Minimal changes had been applied to the TNM staging system of colorectal cancer throughout the last two decades despite their great effect on the course of the disease [14]. Despite the fact that the TNM staging system gives the main needed information required in planning the management of colorectal cancer such as lymph node status and distant metastasis, it does not include any data on other essential risk factors [15]. Moreover, NCCN guidelines state many factors other than that of TNM should be reported such as circumferential resection margin and LVI [16].In a previous study, other risk factors like circumferential tumor margins and preoperative levels of carcinoembryonic antigen were also underreported in the management of colorectal cancer [6]. In 2016, the authors participated in a study suggesting adding category ‘F’ to the TNM staging system to be TNMF, this category can accommodate all risk factors which have no place in the TNM such as the LVI and non-nodal TDs [17].


  Conclusion and recommendations Top


There is inadequate reporting of LVI and non-nodal TDs, which can be improved if the medical team is aware of their importance in the management and prognosis in colorectal cancer especially those that are not included in the TNM staging system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jenkins P, Fairclough PD. Screening guidelines for colorectal cancer and polyps. Gut 2002; 51(Suppl V):v13.  Back to cited text no. 1
    
2.
Calle E, Rodriguez C, Walter-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospective studied cohort of U.S. adults. N Engl J Med 2003; 348:1625.  Back to cited text no. 2
    
3.
Vasen HF, van Duijvendijk P, Buskens E, Bulow C, Bjork J, Jarvinen HJ, Bulow S. Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients. Gut 2001; 49:231–235.  Back to cited text no. 3
    
4.
Eaden J, Abrams K, Mayberry J. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48:526.  Back to cited text no. 4
    
5.
Brunicardi C, Anderson D, Billar T, Dunn D, Hunter J, Matthews J. Charles Brunicardi, Dana Anderson, Timothy Billar, David Dunn, John Hunter and Jeffry Matthews: Schwartz’s principles of general surgery. 9th ed. New York: McGraw-Hill, Medical Pub. Division; 2010.  Back to cited text no. 5
    
6.
Elbarmelgi MY, Farag A, Azim HA, Abozeid AA, Mashour AN, Mikhail HM. Reporting of the circumferential tumour margin involvement and preoperative levels of carcinoembryonic antigen as prognostic risk factors in colorectal cancer patients. Arab J Gastroenterol 2015; 16:113–115.  Back to cited text no. 6
    
7.
Haboubi N. The TNM: a very good staging system that needs continuous appraisal. Colorectal Dis 2010; 13:477.  Back to cited text no. 7
    
8.
Jass JR, O’Brien MJ, Riddell RH, Snover DC. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Hum Pathol 2007; 38:537–545.  Back to cited text no. 8
    
9.
Royal College of Pathologists. Standards and datasets for reporting cancers, dataset for colorectal cancer, 2nd ed. London:RCP;2007.  Back to cited text no. 9
    
10.
Royal College of Pathologists of Australasia. Colorectal cancer, structured reporting protocol. Surry Hills, NSW:RCPA;2010.  Back to cited text no. 10
    
11.
Hamilton S, Vogelstein B, Kudo S, Riboli E, Nakamura S, Hainaut P. Tumours ofthe colon and rectum. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumors. Lyon: IARC Press 2000. 101–142.  Back to cited text no. 11
    
12.
Al Sahaf O, Myers E, Jawad M, Browne TJ, Winter DC, Redmond HP. The prognostic significance of extramural deposits and extra capsular lymph node invasion in colon cancer. Dis Colon Rectum 2011;54:982–988.  Back to cited text no. 12
    
13.
Dukes CE. The classification of cancer of the rectum. J Pathol Bacteriol 1932;35:323–332.  Back to cited text no. 13
    
14.
Farag A. Can a major change in classification, staging and grading of rectal cancer improve planning for treatment, reporting and outcome of the disease?. AJG 2010;11:121–123.  Back to cited text no. 14
    
15.
Group MS. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006;333:779.  Back to cited text no. 15
    
16.
National Comprehensive Cancer Network. Available at: NCCNclinical practice guidelines for colorectal cancer. Version 2.2014. Published by Harborside Press, LLC, in Cold Spring Harbor, New York.  Back to cited text no. 16
    
17.
Ahmed Farag AF, Elbarmelgi MY, Azim HA, Abozeid AA, Mashhour AN. TNMF versus TNM in staging of colorectal cancer. Int J Surg 2016; 27:147–150.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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Patients and methods
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