ISSN : 2146-3123
E-ISSN : 2146-3131

Intramural Component of Venous, Lymphatic, and Perineural Invasion in Colon Cancer: A Threat or an Illusion?
Leyla Özer1, Elif Şenocak Taşçı1, Arda Ulaş Mutlu2, Betül Piyade3, Nur Ramoğlu4, Miraç Ajredini5, Damla Gürleyik6, Recep Çeçen2, Sena Nur Dinçer2, Turan Musevitoğlu2, Süha Göksel7, Ümit İnce7, Cavit Kerem Kayhan8, Sibel Erdamar7, İbrahim Yıldız1, Erman Aytaç4
1Department of Medical Oncology, Faculty of Medicine Acıbadem University, İstanbul, Turkey
2Faculty of Medicine Acıbadem University, İstanbul, Turkey
3Department of Internal Medicine, Faculty of Medicine Marmara University, İstanbul, Turkey
4Department of General Surgery, Faculty of Medicine Acıbadem University, İstanbul, Turkey
5Faculty of Medicine Trakya University, Edirne, Turkey
6Department of Pediatrics, Cerrahpaşa Faculty of Medicine İstanbul-Cerrahpaşa University, İstanbul, Turkey
7Department of Pathology, Faculty of Medicine Acıbadem University, İstanbul, Turkey
8Pathology Laboratory, Acıbadem Maslak Hospital, İstanbul, Turkey
DOI : 10.4274/balkanmedj.galenos.2022.2022-6-94
Pages : 436-443


Background: Extramural venous invasion is an independent predictor of poor outcome in colorectal cancer, whereas the significance of the intramural component of venous and lymphatic and perineural invasion is unclear.
Aims: To evaluate the prognostic impact of intramural components for venous, lymphatic, and perineural invasions and the relation of these invasion patterns with clinicopathological features in patients with colon cancer.
Study Design: A retrospective cross-sectional study.
Methods: The analysis included 626 patients with colon cancer in stages II and III. All patients were divided into four categories (no invasion, intramural invasion only, extramural invasion only, or both intramural and extramural invasions) for vascular invasion, lymphatic invasion and perineural invasion. The primary outcomes were 5-year disease-free and overall survival.
Results: Right-sided (for vascular invasion, 24.7% vs. 33.9%, p = 0.007; for perineural invasion, 34.5% vs. 41.5%, p = 0.034) and dMMR tumors (for vascular invasion, 13.5% vs. 33.5, p < 0.001; for perineural invasion, 25% vs. 41.4%, p = 0.004) exhibited less venous and perineural invasion. Compared with no invasion, presence of intramural invasion only, did not exert any effect on disease-free or overall survival for vascular invasion, lymphatic invasion, and perineural invasion. Multivariate analyses revealed that the presence of both intramural and extramural invasion was independently associated with poor disease-free and overall survival for venous (hazard ratios: 2.39, p = 0.001; hazard ratios: 2.46, p = 0.001), lymphatic (hazard ratios: 2.456, p < 0.001; hazard ratios: 2.13, p = 0.02) and perineural invasion (hazard ratios: 2.99, p < 0.001; hazard ratios: 2.68, p < 0.001), respectively.
Conclusion: Our data strongly advocates the importance of reporting intramural and extramural components of invasion since the presence of intramural invasion alone may not be considered as a high-risk factor for systemic recurrence.

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