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Sun B, Li H, Gu X, Cai H. Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes. Cancers (Basel) 2024; 16:979. [PMID: 38473340 DOI: 10.3390/cancers16050979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. MATERIAL AND METHODS A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). RESULTS We found a strong association between LVI and LNM (p < 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4-8.5, p < 0.001) and 4.4 (95% CI: 2.1-8.9, p < 0.001), respectively. CONCLUSIONS LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies.
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Affiliation(s)
- Bo Sun
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China
| | - Huanhuan Li
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaodong Gu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200031, China
| | - Hong Cai
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China
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Misimi S, Cako D, Demirel Aİ, Nikolovski A, Ulusoy C, Duman MG. The Incidence of Lymphovascular and Perineural Invasion and their Impact on Survival in Patients with Rectal Cancer. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:73-78. [PMID: 38109451 DOI: 10.2478/prilozi-2023-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Aim: Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) represent undesirable but still realistic pathological features of rectal cancer, associated with poor prognosis and worse survival. The aim of this study is to assess the incidence of LVI and PNI in patients treated for rectal cancer and the impact of LVI and PNI on patient survival. Material and Methods: This retrospective single center observational study, conducted in the period of 2016-2019, includes patients with rectal cancer treated with/without long-course neoadjuvant chemoradiotherapy (nCRT). Data collection encompassed demographics, tumor characteristics, type of surgery (abdominal perineal rectal resection - APR and low anterior rectal resection - LAR), and LVI/PNI presence. Survival during follow-up was estimated and compared for patients with/without LVI and PNI involvement. Results: A total number of 234 patients (77 females and 157 males) with mean age of 61.3 enrolled in the study. Neoadjuvant CRT was conducted in 170 patients. APR procedure was performed in 67 of them and LAR in 167. LVI presence was noted in 55 (24.4%) and PNI in 77 (34.2%) patients. Mean survival during follow-up was 42.07 months. The use of nCRT influenced on survival (p < 0.033). Patients treated with LAR had better survival outcomes (p = 0.001). Presence of LVI and PNI was associated with a worse prognosis (p < 0.001). Conclusion: PNI was more frequent than the LVI in this study. Patients with nCRT conduction had better overall survival. LVI and PNI presence was associated with poor prognosis in terms of overall survival in patients with rectal cancer.
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Affiliation(s)
- Shqipe Misimi
- 1Medical Faculty in Skopje, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Dajana Cako
- 1Medical Faculty in Skopje, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Ali İlbey Demirel
- 2Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Turkey
| | - Andrej Nikolovski
- 3Department of Visceral Surgery, University Surgery Clinic "St. Naum Ohridskiˮ, Skopje, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Cemal Ulusoy
- 2Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Turkey
| | - Mehmet Güray Duman
- 2Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Turkey
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Alkader MS, Al-Majthoub MZ, Al-Qerem WA, Alkhader DM, Alhusban AM, Abdulkareem MA, Abweny B, Hamawi AT, Muslem HF, Omeish RA, Al-Adwan AM, Al Halaiqah HA. Prognostic Factors Influencing Survival in Stage II and Stage III Colorectal Cancer Patients. Cureus 2023; 15:e46575. [PMID: 37933355 PMCID: PMC10625675 DOI: 10.7759/cureus.46575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Background Colorectal cancer (CRC) is a global health concern with rising incidence. This study analyzed demographic and clinicopathological factors influencing overall survival (OS) and disease-free survival (DFS) in Jordanian CRC patients. Methodology This retrospective, single-center study collected data from CRC patients at the Royal Medical Services, Jordan, from January 2018 to June 2020. Patient variables included disease stage, stage risk, tumor location, history of chemotherapy, and metastasis status. OS and DFS were defined as the time from surgery to death, last follow-up, or metastasis confirmation. Kaplan-Meier curves and Cox models were used for survival analysis. Results Of 127 CRC patients, 33.3% died during the follow-up period. Most patients were males (55.1%), diagnosed with stage III (55.9%), and classified as high risk (59.2%). Metastasis occurred in 24.4%, and 65.4% received chemotherapy. OS at one, two, and end of the follow-up years was 85.2%, 75.6%, and 66.9%, respectively. Metastasis-free rates were 85%, 78.5%, and 71%, respectively. Multivariate analysis showed that stage III (hazard ratio (HR) = 2.968) and high-risk stage (HR = 2.966) were associated with shorter OS and increased metastasis risk. Right-sided tumors (HR = 2.183) had shorter OS, while chemotherapy recipients (HR = 0.430) had longer OS. Stage III and high-risk stages were strong predictors of mortality, while only stage III and high-risk stages were robust predictors of metastasis. Demographic variables (sex and age) showed no significant associations with survival outcomes. Conclusions Our findings highlight the prognostic significance of disease stage, stage risk, tumor location, and chemotherapy in CRC survival among Jordanian patients. Understanding these factors can guide tailored treatment and improve outcomes.
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Affiliation(s)
- Mohammad S Alkader
- Department of Medical Oncology, Jordanian Royal Medical Services, Amman, JOR
| | - Murad Z Al-Majthoub
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Walid A Al-Qerem
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman, JOR
| | - Doa'a M Alkhader
- Department of Gastroenterology and Hepatology, Jordanian Royal Medical Services, Amman, JOR
| | - Aseel M Alhusban
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Muna A Abdulkareem
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Bashar Abweny
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Alaa T Hamawi
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Hala F Muslem
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Rasha A Omeish
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
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