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Adjuvant Chemotherapy Benefits on Patients with Extramural Vascular Invasion in Stages II and III Colon Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Extramural vascular invasion (EMVI) is a poor prognostic factor in colon cancer. However, the benefit of adjuvant chemotherapy in patients with EMVI is not well defined. The objective of this study is to determine if there is a survival benefit for using adjuvant chemotherapy in patients with EMVI-positive colon cancers.

Methods

We performed a retrospective review of all patients with stages II and III colon adenocarcinoma who underwent surgical resection between 2004 and 2015. Cox regression was used to determine the effect of chemotherapy on EMVI-positive patients while adjusting for the extent of invasion, regional lymph node metastasis, histologic grade, age, site of tumor, and ASA score.

Results

A total of 750 patients were included in this study. Extramural vascular invasion was present in 93 out of 387 stage II patients (24%) and 187 out of 363 stage III patients (52%). The Cox regression model showed that in patients with EMVI, those who did not receive adjuvant chemotherapy had a 1.6-fold (1.1–2.3) increase in the hazard of death compared with those who received chemotherapy.

Conclusions

Patients who were EMVI-negative fared better than those who were EMVI-positive. In patients who were EMVI-positive, adjuvant chemotherapy improved overall survival.

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References

  1. Siegel, R., Miller, K., Fedwea, S., Ahnen, D., Meester, R., Barzi, A., Jemal, A. Colorectal cancer statistics, 2017. CA: A Cancer Journal for Clinicians. March 2017; Volume 67, Issue 3.

  2. Gill, S., Loprinzi, CL., Sargent, DJ., Thome, SD., Alberts, SR., Haller, DG. Pooled Analysis of Fluorouracil-Based Adjuvant Therapy for Stage II and III Colon Cancer: Who Benefits and by How Much? Journal of Clinical Oncology. 2005 May 15; Vol.22 (10), pp.1797-806.

  3. Babaei, M., et al. Administration of adjuvant chemotherapy for stage II-III colon cancer patients: An European population-based study. International Journal of Cancer. Vol 142, Issue 7. 2017

  4. Sargent, D., Sobrero, A., Grothey, A., O’Connell, M. J., Buyse, M., Andre, T., … De Gramont, A. (2009). Evidence for cure by adjuvant therapy in colon cancer: Observations based on individual patient data from 20,898 patients on 18 randomized trials. Journal of Clinical Oncology, 27(6), 872–877

    Article  Google Scholar 

  5. Betge, J., Pollheimer, M. J., Lindtner, R. A., Kornprat, P., Schlemmer, A., Rehak, P., … Langner, C. (2012). Intramural and extramural vascular invasion in colorectal cancer: Prognostic significance and quality of pathology reporting. Cancer, 118(3), 628–638.

    Article  Google Scholar 

  6. Leijssen, L. G. J., Dinaux, A. M., Amri, R., Taylor, M. S., Deshpande, V., Bordeianou, L. G., … Berger, D. L. (2019). Impact of intramural and extramural vascular invasion on stage II-III colon cancer outcomes. Journal of Surgical Oncology, 119(6), 749–757.

    Article  Google Scholar 

  7. Washington, M. K., Berlin, J., Branton, P., Burgart, L. J., Carter, D. K., Fitzgibbons, P. L., … Compton, C. C. (2009, October). Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Archives of Pathology and Laboratory Medicine.

  8. Labianca, R., Nordlinger, B., Beretta, G. D., Brouquet, A., & Cervantes, A. (2010). Primary colon cancer: ESMO clinical practice guidelines for diagnosis, adjuvant treatment and follow-up. Annals of Oncology, 21(SUPPL. 5).

  9. Benson, A. B., Venook, A. P., Cederquist, L., Chan, E., Chen, Y. J., Cooper, H. S., … Freedman-Cass, D. (2017, March 1). Colon cancer, version 1.2017: Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network. Harborside Press.

  10. Li M,Li JY,Zhao AL,Gu J. Colorectal cancer or colon and rectal cancer? Clinicopathological comparison between colonic and rectal carcinomas. Oncology 2007; 73: 52– 7.

    Article  CAS  Google Scholar 

  11. Smith, N. J., Shihab, O., Arnaout, A., Swift, R. I., & Brown, G. (2008). MRI for detection of extramural vascular invasion in rectal cancer. American Journal of Roentgenology, 191(5), 1517–1522.

    Article  Google Scholar 

  12. Jhaveri, K. S., & Hosseini-Nik, H. (2015, July 1). MRI of rectal cancer: An overview and update on recent advances. American Journal of Roentgenology. American Roentgen Ray Society.

  13. Smith, N. J., Barbachano, Y., Norman, A. R., Swift, R. I., Abulafi, A. M., & Brown, G. (2008). Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. In British Journal of Surgery (Vol. 95, pp. 229–236).

  14. Sohn, B., Lim, J. Seok, Kim, H., Myoung, S., Choi, J., Kim, N. K., & Kim, M. J. (2015). MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. European Radiology, 25(5), 1347–1355.

    Article  Google Scholar 

  15. Chand, M., Swift, R. I., Tekkis, P. P., Chau, I., & Brown, G. (2014). Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer. British Journal of Cancer, 110(1), 19–25.

    Article  CAS  Google Scholar 

  16. Edge, S. B., & Compton, C. C. (2010, June). The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology.

  17. National Comprehensive Cancer Network Board. (2017). NCCN Guidelines for Patients: Colon Cancer. National Comprehensive Cancer Network (pp. 1–80).

  18. Norgaard, A., Dam, C., Jakobsen, A., Ploen, J., Lindebjerg, J., & Rafaelsen, S. R. (2014). Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan. Scandinavian Journal of Gastroenterology, 49(2), 202–208.

    Article  CAS  Google Scholar 

  19. Chand, M., Swift, R. I., Chau, I., Heald, R. J., Tekkis, P. P., & Brown, G. (2014). Adjuvant therapy decisions based on magnetic resonance imaging of extramural venous invasion and other prognostic factors in colorectal cancer. Annals of the Royal College of Surgeons of England, 96(7), 543–546.

    Article  CAS  Google Scholar 

  20. Chand, M., Rasheed, S., Heald, R., Swift, I., West, N., Rao, S., … Brown, G. (2017). Adjuvant chemotherapy may improve disease-free survival in patients with rectal cancer positive for MRI-detected extramural venous invasion following chemoradiation. Colorectal Disease, 19(6), 537–543.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Yasmeen Z. Qwaider, Naomi M. Sell, Caitlin E. Stafford, Hiroko Kunitake, Rocco Ricciardi, Liliana G. Bordeianou, Robert N. Goldstone, Christy E. Cauley & David L. Berger

  2. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Vikram Deshpande

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  1. Yasmeen Z. Qwaider
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  2. Naomi M. Sell
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  3. Caitlin E. Stafford
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  4. Hiroko Kunitake
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  5. Rocco Ricciardi
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  6. Liliana G. Bordeianou
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  7. Vikram Deshpande
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  8. Robert N. Goldstone
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  9. Christy E. Cauley
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  10. David L. Berger
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Contributions

• YZQ: contributed to the study design, acquisition, analysis, and interpretation of data. Has drafted the manuscript and approved of the final version to be published and agrees to be accountable for all aspects of the work.

• NMS: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• CES: contributed to the acquisition of data and critical revision, approved of the final version to be published, and agrees to be accountable for all aspects of the work.

• HK: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• RR: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• LGB: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• VD: contributed to the interpretation of data and critical revision, approved of the final version to be published, and agrees to be accountable for all aspects of the work.

• RNG: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• CEC: contributed to the study design, interpretation of data, and critical revision; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

• DLB: contributed to the study design, acquisition, and interpretation of data; approved of the final version to be published; and agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to David L. Berger.

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Qwaider, Y.Z., Sell, N.M., Stafford, C.E. et al. Adjuvant Chemotherapy Benefits on Patients with Extramural Vascular Invasion in Stages II and III Colon Cancer. J Gastrointest Surg 25, 2019–2025 (2021). https://doi.org/10.1007/s11605-020-04810-4

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  • DOI: https://doi.org/10.1007/s11605-020-04810-4

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