Adjuvant Chemotherapy Benefits on Patients with Extramural Vascular Invasion in Stages II and III Colon Cancer
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ORIGINAL ARTICLE
Adjuvant Chemotherapy Benefits on Patients with Extramural Vascular Invasion in Stages II and III Colon Cancer Yasmeen Z. Qwaider 1 & Naomi M. Sell 1 & Caitlin E. Stafford 1 & Hiroko Kunitake 1 & Rocco Ricciardi 1 & Liliana G. Bordeianou 1 & Vikram Deshpande 2 & Robert N. Goldstone 1 & Christy E. Cauley 1 & David L. Berger 1 Received: 16 June 2020 / Revised: 16 August 2020 / Accepted: 22 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
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 EMVIpositive 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 EMVIpositive, adjuvant chemotherapy improved overall survival. Keywords Extramural vascular invasion . EMVI . Colon cancer . Adjuvant chemotherapy
Introduction Colorectal cancer is one of the most common cancers worldwide. The histopathologic features and stage of the tumor determine the treatment options and the prognosis of patients.1 Clinicians administer chemotherapy on a case-by-case basis, especially in stage II disease. Patients with high-risk features—including histologic grade, extent of invasion, and regional lymph node involvement—benefit from adjuvant chemotherapy.2–4 The benefit of chemotherapy has not been Presented at the 16th Annual Academic Surgical Congress (ASC), Orlando, Florida. February 4–6, 2020. * David L. Berger [email protected] 1
Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
adequately studied in patients with other validated high-risk features. Extramural vascular invasion (EMVI) is a high-risk feature defined as the presence of tumor cells in the vascula beyond the muscularis propria.5 Recently, Leijssen et al. reported that EMVI portends a poor prognosis in stages II and III colon cancer, but intramural vascular invasion
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