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. 2024 Dec;12(10):1429-1439.
doi: 10.1002/ueg2.12670. Epub 2024 Oct 30.

Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study

Lisa van der Schee  1 , Annabelle Verbeeck  2 , Ivette A G Deckers  3 , Chantal C H J Kuijpers  3 , G Johan A Offerhaus  1 , Tom C J Seerden  2 , Frank P Vleggaar  4 , Lodewijk A A Brosens  1 , Leon M G Moons  4 , Petur Snaebjornsson  5 , Miangela M Laclé  1 ; Dutch T1 CRC Working Group
Affiliations

Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study

Lisa van der Schee et al. United European Gastroenterol J. 2024 Dec.

Abstract

Background: Lymphovascular invasion (LVI) plays an important role in determining the risk of lymph node metastasis (LNM) in T1 colorectal cancer (CRC) patients and influencing treatment decisions and patient outcomes.

Objective: This study evaluated how the detection of LVI varies between Dutch laboratories and investigated its impact on the treatment and oncological outcomes of T1 CRC patients.

Methods: Pathology reports and clinical data of T1 CRC patients who underwent local resection between 2015 and 2019 were obtained from the Dutch nationwide pathology databank (Palga cohort, n = 5513). Data on the standard of LVI diagnosis (H&E/Immunohistochemistry) were not available. We categorized laboratories as low, average, or high detectors and evaluated the impact of LVI detection practice on the surgical resection rate and the proportion of LNM-negative (LNM-) surgeries. In the second part of the study, we used the Dutch T1 CRC Working Group cohort (n = 1268) to evaluate the impact of LVI detection practice on cancer recurrences during follow-up. Multivariable logistic regression analyses and Cox proportional hazard regression were used to study the association between LVI detection practice and the outcomes.

Results: In the PALGA cohort, the proportion of surgical resections after local resection of a T1 CRC was significantly higher among patients diagnosed by laboratories with a high LVI detection rate (high vs. low: adjusted OR [aOR] 1.87; 95% confidence interval [CI] 1.52-2.31) as was the proportion of LNM-surgeries (aOR 1.73; 95% CI 1.39-2.15). In the second cohort, no significant difference was observed in cancer recurrences among patients diagnosed in laboratories with high detection rates compared with low detection rates (aHR 2.23; 95% CI 0.94-5.23).

Conclusion: These findings suggest that a high detection rate of LVI does not improve oncological outcomes and may expose more patients to unnecessary oncological surgery, emphasizing the need for standardization of LVI diagnosis.

Keywords: CRC; bowel; histology; intestine; lymph node; metastasis; neoplasia; outcomes; stadiation; therapy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of included and excluded patients of the Palga cohort. CRC, colorectal cancer.
FIGURE 2
FIGURE 2
Funnel plot showing the percentage of T1 CRCs with positive LVI per laboratory from the Palga cohort adjusted for case‐mix factors, plotted against the total number of T1 CRCs from the corresponding laboratory. CI, confidence interval; CRC, colorectal cancer; LVI, lymphovascular invasion.
FIGURE 3
FIGURE 3
Percentage of T1 CRC patients treated with surgical resection after local excision and the percentage of patients who had LNM‐negative surgery in laboratories with low, average and high LVI detection rates (Palga cohort). aOR, adjusted odds ratio; CI, confidence interval; CRC, colorectal cancer; LNM, lymph node metastasis; LVI, lymphovascular invasion.
See this image and copyright information in PMC

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