Venous invasion may predict lymph node metastasis in early rectal cancer

S. Bayar, Romil Saxena, B. Emir, R. R. Salem

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Aim: The aim of this study was to evaluate the role of histopathological and demographic characteristics in predicting lymph node metastasis in patients with adenocarcinoma of the rectum confined to the mucosal and submucosal layers. Methods: Fifty-nine patients with early rectal cancer underwent resection of the rectum including lymph nodes and five showed lymph node metastasis (8.6%). Pathology slides of these patients were reviewed by a single pathologist. Demographic and clinical characteristics of these 59 patients were correlated with the existence of nodal metastasis. Formal tests of comparability were carried out by using Fisher's exact test. Logistic regression models were fitted to data to examine possible relationships with 12 covariates measured from each patient and to obtain corresponding odds ratios (as well as a 95% confidence interval for the odds ratios). These covariates included age at surgery, gender, morphology, histology, degree of differentiation, Haggitt's classification for polyps according to the level of invasion, lymphatic and venous invasion, desmoplastic reaction, degree of lymphocytic invasion, presence of lymphoid follicles and presence of infiltrating or pushing margins. Results: A significantly higher rate of lymph node metastasis occurs in the presence of venous invasion (P <0.01). Venous invasion was present in three of five (60%) patients with lymph node metastasis and only four of 54 (7%) patients without lymph node metastasis. Other variables did not achieve statistical significance. Conclusions: Only the presence of venous invasion was found to be highly significant. The odds ratio of lymph node metastasis increased 18-fold for a patient who had venous invasion compared with a patient who did not. This suggests that the presence of venous invasion in early rectal cancer may provide valuable information to determine which patients would benefit from radical surgery, or adjuvant radiation therapy after sphincter-sparing surgery owing to an increased risk of lymph node metastasis.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalEuropean Journal of Surgical Oncology
Volume28
Issue number4
DOIs
StatePublished - Jun 2002
Externally publishedYes

Fingerprint

Rectal Neoplasms
Lymph Nodes
Neoplasm Metastasis
Odds Ratio
Rectum
Logistic Models
Demography
Polyps
Histology
Adenocarcinoma
Radiotherapy
Confidence Intervals
Pathology

Keywords

  • Early rectal cancer
  • Lymph node metastasis
  • Polypectomy
  • Venous invasion

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Venous invasion may predict lymph node metastasis in early rectal cancer. / Bayar, S.; Saxena, Romil; Emir, B.; Salem, R. R.

In: European Journal of Surgical Oncology, Vol. 28, No. 4, 06.2002, p. 413-417.

Research output: Contribution to journalArticle

@article{9523dd6eca0c41108aaf45c1bb7dc27b,
title = "Venous invasion may predict lymph node metastasis in early rectal cancer",
abstract = "Aim: The aim of this study was to evaluate the role of histopathological and demographic characteristics in predicting lymph node metastasis in patients with adenocarcinoma of the rectum confined to the mucosal and submucosal layers. Methods: Fifty-nine patients with early rectal cancer underwent resection of the rectum including lymph nodes and five showed lymph node metastasis (8.6{\%}). Pathology slides of these patients were reviewed by a single pathologist. Demographic and clinical characteristics of these 59 patients were correlated with the existence of nodal metastasis. Formal tests of comparability were carried out by using Fisher's exact test. Logistic regression models were fitted to data to examine possible relationships with 12 covariates measured from each patient and to obtain corresponding odds ratios (as well as a 95{\%} confidence interval for the odds ratios). These covariates included age at surgery, gender, morphology, histology, degree of differentiation, Haggitt's classification for polyps according to the level of invasion, lymphatic and venous invasion, desmoplastic reaction, degree of lymphocytic invasion, presence of lymphoid follicles and presence of infiltrating or pushing margins. Results: A significantly higher rate of lymph node metastasis occurs in the presence of venous invasion (P <0.01). Venous invasion was present in three of five (60{\%}) patients with lymph node metastasis and only four of 54 (7{\%}) patients without lymph node metastasis. Other variables did not achieve statistical significance. Conclusions: Only the presence of venous invasion was found to be highly significant. The odds ratio of lymph node metastasis increased 18-fold for a patient who had venous invasion compared with a patient who did not. This suggests that the presence of venous invasion in early rectal cancer may provide valuable information to determine which patients would benefit from radical surgery, or adjuvant radiation therapy after sphincter-sparing surgery owing to an increased risk of lymph node metastasis.",
keywords = "Early rectal cancer, Lymph node metastasis, Polypectomy, Venous invasion",
author = "S. Bayar and Romil Saxena and B. Emir and Salem, {R. R.}",
year = "2002",
month = "6",
doi = "10.1053/ejso.2002.1254",
language = "English (US)",
volume = "28",
pages = "413--417",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Venous invasion may predict lymph node metastasis in early rectal cancer

AU - Bayar, S.

AU - Saxena, Romil

AU - Emir, B.

AU - Salem, R. R.

PY - 2002/6

Y1 - 2002/6

N2 - Aim: The aim of this study was to evaluate the role of histopathological and demographic characteristics in predicting lymph node metastasis in patients with adenocarcinoma of the rectum confined to the mucosal and submucosal layers. Methods: Fifty-nine patients with early rectal cancer underwent resection of the rectum including lymph nodes and five showed lymph node metastasis (8.6%). Pathology slides of these patients were reviewed by a single pathologist. Demographic and clinical characteristics of these 59 patients were correlated with the existence of nodal metastasis. Formal tests of comparability were carried out by using Fisher's exact test. Logistic regression models were fitted to data to examine possible relationships with 12 covariates measured from each patient and to obtain corresponding odds ratios (as well as a 95% confidence interval for the odds ratios). These covariates included age at surgery, gender, morphology, histology, degree of differentiation, Haggitt's classification for polyps according to the level of invasion, lymphatic and venous invasion, desmoplastic reaction, degree of lymphocytic invasion, presence of lymphoid follicles and presence of infiltrating or pushing margins. Results: A significantly higher rate of lymph node metastasis occurs in the presence of venous invasion (P <0.01). Venous invasion was present in three of five (60%) patients with lymph node metastasis and only four of 54 (7%) patients without lymph node metastasis. Other variables did not achieve statistical significance. Conclusions: Only the presence of venous invasion was found to be highly significant. The odds ratio of lymph node metastasis increased 18-fold for a patient who had venous invasion compared with a patient who did not. This suggests that the presence of venous invasion in early rectal cancer may provide valuable information to determine which patients would benefit from radical surgery, or adjuvant radiation therapy after sphincter-sparing surgery owing to an increased risk of lymph node metastasis.

AB - Aim: The aim of this study was to evaluate the role of histopathological and demographic characteristics in predicting lymph node metastasis in patients with adenocarcinoma of the rectum confined to the mucosal and submucosal layers. Methods: Fifty-nine patients with early rectal cancer underwent resection of the rectum including lymph nodes and five showed lymph node metastasis (8.6%). Pathology slides of these patients were reviewed by a single pathologist. Demographic and clinical characteristics of these 59 patients were correlated with the existence of nodal metastasis. Formal tests of comparability were carried out by using Fisher's exact test. Logistic regression models were fitted to data to examine possible relationships with 12 covariates measured from each patient and to obtain corresponding odds ratios (as well as a 95% confidence interval for the odds ratios). These covariates included age at surgery, gender, morphology, histology, degree of differentiation, Haggitt's classification for polyps according to the level of invasion, lymphatic and venous invasion, desmoplastic reaction, degree of lymphocytic invasion, presence of lymphoid follicles and presence of infiltrating or pushing margins. Results: A significantly higher rate of lymph node metastasis occurs in the presence of venous invasion (P <0.01). Venous invasion was present in three of five (60%) patients with lymph node metastasis and only four of 54 (7%) patients without lymph node metastasis. Other variables did not achieve statistical significance. Conclusions: Only the presence of venous invasion was found to be highly significant. The odds ratio of lymph node metastasis increased 18-fold for a patient who had venous invasion compared with a patient who did not. This suggests that the presence of venous invasion in early rectal cancer may provide valuable information to determine which patients would benefit from radical surgery, or adjuvant radiation therapy after sphincter-sparing surgery owing to an increased risk of lymph node metastasis.

KW - Early rectal cancer

KW - Lymph node metastasis

KW - Polypectomy

KW - Venous invasion

UR - http://www.scopus.com/inward/record.url?scp=0036621034&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036621034&partnerID=8YFLogxK

U2 - 10.1053/ejso.2002.1254

DO - 10.1053/ejso.2002.1254

M3 - Article

VL - 28

SP - 413

EP - 417

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 4

ER -