Prognostic Significance of Lymphovascular Invasion in Sporadic Colorectal Cancer

PURPOSE: It remains unclear whether lymphovascular invasion marks a poor prognosis for patients with sporadic colorectal cancers. Here, we analyzed the association between lymphovascular invasion and the clinicopathological features and prognosis of sporadic colorectal cancer patients. METHODS: The clinicopathological features and prognosis of 2417 patients with sporadic primary colorectal cancer who underwent an operation at the Asan Medical Center between January 1998 and December 2002 were examined. The patients' clinicopathological parameters and follow-up and survival data were obtained from a prospectively collected database. RESULTS: Of the 2417 patients, a lymphovascular invasion-positive tumor was detected in 610 (25.2%). Compared with patients with lymphovascular invasion-negative tumors those with lymphovascular invasion-positive tumors were older (P < .001) and had higher preoperative serum carcinoembryonic antigen levels (P = .011). Their tumors were also more likely to be poorly differentiated (P < .001) and more advanced in terms of T and N categories (P < .001 and P < .001, respectively). The lymphovascular invasion-positive tumors were also more likely to have metastasized systemically (P < .001). Although lymphovascular invasion-positive and lymphovascular invasion-negative tumors metastasized equally frequently to the liver, lung, peritoneum, and bone, lymphovascular invasion-positive tumors metastasized to systemic lymph nodes more often (P < .001). These tumors also recurred at systemic lymph nodes after curative intent surgery more often (P = .007). Lymphovascular invasion-positive status was an independent unfavorable prognostic factor for the 5-year overall and 5-year disease-free survival of patients with sporadic colorectal cancer (P < .001 and P < .001, respectively). CONCLUSION: Lymphovascular invasion-positive status could be used to identify patients with sporadic primary colorectal cancer with aggressive tumors and as a factor that independently indicates an unfavorable prognosis.