547P - Prognostic significance of combined positivity of lymphatic, vascular, and perineural invasion (triple positive) in stage II/III colorectal cancer;...

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Colon and Rectal Cancer
Pathology/Molecular Biology
Basic Scientific Principles
Presenter Faysal Dane
Authors F. Dane1, M.A. Ozturk2, M. Koçar1, B.M. Atasoy3, B. Aktas4, F. Telli1, M. Kanıtez1, M. BeŞİroĞlu1, P.F. Yumuk1, S.N. Turhal2
  • 1Internal Medicine Dpt., Medical Oncology Div., MARMARA UNIVERSITY FACULTY OF MEDICINE, ISTANBUL/TR
  • 3Radiation Oncology Dpt., Marmara University Faculty of Medicine, Istanbul/TR



Despite the studies showing the impact of each lymphatic, vascular or perineural invasion on prognosis separately, the exact effect of these parameters in together (triple positive) on prognosis is not known. In this study, we assessed the pathological features and the survival outcomes of triple positive colorectal cancer patients.


The files of stage II/III colorectal cancer (CRC) patients (n = 532) who received adjuvant systemic treatment following curative resection in our center were analyzed, retrospectively. Tumors with vascular, lymphatic, and perineural invasions were called triple positive (TP), all others were called non-triple positive (NTP) tumors. Patients with unknown vascular, lymphatic or perineural invasion status (n = 93) were excluded from the analysis. Adjuvant therapy was consisted of either fluorouracil or oxaliplatin-based chemotherapy (CT) regimens. Rectal cancer patients were given adjuvant radiation therapy also. Survival was determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test.


A total of 439 patients (243 male: 196 female) with stage II/III colorecral cancer who received adjuvant therapy were evaluated retrospectively. The median age was 60 (range: 23–84 years). Median follow-up was 36 months. Fifteen percent of the patients were TP. The rate of TP tumors were 4%, 13,6%, and 29% in T2, T3, and T4 tumors, respectively (p:0.001). The rate of TP tumors were 5,6%, 13,9%, and 40,5% in N0, N1, and N2 tumors, respectively (p:0.0001). There were no relation between TP tumors rates and age, gender or tumor localization (p > 0.05). Five years DFS and OS rates were 37,7% vs 64,7% (p:0.0001) and 53,4% vs 78,1% (p:0.0001) for TP and NTP tumors, respectively.


Our findings revealed that patients with TP tumors have inferior survival outcomes when compared to NTP tumors. However results of multivariate analyses for DFS and cancer specific OS did not support the preanalysis hypothesis of TP being a poor prognostic sign in early stage CRC patients. Nevertheless, we believe that accurate answer to this question can be given via retrospective analysis of prospectively collected data from multi-center clinical trials.


All authors have declared no conflicts of interest.