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

Lisa van der Schee; Annabelle Verbeeck; Ivette A G Deckers; Chantal C H J Kuijpers; G Johan A Offerhaus; Tom C J Seerden; Frank P Vleggaar; Lodewijk A A Brosens; Leon M G Moons; Petur Snaebjornsson; Miangela M Laclé

doi:10.1002/ueg2.12670

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

Lisa van der Schee, Annabelle Verbeeck, Ivette A G Deckers, Chantal C H J Kuijpers, G Johan A Offerhaus, Tom C J Seerden, Frank P Vleggaar, Lodewijk A A Brosens, Leon M G Moons, Petur Snaebjornsson, Miangela M Laclé,

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	1429-1439
Number of pages	11
Journal	United European Gastroenterology Journal
Volume	12
Issue number	10
Early online date	30 Oct 2024
DOIs	https://doi.org/10.1002/ueg2.12670
Publication status	Published - Dec 2024

Keywords

CRC
bowel
histology
intestine
lymph node
metastasis
neoplasia
outcomes
stadiation
therapy

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UEG Journal - 2024 - Schee - Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impactFinal published version, 514 KBLicence: CC BY-NC-ND

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van der Schee, L., Verbeeck, A., Deckers, I. A. G., Kuijpers, C. C. H. J., Offerhaus, G. J. A., Seerden, T. C. J., Vleggaar, F. P., Brosens, L. A. A., Moons, L. M. G., Snaebjornsson, P., Laclé, M. M. (2024). Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study. United European Gastroenterology Journal, 12(10), 1429-1439. https://doi.org/10.1002/ueg2.12670

@article{1365e9441100496ca3dd35872db79001,

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

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",

author = "{van der Schee}, Lisa and Annabelle Verbeeck and Deckers, {Ivette A G} and Kuijpers, {Chantal C H J} and Offerhaus, {G Johan A} and Seerden, {Tom C J} and Vleggaar, {Frank P} and Brosens, {Lodewijk A A} and Moons, {Leon M G} and Petur Snaebjornsson and Lacl{\'e}, {Miangela M}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.",

year = "2024",

month = dec,

doi = "10.1002/ueg2.12670",

language = "English",

volume = "12",

pages = "1429--1439",

journal = "United European Gastroenterology Journal",

issn = "2050-6406",

publisher = "John Wiley & Sons Inc.",

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}

van der Schee, L, Verbeeck, A, Deckers, IAG, Kuijpers, CCHJ, Offerhaus, GJA, Seerden, TCJ, Vleggaar, FP , Brosens, LAA , Moons, LMG, Snaebjornsson, P, Laclé, MM 2024, 'Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study', United European Gastroenterology Journal, vol. 12, no. 10, pp. 1429-1439. https://doi.org/10.1002/ueg2.12670

Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study. / van der Schee, Lisa; Verbeeck, Annabelle; Deckers, Ivette A G et al.
In: United European Gastroenterology Journal, Vol. 12, No. 10, 12.2024, p. 1429-1439.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment

T2 - A nationwide Dutch study

AU - van der Schee, Lisa

AU - Verbeeck, Annabelle

AU - Deckers, Ivette A G

AU - Kuijpers, Chantal C H J

AU - Offerhaus, G Johan A

AU - Seerden, Tom C J

AU - Vleggaar, Frank P

AU - Brosens, Lodewijk A A

AU - Moons, Leon M G

AU - Snaebjornsson, Petur

AU - Laclé, Miangela M

PY - 2024/12

Y1 - 2024/12

N2 - 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.

AB - 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.

KW - CRC

KW - bowel

KW - histology

KW - intestine

KW - lymph node

KW - metastasis

KW - neoplasia

KW - outcomes

KW - stadiation

KW - therapy

UR - http://www.scopus.com/inward/record.url?scp=85208036919&partnerID=8YFLogxK

U2 - 10.1002/ueg2.12670

DO - 10.1002/ueg2.12670

M3 - Article

C2 - 39476327

SN - 2050-6406

VL - 12

SP - 1429

EP - 1439

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

IS - 10

ER -

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

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