Lymphovascular invasion determines the outcome of stage I colorectal cancer patients

Introduction: The outcome of stage I colorectal cancer (CRC) patients is excellent. However, even after radical surgery, 10% of patients develop tumor recurrence or metastasis. Aim: The aim of this study was to evaluate the prognostic significance of clinicopathologic features to identify high-risk stage I CRC patients. Methods: A total of 292 stage I CRC patients undergoing curative-intention surgery at Taipei Veterans General Hospital between 2000 and 2006 were enrolled. The measured end point was the postoperative disease-free survival (DFS). Results: Of 292 cases, 185 (63.4%) had tumors of T2 stage, 16 (5.5%) had lymphovascular invasion (LVI), and 68 (23.3%) had a carcinoembryonic antigen (CEA) level of higher than 5 ng/mL. With a median follow-up period of 60 months (range, 6-130 months), CRC recurred in 23 patients. Overall, 5-year DFS was 88.7% in stage I disease patients. In the univariate analysis, 5-year DFS of patients with LVI was 52.7%, which was significantly poorer than that of patients without LVI (90.9%). Patients with a high CEA level or T2 lesion had a poor 5-year DFS, but the difference did not reach statistical significance. In the multivariate analysis, the only important independent factor affecting the 5-year DFS was LVI (hazard ratio = 4.27; 95% confidence interval: 1.88-9.68; p = 0.001). In the T1 disease, 5-year DFS of patients with LVI was 60.0%, significantly poorer than that of patients without LVI (93.4%; p = 0.045). In the T2 disease, the difference of 5-year DFS between patients with and without LVI was more significant (50.5% vs. 85.1%; p = 0.003). Conclusion: Stage I CRC patients in this study had an excellent outcome. Prognosis of patients having tumor with LVI was poor and should receive an aggressive follow-up protocol.