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Is there a rationale to record lymphatic invasion in node-positive colorectal cancer?
  1. Johannes Betge1,
  2. Nora I Schneider1,
  3. Marion J Pollheimer1,
  4. Richard A Lindtner1,
  5. Peter Kornprat2,
  6. Andrea Schlemmer3,
  7. Peter Rehak4,
  8. Cord Langner1
  1. 1Institute of Pathology, Medical University of Graz, Graz, Austria
  2. 2Department of Surgery, Division of General Surgery, Medical University of Graz, Graz, Austria
  3. 3Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  4. 4Department of Surgery, Research Unit for Biomedical Engineering & Computing, Medical University of Graz, Graz, Austria
  1. Correspondence to Dr Cord Langner, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria; cord.langner{at}


This study aimed to evaluate the prognostic significance of lymphatic invasion in colorectal cancers that have already spread to regional lymph nodes. 168 patients with node-positive tumours (colon, n=98; rectum, n=70) were retrospectively evaluated. Lymphatic invasion was assessed on H&E stained slides and univariable and multivariable analyses were applied. Lymphatic invasion was detected in 95 (57%) cases and was significantly associated with tumour and node classification and tumour differentiation. Patients with tumours showing lymphatic invasion had decreased progression-free survival (p=0.025) and cancer-specific survival (p=0.082). Stratified by location, lymphatic invasion was significantly associated with decreased progression-free (p=0.010) and cancer-specific (p=0.023) survival in colon cancers, yet not in rectal cancers. Multivariable analysis proved T4 (HR 2.18, 95% CI 1.40 to 3.39; p<0.001) and N2 (HR 1.68, 95% CI 1.07 to 2.66; p=0.03) as independent predictors of progression-free survival and T4 (HR 1.90, 95% CI 1.17 to 3.07; p=0.009), N2 (HR 2.27, 95% CI 1.38 to 3.73; p=0.001) and poor tumour differentiation (HR 2.18, 95% CI 1.39 to 3.43; p<0.001) as independent predictors of cancer-specific survival, while for lymphatic invasion no influence on outcome was noted. In conclusion, only tumour and node classification, and tumour differentiation proved to be independent prognostic variables in node-positive colorectal cancer and merit special attention in clinical decision-making.

  • Colon cancer
  • rectal cancer
  • lymphatic invasion
  • lymph node metastasis
  • prognosis
  • gastroenterology
  • colorectal cancer
  • GI neoplasms
  • bone
  • cancer research
  • surgery
  • oncology
  • oncogenes
  • urinary tract tumours
  • bladder
  • carcinoma
  • urogenital pathology

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Ethics committee of the Medical University of Graz.

  • Provenance and peer review Not commissioned; externally peer reviewed.