Background/Objectives: Vascular invasion, especially extramural vascular invasion (EMVI), has emerged as a prognostic parameter for rectal cancer (RC) in recent years. Prediction of recurrence and metastasis development poses a significant challenge for oncologists, who need markers for prediction of adverse outcome. The aim of this study was to examine the prognostic significance of pathohistologically detected EMVI in untreated rectal cancer and its implications in separate reporting. Methods: We examined 100 untreated RC patients who underwent curative resection from January 2016 to June 2018 with a follow-up of 5 years. Patients were divided into equal EMVI− and EMVI+ groups based on histological re-examination of H&E-stained postoperative surgical samples. Results: The presence of EMVI within the selected cohort was significantly associated with female gender, T3/T4 and N1/N2 post-operative stages, positive lymph nodes, lymph node ratio LNR2 and LNR3 groups, abundant tumor-infiltrating lymphocytes, positive lympho-vascular invasion (LVI), perineural (PNI), and circumferential resection margin (CRM) (p< 0.05 in all tests). Within EMVI+ patients, local recurrences and/or metastases and death outcomes were more frequent events (p= 0.029 andp= 0.035, respectively), while survival analyses revealed that EMVI+ patients had significantly shorter overall survival (OS,p= 0.040) and disease-free survival (DFS,p= 0.028). Concerning LVI, differences in OS between LVI+ and LVI− patients were not statistically significant (p= 0.068), while LVI+ patients had significantly shorter DFS (p= 0.024). Moreover, univariate COX regression analysis demonstrated the negative impact of EMVI on OS (HR: 2.053, 95% CI: 1.015–4.152;p= 0.045) and DFS (HR: 2.106, 95% CI: 1.066–4.870;p= 0.038), which was not the case for LVI + RC patients. Conclusions: The obtained results strongly suggest the significance of separate reporting of EMVI from lympho-vascular invasion, as it is potentially a surrogate marker for adverse prognosis and outcome.
背景/目的：近年来，血管侵犯，尤其是壁外血管侵犯（EMVI），已成为直肠癌（RC）的重要预后参数。预测复发和转移对肿瘤科医生构成重大挑战，他们需要能够预测不良结局的标志物。本研究旨在探讨病理组织学检测到的EMVI在未经治疗的直肠癌中的预后意义及其在单独报告中的重要性。方法：我们研究了2016年1月至2018年6月期间接受根治性切除术的100例未经治疗的RC患者，并进行了5年随访。根据术后手术样本的H&E染色组织学复查，将患者分为EMVI阴性组和EMVI阳性组，每组各50例。结果：在所选队列中，EMVI的存在与女性性别、T3/T4和N1/N2术后分期、阳性淋巴结、淋巴结比率LNR2和LNR3组、丰富的肿瘤浸润淋巴细胞、阳性淋巴血管侵犯（LVI）、神经侵犯（PNI）以及环周切缘（CRM）显著相关（所有检验p<0.05）。在EMVI阳性患者中，局部复发和/或转移以及死亡结局的发生更为频繁（分别为p=0.029和p=0.035），而生存分析显示，EMVI阳性患者的总生存期（OS，p=0.040）和无病生存期（DFS，p=0.028）显著缩短。关于LVI，LVI阳性与LVI阴性患者之间的OS差异无统计学意义（p=0.068），但LVI阳性患者的DFS显著缩短（p=0.024）。此外，单变量COX回归分析表明，EMVI对OS（HR：2.053，95% CI：1.015–4.152；p=0.045）和DFS（HR：2.106，95% CI：1.066–4.870；p=0.038）有负面影响，而LVI阳性RC患者则未显示出这种影响。结论：所得结果强烈表明，将EMVI与淋巴血管侵犯分开报告具有重要意义，因为它可能是预后不良和结局不佳的替代标志物。
肿瘤(癌症)患者之家