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Session:: ePosters-Sun800-M2: Colon & Colorectal Cancer

EP219 - Lymphovascular and perineural invasion independently predict survival outcomes in stage III colon cancer

Sunday, May 10, 2026
8:54 AM - 8:59 AM ET

    ePoster Presenter(s)

  • George Q. Zhang, MD, MPH

    Resident
    Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
    Brigham and Women's Hospital, Boston, MA
    Boston, MA, United States

    Disclosure information not submitted.

    • Author(s)

  • Ezra S. Brooks, MD

    Surgery Resident
    Brigham and Women's Hospital
    Brigham and Women’s Hospital
    Brookline, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Nelya Melnitchouk, MD

    Assistant Professor
    Brigham and Women's Hospital
    Harvard Medical School
    Boston, Massachusetts, United States

    Disclosure information not submitted.

  • Jennifer Irani, MD (she/her/hers)

    Assistant Professor of Surgery
    Brigham and Women's Hospital
    Boston, MA, United States

    Disclosure information not submitted.

  • Ronald Bleday, M.D.

    Chief of Colorectal Surgery
    Brigham and Woman's Hospital
    Boston, Massachusetts, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • JG

    Joel E. Goldberg, MD, MPH

    Colorectal Surgeon
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Ezra S. Brooks, MD: This individual has no financial relationships with ineligible companies.
Purpose/Background: Lymphovascular invasion (LVI) and perineural invasion (PNI) are well-recognized adverse histopathologic factors in resected colon cancer. Previous studies among patients with stage II colon have demonstrated that pathologic LVI and PNI are associated with worsened survival and therefore warrant consideration of adjuvant chemotherapy; however, their prognostic role in resected stage III colon cancer, for which adjuvant doublet chemotherapy is standard of care, is less understood.

Methods/Interventions: We evaluated the independent association of LVI and PNI with longitudinal survival among patients with stage III colon cancer. This was a retrospective cohort study using the National Cancer Database (2004-2018). Patients with stage III adenocarcinoma of the colon who underwent curative resection followed by adjuvant chemotherapy were included and stratified by pathologic LVI and PNI status (positive vs. negative) in a 2x2 fashion. Overall survival (OS) was estimated using Kaplan-Meier analysis and multivariable Cox proportional hazard models to adjust for baseline clinicopathologic factors. A multiplicative interaction model with likelihood ratio test was used to evaluate the effect modification of LVI and PNI on OS.

Results/Outcomes: In total, 50648 patients with stage III colon cancer were included (median follow-up = 5.8 years), of whom 46.1% were LVI-/PNI-, 35.5% were LVI+/PNI-, 4.3% were LVI-/PNI+, and 14.1% were LVI+/PNI+. Five-year mortality for the overall cohort was 23.9% (N=12094/50648). Among patients with pathologic LVI-/PNI- and LVI+/PNI+, 5-year mortality was 23.9% and 33.7%, respectively (Figure). Adjusting for baseline characteristics, patients with LVI+/PNI+ tumors had the worst prognosis (reference: LVI-/PNI-, adjusted hazard ratio [HR]=1.52, 95% confidence interval [CI] 1.42-1.61, p< 0.001). Patients with a singular pathologic risk factor (LVI+/PNI- and LVI-/PNI+) had worsened prognosis compared to those with LVI-/PNI- tumors (adjusted HR=1.21 [1.15-1.28]; adjusted HR=1.31 [1.18-1.46]; respectively). The interaction between LVI and PNI status was not statistically significant (P=0.416).

Conclusion/Discussion: Among patients with resected stage III colon cancer, both pathologic LVI and PNI were independently associated worsened survival. The absence of an interaction effect suggest that they are additive, rather than synergistic effects. Further studies are needed to evaluate whether escalation of adjuvant therapy is indicated for individuals with high-risk pathologic factors outside of traditional TNM staging.

Figure. Overall survival by pathologic LVI and PNI status among patients with resected stage III colon cancer.
Data cutoff occurred at 6 years after surgery. Abbreviations: LVI, lymphovascular invasion; PNI, perineural invasion.