Elastica staining for venous invasion results in superior prediction of cancer-specific survival in colorectal cancer.

Abstract

OBJECTIVE:

To examine the prognostic implications of routine elastica staining for venous invasion on prediction of cancer-specific survival in colorectal cancer.

SUMMARY BACKGROUND DATA:

Venous invasion is an important high risk feature in colorectal cancer, although prevalence in published studies ranges from 10% to 90%. To resolve the disparity, elastica stains have been used in our institution to provide a more objective judgment since 2002.

METHODS:

The study included 419 patients undergoing curative elective colorectal cancer resection between 1997 and 2006. Patients were grouped prior to (1997-2001 [cohort 1]) and following the introduction of elastica staining (2003-2006 [cohort 2]).

FINDINGS:

Clinicopathologic characteristics and 3-year survival rates were similar in both groups. Rate of detected venous invasion increased from 18% to 58% following introduction of elastica staining (P < 0.001). The 3-year cancer-specific survival rate associated with the absence of venous invasion was 84% in cohort 1, compared with 96% in cohort 2 (P < 0.01). Elastica staining improved the prognostic value of venous invasion, showing the area under the receiver operator curve rising from 0.59 (P = 0.040; 1997-2001) to 0.68 (P < 0.001; 2003-2006), using cancer mortality as an end point. A direct comparison between H&E alone and elastica Hematoxylin and Eosin (H&E) was made in 53 patients. The area under the receiver operator curve increased from 0.58, P = 0.293 (H&E alone) to 0.74, P = 0.003 for venous invasion detected using the elastica method.

CONCLUSIONS:

Increased detection of venous invasion with elastica staining, compared with H&E staining, provides superior prediction of cancer survival in colorectal cancer. This relationship was seen in the comparison of 2 consecutive cohorts and in a direct comparison in a single cohort. Based on these results, elastica staining should be incorporated into the routine pathologic assessment of venous invasion in colorectal cancer.

• Authors: Campbell S D Roxburgh, Donald C McMillan, John H Anderson, Ruth F McKee, Paul G Horgan, Alan K Foulis
• Journal: Annals of surgery (Ann Surg) Vol. 252 Issue 6 Pg. 989-97 (Dec 2010) ISSN: 1528-1140 [Electronic] United States
• PMID: 21107109 (Publication Type: Journal Article)

Chemical References

• Coloring Agents
• Rubber

Topics

• Aged
• Colorectal Neoplasms (mortality, pathology)
• Coloring Agents
• Female
• Humans
• Male
• Neoplasm Invasiveness (diagnosis)
• Predictive Value of Tests
• Prognosis
• Rubber (analysis)
• Survival Analysis
• Veins (pathology)