Prognostic Significance of Lymphovascular Invasion Detected by D2-40 in Low-Risk Stage II Colon Cancer

Background Lymphovascular invasion (LVI) is included in the criteria of high-risk stage II colon cancer. However, there are limitations to detecting LVI by routine hematoxylin and eosin (H&E) staining. Alternatively, immunohistochemistry (IHC) for the lymphatic endothelial marker D2-40 may help detect LVI, but its prognostic significance remains unknown. This study aimed to evaluate the prognostic significance of LVI, detected by IHC for D2-40, in low-risk stage II colon cancer. Materials and Methods A total of 69 patients with low-risk stage II colon cancer were tested for D2-40 to assess LVI. Then, the relationships between IHC-detected LVI and clinical outcomes, including disease-free survival (DFS) and overall survival (OS), were analyzed using both univariate and multivariate analyses. Results IHC for D2-40 revealed that 24 out of the 69 cases (34.78%) had LVI-positive tumors. IHC-detected LVI was significantly associated with adverse clinical outcomes on univariate analysis, i.e., both reduced DFS (P = 0.002) and OS (P = 0.0163). In multivariate analysis, controlling for age, IHC-detected LVI remained a significant predictor of reduced DFS with a hazard ratio (HR) of 3.37 and a 95% confidence interval (CI) of 1.39-8.15 (P = 0.007) and OS (HR, 5.66; 95% CI, 1.02-31.51; P = 0.048). Conclusions Our results demonstrated that IHC analysis for D2-40 enhanced LVI detection in patients with low-risk stage II colon cancer and that cases with a missed diagnosis of LVI by routine H&E staining had adverse clinical outcomes, that is, reduced DFS and OS.