Multifocal extramural venous invasion is a powerful predictor of adverse oncological outcomes in stages I– <scp>III</scp> colorectal cancer
Bibliographic record
Abstract
AIMS: This study aimed to determine the impact of venous invasion (VI) characteristics on oncological outcomes in colorectal cancer (CRC). METHODS AND RESULTS: Resection specimens from 368 patients with TNM stages I-III CRC were assessed for VI including its presence/absence, location [intramural (IMVI) or extramural (EMVI)], number and size of the largest VI focus. VI and EMVI were identified in 55% and 32% of cases, respectively. EMVI, but not IMVI, was significantly associated with decreased 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) (hazard ratio [HR] 4.2, 95% confidence interval CI [2.6-6.9] and 3.7 [95% CI 1.9-6.9], p < 0.0001, respectively). Multifocal EMVI (mEMVI), defined as 2 or more EMVI foci, was identified in 67% of EMVI-positive cases. In multivariable analysis, EMVI (HR 2.4 [95% CI 1.3-4.3], P = 0.003) and mEMVI (HR 2.4 [95% CI: 1.3-4.4], P = 0.02) were independently associated with RFS and demonstrated stronger associations than all other examined features, including T and N stage. These associations were maintained when the cohort was expanded to include 113 patients who received neoadjuvant therapy in addition to the original 368 patients who had not ('expanded cohort', n = 481). An increasing number of EMVI foci was significantly associated with decreased RFS and DSS (P < 0.0001). Patients with >5 EMVI foci (n = 31) had a particularly poor prognosis with 5-year RFS and DSS of 29% and 56%, respectively. EMVI dimensions were not associated with oncological outcomes. CONCLUSIONS: Extramural location and multifocality are features of VI strongly associated with adverse oncological outcomes. If externally validated, incorporation of EMVI multifocality into future reporting protocols merits consideration.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".