Prognostic value of lymphovascular invasion and CEA for cancer-specific survival in octogenarian colorectal cancer patients

OBJECTIVE: To investigate the prognostic value of lymphovascular invasion (LVI) and preoperative carcinoembryonic antigen (CEA) level for cancer-specific survival (CSS) in octogenarian (≥ 80 years) colorectal cancer (CRC) patients, and to explore the modifying effects of tumor laterality and histological subtype on this prognostic value. METHODS: This retrospective cohort study enrolled 214 octogenarian CRC patients and 214 age-matched younger patients (50-79 years) as controls. The associations between LVI/CEA status and clinicopathological characteristics were analyzed. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate prognostic impacts, with subgroup analyses by tumor laterality and histological subtype. RESULTS: Octogenarian patients had higher rates of LVI positivity (38.3% vs. 29.9%, P = 0.042) and elevated CEA (41.1% vs. 32.7%, P = 0.038) than younger patients, with a lower 5-year CSS rate (52.3% vs. 68.7%, P < 0.001). LVI positivity (HR = 2.14, 95% CI = 1.57-2.91, P < 0.001) and elevated CEA (HR = 1.87, 95% CI = 1.35-2.59, P < 0.001) were independent prognostic factors for worse CSS in octogenarians, with more pronounced adverse effects in right-sided colon cancer and adenocarcinoma subtypes. CONCLUSION: LVI positivity and elevated preoperative CEA levels are independent prognostic factors for poor CSS in octogenarian CRC patients. Their prognostic impact varies by tumor laterality and histological subtype, highlighting the need for personalized risk stratification in this population.