Perineural Invasion in pT3N0 Rectal Cancer The Incidence and Its Prognostic Effect
Perineural Invasion in pT3N0 Rectal Cancer The Incidence and Its Prognostic Effect
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DOI：
10.1002/cncr.25620
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发表时间：
2011-04-01
期刊：
影响因子：
6.2
通讯作者：
Cai, Sanjun
中科院分区：
文献类型：
--
作者：
Peng, Junjie;Sheng, Weiqi;Cai, Sanjun
背景：作者的目的是探讨 pT3N0 直肠癌神经周围浸润 (PNI) 的发生率和预后意义。方法：回顾性收集173例pT3N0直肠癌切除标本的病理资料。 PNI 阳性分为 2 组：围绕神经鞘（SS-PNI）和侵入神经鞘（TS-PNI）。将 PNI 阳性率与原始报告中最初记录的 PNI 进行比较。对具有不同 PNI 状态的患者的结果进行研究，并进行多变量分析以确定其预后价值。结果：在本次回顾性分析中，所有病例中 PNI 阳性率为 24.3%，其中 SS-PNI 和 TS-PNI 分别为 11% 和 13.3%，且与淋巴血管侵犯有关。在最初的报告中，只有 7.5% 的患者标本呈 PNI 阳性。 SS-PNI 的检测比 TS-PNI 更容易被遗漏。 SS-PNI 和 TS-PNI 组的局部复发率、无病生存率和 5 年总生存率相似。与 PNI 阴性组相比，PNI 阳性组的 5 年局部复发率高出 2.5 倍以上（分别为 22.7% 和 7.9%；P = .017）。多变量分析证明，PNI 阳性是预测 5 年局部复发率的唯一独立危险因素，而仅采样淋巴结与 5 年无病生存率和总生存率相关。结论：PNI 是直肠癌的常见病理特征。 PNI 的定义应包括 SS-PNI 和 TS-PNI。 PNI 阳性的直肠癌患者局部复发的风险较高，应考虑接受更强化的治疗。癌症2011； 117：1415-21。 (C) 2010 年美国癌症协会。
BACKGROUND: The authors' purpose was to explore the incidence and prognostic significance of perineural invasion (PNI) in pT3N0 rectal cancer. METHODS: Pathologic materials from resected specimens of 173 patients with pT3N0 rectal cancer were retrospectively collected. PNI-positivity was categorized into 2 groups: surrounding the nerve sheath (SS-PNI) and invading through the nerve sheath (TS-PNI). The rate of PNI-positivity was compared with PNI as initially recorded in the original reports. Patients' outcome was studied in groups with different PNI status, and multivariate analysis was performed to determine its prognostic value. RESULTS: In this retrospective analysis, PNI-positivity was found in 24.3% of all cases, in which SS-PNI and TS-PNI were 11% and 13.3%, respectively, and was related to lymphovascular invasion. Only 7.5% of patients' specimens were reported as PNI-positive in the original reports. Detection of SS-PNI was likelier to be missed than TS-PNI. The rates of local recurrence, disease-free survival, and overall survival at 5 years were similar between the groups of SS-PNI and TS-PNI. The 5-year local recurrence rate was more than 2.5-fold higher in the PNI-positive group compared with the PNI-negative group (22.7% vs 7.9%, respectively; P = .017). Multivariate analysis proved that PNI-positivity was the only independent risk factor for predicting 5-year local recurrence rate, whereas only sampled lymph nodes was related to 5-year disease-free survival and overall survival. CONCLUSIONS: PNI is a common pathologic feature in rectal cancer. The definition of PNI should include SS-PNI and TS-PNI. Rectal cancer patients who are PNI-positive are at higher risk of local recurrence and should be considered for more intensive treatment. Cancer 2011; 117: 1415-21. (C) 2010 American Cancer Society.