Impact of perineural invasion on survival in node negative colon cancer
Impact of perineural invasion on survival in node negative colon cancer
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DOI：
10.1080/15384047.2017.1323602
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发表时间：
2017-01-01
影响因子：
3.6
通讯作者：
Messaris, Evangelos
中科院分区：
文献类型：
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作者：
Mirkin, Katelin A.;Hollenbeak, Christopher S.;Messaris, Evangelos
在许多癌症中，神经周围侵袭(PNI)被认为是一个预后不良的指标。国家综合癌症网络建议考虑在早期结肠癌患者中观察或辅助治疗PNI。这些建议是基于单一机构的研究，这些研究未能在辅助化疗的背景下评估PNI。回顾了美国国家癌症数据库(2004-2012)中结节阴性的结肠癌患者，并按PNI和接受化疗进行分层。在21,488名患者中，55.2%的患者患有T3疾病(n=11,852)，23.1%的患者患有T2疾病(n=4,971)，14.4%的患者患有T1(n=3,088)，7.3%的患者患有T4疾病(n=1,577)；4.6%(n=987)的患者患有PNI。大多数患者(86.8%，n=18,641)未发生PNI而未接受化疗，8.7%(n=1,860)未发生PNI但接受化疗，3.7%(n=785)PNI未接受化疗，0.9%(n=202)有PNI并接受化疗。在PNI患者中，接受化疗的患者往往更年轻(P<；0.001)，私人保险覆盖(P<；0.001)，合并症较少(P<；0.001)，T期疾病较多(P<；0.001)。与未接受化疗的患者相比，接受化疗的患者存活率显著提高(P<；0.001)，但在T1-2患者中并非如此。多变量分析显示，肺感染患者的死亡率高38%(HR1.38，P<；0.001)。此外，化疗使死亡率降低了43%(HR0.57，P<；0.001)。PNI似乎是T3-4期结肠癌预后不良的独立指标。对这类患者实施化疗与提高存活率有关。
Perineural invasion (PNI) has been implicated as a poor prognostic indicator in many cancers. The National Comprehensive Cancer Network recommends consideration of observation or adjuvant therapy in the presence of PNI in early colon cancer. These recommendations are based on single institutional studies that fail to evaluate PNI within the context of adjuvant chemotherapy. The US National Cancer Database (2004-2012) was reviewed for patients with node negative colon cancer, and stratified by PNI and receipt of chemotherapy.Of 21,488 patients evaluated, 55.2% had T3 disease (n = 11,852), 23.1% had T2 (n = 4,971), 14.4% had T1 (n = 3,088), and 7.3% had T4 disease (n = 1,577); 4.6% (n = 987) had PNI. Most patients (86.8%, n = 18,641) did not have PNI and did not receive chemotherapy; 8.7% (n = 1,860) did not have PNI but received chemotherapy; 3.7% (n = 785) had PNI and did not receive chemotherapy, and 0.9% (n = 202) had PNI and received chemotherapy. Among those with PNI, patients who received chemotherapy tended to be younger (P < 0.001), covered by private insurance (P < 0.001), with fewer comorbidities (P < 0.001), and greater T stage disease (P < 0.001). Those with PNI who received chemotherapy had significantly improved survival over those who did not in T3-4 disease (P < 0.001), but not in T1-2 disease. On multivariate analysis, those with PNI had a 38% greater hazard of mortality (HR 1.38, P < 0.001). Additionally, chemotherapy decreased the hazard of mortality by 43% (HR 0.57, P < 0.001). PNI appears to be an independent poor prognostic indicator in stage T3-4 node negative colon cancer. Chemotherapy administered to this patient population is associated with improved survival.