Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma
Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma
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神经周围浸润是比淋巴管浸润更好的预后指标，也是 pN0M0 食管鳞状细胞癌的潜在辅助治疗指标
DOI：
10.1245/s10434-020-08667-4
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发表时间：
2020-10-01
影响因子：
3.7
通讯作者：
Su, Min
中科院分区：
文献类型：
--
作者：
Guo, Yuan-ning;Tian, Dong-ping;Su, Min
背景资料。PN0M0的食管鳞状细胞癌比有淋巴结转移和远处转移的食管鳞癌具有更强的局部侵袭性和播散性。神经周围侵袭(PNI)被认为是癌症预后不良的因素，被认为与肿瘤的局部扩散和转移有关。然而，其在pN0M0ESCC中的临床病理作用和治疗意义尚不清楚。应用免疫组织化学方法对pN0M0ESCC患者的肿瘤组织进行PNI和淋巴血管侵袭(LI、VI)评分。应用ROC分析、Kaplan-Meier分析、Cox回归和v2检验进行生存分析，比较PNI与LI和VI的相关性，并探讨PNI与其他临床病理特征的相关性。在pN0M0患者中，PNI的存在与生存不良显著相关，而LI和VI不能预测预后(P>；0.05)。神经侵袭指数(NII)是衡量肿瘤侵袭神经数的最一致指标(P=0.006，HR=6.892，1.731~27.428)。术后放疗显著提高了高NII期患者的生存率(P=0.035，HR=0.390，0.163~0.936)。PNI是影响pN0M0 ESCC患者预后的重要危险因素。NII可用于风险评估和在该人群中定制辅助放射治疗。
Background. Esophageal squamous cell carcinoma (ESCC) at pN0M0 can be more locally aggressive and disseminated than those with lymph node and distant metastasis. Perineural invasion (PNI) is reported as a poor prognostic factor in cancer and is thought to be related to regional tumor spread and metastasis. However, its clinicopathological role and meaning for treatment in pN0M0 ESCC are unknown.Patients and Methods. We applied scoring methods of PNI and lymphatic and vascular invasion (LI, VI) based on immunohistochemistry staining on tumor tissues of pN0M0 ESCC patients. ROC analyses, Kaplan-Meier analyses, Cox regression, and v2 test were performed for survival analysis, comparison of PNI with LI and VI, and exploration of the relevance between PNI and other clinicopathological features.Results. Presence of PNI was significantly associated with poor survival in pN0M0 patients, whereas LI and VI were not predictive of outcome (P > 0.05). Neural invasion index (NII), defined as the ratio of the number of tumorinvaded nerves to the total number of nerves per tumor microsection, was the most consistent measure of PNI (P = 0.006, HR = 6.892, 1.731-27.428). Postoperative radiotherapy significantly improved survival in high-NII patients (P = 0.035, HR = 0.390, 0.163-0.936).Conclusions. PNI is an important risk factor for the outcome of pN0M0 ESCC patients. NII can be used for risk assessment and to tailor adjuvant radiotherapy in this population.