A novel classification system for perineural invasion in noncutaneous head and neck squamous cell carcinoma: histologic subcategories and patient outcomes
A novel classification system for perineural invasion in noncutaneous head and neck squamous cell carcinoma: histologic subcategories and patient outcomes
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DOI：
10.1016/j.amjoto.2011.06.003
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发表时间：
2012-03-01
影响因子：
2.5
通讯作者：
Lai, Chi K.
中科院分区：
文献类型：
--
作者：
Miller, Mia E.;Palla, Beth;Lai, Chi K.
目的：本研究的目的是定义一种新的肿瘤神经周围浸润（PNI）分类系统，该系统与肿瘤/神经受累有关，例如肿瘤内（IT）、外周或肿瘤外（ET），并确定这些组织学亚类中的每一个在非皮肤头颈部鳞状细胞癌（HNSCC）患者中的预后意义。本研究是一项回顾性图表审查和组织学分析的患者与HNSCC的设置在三级医疗中心。方法：对2004年1月至2007年12月接受初次手术治疗的142例HNSCC患者进行了临床病历审查。收集的临床信息包括患者年龄、性别、酒精和烟草使用、肿瘤位置、TNM分期、术后辅助化疗和/或放疗以及患者结局。对每例患者，测量PNI密度、每个PNI病灶到肿瘤边缘的距离以及受累最大神经的大小。此外，PNI被细分为IT、外周或ET。进行考克斯回归分析以确定PNI是否与局部疾病复发相关。结果：142例患者中，37例（26%）有疾病进展。在多变量分析中，PNI的最大程度与无病生存率显著相关（P = 0.019），并且当T分期（P = 0.017）、N分期（P = 0.021）以及T和N分期（P = 0.02）加入到考克斯回归模型中时，PNI的最大程度与无病生存率也显著相关。Kaplan-Meier分析显示，与ET PNI相比，PNI阴性和IT/外周PNI的无病生存率有增加的趋势。结论：神经周围浸润与淋巴结状态和T分期相关，与无病生存率相关。它可以细分为IT、外设或ET。这种新的分类系统对临床结果有重要意义，并可能有助于确定可能需要更积极管理的患者队列。爱思唯尔公司出版
Objective: The aims of this study were to define a novel classification system of tumor perineural invasion (PNI) with respect to tumor/nerve involvement such as intratumoral (IT), peripheral, or extratumoral (ET) and to determine the prognostic significance of each of these histologic subcategories in patients with noncutaneous head and neck squamous cell carcinoma (HNSCC).Study design: This study is a retrospective chart review and histologic analysis of patients with HNSCC in the setting of a tertiary care medical center.Methods: A clinical chart review of 142 patients with HNSCC who underwent primary surgical treatment from January 2004 through December 2007 was performed. Clinical information collected included patient age, sex, alcohol and tobacco use, tumor location, TNM stage, postoperative adjuvant chemotherapy and/or radiation treatment, and patient outcome. For each case, PNI density, the distance of each PNI focus to the tumor edge, and size of the largest nerve involved were measured. Furthermore, PNI was subcategorized as IT, peripheral, or ET. A Cox regression analysis was performed to determine if PNI was related to regional disease recurrence. Kaplan-Meier survival analysis was also performed.Results: Among the 142 patients, 37 (26%) had disease progression. The maximum extent of PNI was significantly correlated with disease-free survival on multivariate analysis (P = .019) and was also significantly related to disease-free survival when T stage (P = .017), N stage (P = .021), and T and N stages (P = .02) were added to the Cox regression model. Kaplan-Meier analysis demonstrated a trend toward increased disease-free survival of PNI negative and IT/peripheral PNI compared with ET PNI.Conclusion: Perineural invasion is correlated with nodal status and T stage and is related to disease-free survival. It can be subcategorized as IT, peripheral, or ET. This novel classification system has important implications with regard to clinical outcome and may help define a cohort of patients that may require more aggressive management. Published by Elsevier Inc.