Perineural Invasion Is a Strong Prognostic Factor in Colorectal Cancer A Systematic Review
Perineural Invasion Is a Strong Prognostic Factor in Colorectal Cancer A Systematic Review
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DOI：
10.1097/pas.0000000000000518
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发表时间：
2016-01-01
影响因子：
5.6
通讯作者：
Nagtegaal, Iris D.
中科院分区：
文献类型：
--
作者：
Knijn, Nikki;Mogk, Stephanie C.;Nagtegaal, Iris D.
神经周围浸润（PNI）是各种癌症类型（包括结直肠癌（CRC））转移扩散的可能途径。PNI与不良预后有关，但缺乏系统的分析。本研究系统地回顾了PNI在CRC中的频率和影响。使用PubMed数据库进行了从开始到2014年1月1日的文献检索。使用Review Manager 5.3分析数据。质量评估的基础上进行修改的REMARK标准。终点为局部复发（LR）、5年无病生存（5 yDFS）、5年癌症特异性生存（5 yCSS）和5年总生存（5 yOS）。采用风险比（RR）和风险比（HR）及95%置信区间（95% CI）进行荟萃分析。在这项荟萃分析中，纳入了58篇文章，22，900例患者。PNI在18.2%的肿瘤中存在。PNI与LR增加（RR 3.22，95% CI，2.33-4.44）和5 yDFS（RR 2.35，95% CI，1.66-3.31）、5 yCSS（RR 3.61，95% CI，2.76-4.72）和5 yOS（RR 2.09，95% CI，1.68-2.61）降低相关。在多变量分析中，PNI仍然是5 yDFS、5 yCSS和5 yOS的独立预后因素（分别为HR 2.35，95% CI，1.97-3.08; HR 1.91，95% CI，1.50-2.42; HR 1.85，95% CI，1.63-2.12）。我们证实了PNI对LR和CRC生存率的强烈影响。PNI的预后价值与浸润深度、分化程度、淋巴结转移、淋巴管和壁外血管浸润等公认的预后因素相似。因此，PNI应该是CRC标准化报告的因素之一，并可能被视为高风险特征。
Perineural invasion (PNI) is a possible route for metastatic spread in various cancer types, including colorectal cancer (CRC). PNI is linked to poor prognosis, but systematic analyses are lacking. This study systematically reviews the frequency and impact of PNI in CRC. A literature search was performed using PubMed database from inception to January 1, 2014. Data were analyzed using Review Manager 5.3. A quality assessment was performed on the basis of modified REMARK criteria. Endpoints were local recurrence (LR), 5-year disease-free survival (5yDFS), 5-year cancer-specific survival (5yCSS), and 5-year overall survival (5yOS). Meta-analysis was performed in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). In this meta-analysis, 58 articles with 22,900 patients were included. PNI was present in 18.2% of tumors. PNI is correlated with increased LR (RR 3.22, 95% CI, 2.33-4.44) and decreased 5yDFS (RR 2.35, 95% CI, 1.66-3.31), 5yCSS (RR 3.61, 95% CI, 2.76-4.72), and 5yOS (RR 2.09, 95% CI, 1.68-2.61). In multivariate analysis PNI remains an independent prognostic factor for 5yDFS, 5yCSS, and 5yOS (HR 2.35, 95% CI, 1.97-3.08; HR 1.91, 95% CI, 1.50-2.42; and HR 1.85, 95% CI, 1.63-2.12, respectively). We confirmed the strong impact of PNI for LR and survival in CRC. The prognostic value of PNI is similar to that of well-established prognostic factors as depth of invasion, differentiation grade, lymph node metastases, and lymphatic and extramural vascular invasion. Therefore, PNI should be one of the factors in the standardized reporting of CRC and might be considered a high-risk feature.