Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma.
Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma.
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DOI：
10.1097/pas.0b013e31824104c5
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
Wang H
中科院分区：
文献类型：
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作者：
Chatterjee D;Katz MH;Rashid A;Wang H;Iuga AC;Varadhachary GR;Wolff RA;Lee JE;Pisters PW;Crane CH;Gomez HF;Abbruzzese JL;Fleming JB;Wang H
神经周围浸润（PNI）是胰管腺癌（PDAC）的预后因素之一。然而，PNI在接受新辅助治疗和胰十二指肠切除术（PD）的PDAC患者中的预后意义尚不清楚。在这项研究中，我们对1999年1月至2007年12月在我院接受新辅助放化疗的212例PDAC患者（治疗组）和60例未经治疗的PD标本进行了神经侵犯的详细检查。PNI发生率未治疗组（80%,48/60）高于治疗组（58%,123/212）。在123例PNI阳性的治疗病例中，分别有86例（69.9%）、37例（30.1%）、11例（8.9%）、112例（91.1%）和35例（28.5%）发现肿瘤外PNI、肿瘤内PNI、胰腺内PNI、胰腺外PNI和神经内侵犯。治疗组PNI的存在与肿瘤大小、切缘状态、淋巴结转移、病理肿瘤及AJCC分期相关。与累及≤0.8 mm神经的PNI相比，肿瘤累及>0.8 mm的神经与更高的阳性切缘频率相关，但与其他临床病理参数和生存率无关。在治疗组中，与没有PNI或只有PNI的患者相比，PNI或神经内侵袭的存在与更短的无病生存期（DFS）和总生存期（OS）显著相关。在多变量分析中，PNI是DFS和OS的独立预后因素。我们的研究结果表明，PNI在PDAC的进展和预测该组患者的预后中起着重要作用。
Perineural invasion (PNI) is one of the established prognostic factors in pancreatic ductal adenocarcinoma (PDAC). However, the prognostic significance of PNI in patients with PDAC who received neoadjuvant therapy and pancreaticoduodenectomy (PD) is not clear. In this study, we performed detailed examination of neural invasion in PD specimens from 212 patients with PDAC who received neoadjuvant chemoradiation (treated group) and 60 untreated patients at our institution between January 1999 and December 2007. The frequency of PNI was higher in untreated group (80%, 48/60) than the treated group (58%, 123/212). For the 123 treated cases that were positive for PNI, extra-tumoral PNI, intra-tumoral PNI, intra-pancreatic PNI only, extra-pancreatic PNI, and intra-neural invasion were identified in 86 (69.9%), 37 (30.1%), 11 (8.9%), 112 (91.1%), and 35 (28.5%) respectively. Presence of PNI correlated with tumor size, margin status, lymph node metastasis, pathologic tumor and AJCC stages in the treated group. Tumor involvement of nerves >0.8 mm correlated with higher frequency of positive margin compared to those with PNI involving nerves ≤0.8 mm, but not with other clinicopathologic parameters and survival. In treated group, the presence of PNI or intra-neural invasion correlated significantly with shorter disease-free survival (DFS) and overall survival (OS) compared to those with no PNI or PNI only respectively. PNI was an independent prognostic factor for both DFS and OS in multivariate analysis. Our results showed that PNI plays an important role in the progression of PDAC and in predicting the prognosis in this group of patients.