Obstruction is associated with perineural invasion in T3/T4 colon cancer
Obstruction is associated with perineural invasion in T3/T4 colon cancer
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DOI：
10.1111/codi.14655
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发表时间：
2019-08-01
影响因子：
3.4
通讯作者：
Ishihara, S.
中科院分区：
文献类型：
--
作者：
Nozawa, H.;Morikawa, T.;Ishihara, S.
目的围神经浸润（PNI）是多种恶性肿瘤复发和转移的危险因素，导致患者生存期降低。最近的研究表明，梗阻性结肠癌支架置入可增加PNI的发生频率。我们假设包括梗阻在内的机械应力可能与PNI有关。方法回顾性分析496例术前未接受治疗的病理性T3或T4结肠癌患者。数据来源于医学图表和病理结果。采用单因素和多因素分析PNI与其他临床病理因素的关系。结果239例（48%）患者出现PNI。pni阳性肿瘤的梗阻发生率（39%）明显高于pni阴性肿瘤（24%,P = 0.0003）。多因素分析发现梗阻是与PNI相关的重要因素之一（OR 1.68, P = 0.028）。此外，在414例完全切除的无远处转移患者中，PNI是与无复发生存率差相关的独立因素（风险比2.35,P = 0.003）。与PNI阴性和/或非梗阻病例相比，PNI和梗阻共存导致无复发生存率的更大下降。结论：梗阻与PNI相关，导致结肠癌术后复发率增加。
Aim Perineural invasion (PNI) is a risk factor for recurrence and metastasis and consequently leads to decreased survival in patients with various malignancies. Recent studies showed that stent placement in obstructive colon cancer increases the frequency of PNI. We hypothesized that mechanical stress including obstruction itself may be associated with PNI. Method We retrospectively reviewed 496 patients with pathological T3 or T4 colon cancer who did not receive preoperative treatment. Data were collected from medical charts and pathological findings. The relationships between PNI and other clinicopathological factors were analysed using univariate and multivariate analyses. Results PNI was observed in 239 (48%) patients. Obstruction was markedly more frequent in PNI-positive cancer (39%) than in PNI-negative cancer (24%, P = 0.0003). Multivariate analyses identified obstruction as one of the significant factors associated with PNI (OR 1.68, P = 0.028). Moreover, in 414 patients without distant metastasis who underwent complete resection, PNI was an independent factor associated with poor recurrence-free survival (hazard ratio 2.35, P = 0.003). The coexistence of PNI and obstruction resulted in greater decreases in recurrence-free survival than PNI-negative and/or non-obstructive cases. Conclusion Our results suggest that obstruction is associated with PNI and consequently contributes to an increased postoperative recurrence in colon cancer.