Horn A, Dahl O, Morild I
Department of Surgery, Haukeland Hospital, University of Bergen, Norway.
Dis Colon Rectum. 1991 Sep;34(9):798-804. doi: 10.1007/BF02051074.
After radical surgery for rectal adenocarcinoma, the presence of venous and neural invasion of tumor cells was correlated with the pattern of treatment failure, local in the pelvis or distant. Of 128 operation specimens, venous and neural invasion was demonstrated in 22 percent and 32 percent, respectively. A significant decrease of the distant recurrence-free 5-year survival (Kaplan-Meier method) was seen when venous invasion was demonstrated (32.9 percent vs. 84.3 percent; P less than 0.0001), whereas more local failures were registered in patients with neural invasion. The local recurrence-free 5-year survival in patients with neural invasion was 64.3 percent, compared with 81.1 percent when neural invasion was not demonstrated (P = 0.03). Their prognostic value was then studied in a Cox regression model including stage and grade. Neural invasion had the strongest association with local recurrences, whereas venous invasion was found to be the third strongest independent predictor of metastasis, after lymph node status and extent of local tumor infiltration. We conclude that examining for the presence of venous and neural invasion gives reliable prediction of recurrences after radical resection of rectal cancer. Recording of tumor recurrence pattern may lead to a better selection of patients for adjuvant therapy after surgery.
直肠腺癌根治性手术后，肿瘤细胞的静脉和神经侵犯情况与治疗失败模式相关，包括盆腔局部复发或远处转移。在128份手术标本中，静脉侵犯和神经侵犯的发生率分别为22%和32%。当存在静脉侵犯时，远处无复发生存5年率（Kaplan-Meier法）显著降低（32.9%对84.3%；P<0.0001），而神经侵犯患者的局部复发更多。神经侵犯患者的局部无复发生存5年率为64.3%，无神经侵犯时为81.1%（P=0.03）。随后在包含分期和分级的Cox回归模型中研究了它们的预后价值。神经侵犯与局部复发的关联最强，而静脉侵犯是继淋巴结状态和局部肿瘤浸润范围之后，转移的第三强独立预测因素。我们得出结论，检查静脉和神经侵犯情况能可靠预测直肠癌根治性切除术后的复发情况。记录肿瘤复发模式可能有助于更好地选择术后辅助治疗的患者。
