National Cancer Center Hospital, Tokyo, Japan.
Pancreas. 2011 Apr;40(3):464-8. doi: 10.1097/MPA.0b013e31820b5d37.
Neural invasion is a distinct route for the spread of pancreatic carcinoma. However, the clinicopathologic significance of neural invasion, with particular reference to intrapancreatic nerve invasion, remains to be elucidated.
One hundred fifty-three patients who underwent pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas between 2004 and 2008 were retrospectively examined. The clinical and histopathologic factors, including intrapancreatic nerve invasion, were analyzed in these patients. The relationships between the degree of intrapancreatic nerve invasion and disease-free survival, as well as various histopathologic factors, were investigated.
There were significant differences in the degree of intrapancreatic nerve invasion with regard to disease-free survival (P < 0.001). A lack of lymph node metastases (P = 0.001), lower incidence of intrapancreatic nerve invasion (P = 0.001), and negative surgical margin (P = 0.011) significantly increased the disease-free survival. The tumor stage was not associated with intrapancreatic nerve invasion (P = 0.255). However, a larger tumor size (P = 0.024), a higher incidence of lymphatic invasion (P = 0.036), and the presence of extrapancreatic nerve plexus invasion (P < 0.001) were identified as independent factors associated with a higher incidence of intrapancreatic nerve invasion.
Intrapancreatic nerve invasion may be useful as a predictor for recurrence after pancreaticoduodenectomy in patients with invasive ductal carcinoma of the pancreas.
神经侵犯是胰腺癌扩散的一种独特途径。然而，神经侵犯的临床病理意义，特别是胰内神经侵犯，仍有待阐明。
回顾性分析 2004 年至 2008 年间行胰十二指肠切除术的 153 例浸润性导管胰腺癌患者的临床和组织病理学因素，包括胰内神经侵犯。研究胰内神经侵犯的程度与无病生存的关系，以及与各种组织病理学因素的关系。
无病生存与胰内神经侵犯的程度有显著差异（P<0.001）。无淋巴结转移（P=0.001）、胰内神经侵犯发生率较低（P=0.001）和阴性手术切缘（P=0.011）显著增加了无病生存。肿瘤分期与胰内神经侵犯无关（P=0.255）。然而，肿瘤较大（P=0.024）、淋巴管侵犯发生率较高（P=0.036）和存在胰外神经丛侵犯（P<0.001）被确定为与胰内神经侵犯发生率较高相关的独立因素。
胰内神经侵犯可能是预测浸润性导管胰腺癌患者胰十二指肠切除术后复发的有用指标。
