Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, USA.
Gynecol Oncol. 2011 Dec;123(3):561-4. doi: 10.1016/j.ygyno.2011.08.028. Epub 2011 Oct 2.
Cervical cancer spreads directly and through lymphatic and vascular channels. Perineural invasion is an alternative method of spread. Several risk factors portend poor prognosis and inform management decisions regarding adjuvant therapy.
To evaluate the incidence and significance of PNI in early cervical cancer.
Retrospective chart review of early-stage cervical cancer patients (IA-IIA) from 1994 to 2009.
One hundred ninety two patients were included, 24 with perineural invasion in the cervical stroma (cases) and 168 without (controls). The mean age of the cases was 53 years, versus 45.9 in the controls (P=0.01). PNI was associated with more adjuvant therapy (P=0.0001), a higher stage (P=0.005), a larger tumor size (≥ 4 cm) (P<0.0001), lymphovascular space invasion (P=0.002), parametrial invasion (P<0.0001) and more tumor extension to the uterus (P=0.015). On multivariate analysis using an adjusted hazard ratio, risk factors for recurrence included grade (HR, 95% CI; 3.61, 1.38-9.41) and histopathology (HR, 95% CI; 2.85, 100-8.09). Similarly, risk factors for death included grade (HR, 95% CI; 3.43, 1.24-9.49) and histopathology (HR, 95% CI; 3.71, 1.03-13.33). Perineural invasion was not identified as an independent risk factor for either recurrence or death. The mean follow up time was 56 months. There was no significant difference in recurrence (P=0.601) or over-all survival (P=0.529) between cases and controls.
While perineural invasion was found to be associated with multiple high-risk factors, it was not found to be associated with a worse prognosis in early cervical cancer.
宫颈癌直接通过淋巴和血管通道扩散。神经周围侵犯是一种替代的扩散方式。一些危险因素预示着不良预后，并为辅助治疗的管理决策提供信息。
评估早期宫颈癌中 PNI 的发生率和意义。
回顾性分析 1994 年至 2009 年早期宫颈癌患者（IA-IIA）的病历。
共纳入 192 例患者，其中 24 例宫颈间质存在神经周围侵犯（病例组），168 例无神经周围侵犯（对照组）。病例组的平均年龄为 53 岁，对照组为 45.9 岁（P=0.01）。PNI 与更多的辅助治疗（P=0.0001）、更高的分期（P=0.005）、更大的肿瘤大小（≥4cm）（P<0.0001）、淋巴血管间隙侵犯（P=0.002）、宫旁侵犯（P<0.0001）和更多的子宫侵犯（P=0.015）相关。多变量分析采用调整后的风险比，复发的危险因素包括分级（HR，95%CI；3.61，1.38-9.41）和组织病理学（HR，95%CI；2.85，100-8.09）。同样，死亡的危险因素包括分级（HR，95%CI；3.43，1.24-9.49）和组织病理学（HR，95%CI；3.71，1.03-13.33）。神经周围侵犯未被确定为复发或死亡的独立危险因素。平均随访时间为 56 个月。病例组与对照组在复发（P=0.601）或总生存（P=0.529）方面无显著差异。
虽然神经周围侵犯与多种高危因素相关，但在早期宫颈癌中与不良预后无关。
