II期和III期结直肠癌中神经周围侵犯的临床意义。

Clinical significance of perineural invasion in stages II and III colorectal cancer.

作者信息

Zhou Yi, Wang Hongyan, Gong Huilin, Cao Meng, Zhang Guanjun, Wang Yili

机构信息

Institute for Cancer Research, Health Science Center of Xi'an Jiaotong University, Xi'an, China; Department of Pathology, Xi'an Medical University, Xi'an, China.

Department of Pathology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

出版信息

Pathol Res Pract. 2015 Nov;211(11):839-44. doi: 10.1016/j.prp.2015.09.001. Epub 2015 Sep 4.

DOI:10.1016/j.prp.2015.09.001

PMID:26429129

Abstract

PURPOSE

This study aimed to determine the prognostic value of perineural invasion (PNI) in patients with colorectal cancer (CRC), particularly patients with TNM stage II and stage III.

METHODS

A total of 159 CRC patients who had undergone radical resection were retrospectively analyzed. Histopathological evaluation of tissue samples was conducted on hematoxylin and eosin-stained sections. PNI was considered positive when cancer cells were observed inside the nerve sheath, or when at least 33% of the nerve periphery was surrounded by cancer cells. A 3-tier grading system (PNI0, PNI1, PNI2) based on the depth of PNI was used to assess the localization of PNI in the bowel. PNI and other prognostic factors were evaluated by survival analysis.

RESULTS

PNI status in CRC significantly affected postoperative overall survival (P<0.001). The five-year survival rates for PNI-negative and PNI-positive patients were 77% and 32%, respectively. PNI was closely correlated with tumor gross type, tumor grade, depth of invasion, lymph node metastasis, clinical stage, vessel invasion, tumor budding grade, and tumor growth pattern. Multivariate analysis revealed that PNI was an independent prognostic factor (HR=2.223, P=0.003). The survival of PNI-positive patients was significantly poorer than that of PNI-negative patients in stages II and III (P=0.003 and P=0.008, respectively). The overall survival of colorectal patients was in the descending order of PNI-negative at stage II, PNI-positive at stage II/PNI-negative at stage III, and PNI-positive at stage III (P<0.001). When the PNI status and T stage were considered together, overall survival curves of the PNI2 patients were significantly worse than those of PNI1 patients in pT4 stage (P=0.019).

CONCLUSIONS

PNI is a poor independent prognostic factor for CRC. It could complement classic TNM staging classification in stratifying CRC patients in stages II and III. Assessment of the site-specific distribution of PNI may further enhance the impact of PNI contribution to the prognosis of CRC.

摘要

目的

本研究旨在确定神经周围侵犯（PNI）在结直肠癌（CRC）患者中的预后价值，尤其是TNM分期为II期和III期的患者。

方法

回顾性分析159例接受根治性切除的CRC患者。对苏木精和伊红染色切片进行组织样本的组织病理学评估。当在神经鞘内观察到癌细胞，或至少33%的神经周围被癌细胞包围时，PNI被视为阳性。基于PNI深度的三级分级系统（PNI0、PNI1、PNI2）用于评估PNI在肠内的定位。通过生存分析评估PNI和其他预后因素。

结果

CRC中的PNI状态显著影响术后总生存期（P<0.001）。PNI阴性和阳性患者的五年生存率分别为77%和32%。PNI与肿瘤大体类型、肿瘤分级、浸润深度、淋巴结转移、临床分期、血管侵犯、肿瘤芽生分级和肿瘤生长模式密切相关。多因素分析显示PNI是一个独立的预后因素（HR=2.223，P=0.003）。在II期和III期，PNI阳性患者的生存率显著低于PNI阴性患者（分别为P=0.003和P=0.008）。结直肠癌患者的总生存期按以下顺序递减：II期PNI阴性、II期PNI阳性/III期PNI阴性、III期PNI阳性（P<0.001）。当同时考虑PNI状态和T分期时，在pT4期，PNI2患者的总生存曲线显著差于PNI1患者（P=0.019）。