Kraus Ryan Douglas, Barsky Andrew, Ji Lingyun, Garcia Santos Patricia Mae, Cheng Nathan, Groshen Susan, Vapiwala Neha, Ballas Leslie K
University of Southern California, Keck School of Medicine, Department of Radiation Oncology, Los Angeles, California.
Perelman School of Medicine, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2018 Sep 19;4(1):96-102. doi: 10.1016/j.adro.2018.09.006. eCollection 2019 Jan-Mar.
Perineural invasion (PNI) is a histologic feature that is present in as many as 84% of patients with prostate cancer. The prognostic significance of PNI is controversial, with recent studies yielding contradictory results. This study aims to assess whether PNI, on the surgical pathology of patients with pT2N0M0 disease and with negative surgical margins, is an independent prognostic indicator of the risk of biochemical recurrence.
We identified 1549 patients who received a diagnosis of margin-negative pT2N0M0 prostate cancer at 3 separate institutions between January 1, 2008 and December 31, 2014. We reviewed the electronic medical records of these patients and collected clinical and histologic data. A multivariable analysis was performed to assess the association between PNI and biochemical recurrence.
Of the 1549 patients identified, 936 (60.4%) had PNI and 96 (6.2%) had biochemical recurrence. The median time until recurrence was 16 months. The median follow-up in patients without recurrence was 26.5 months. PNI was associated with pT2c disease. The proportion of patients with pT2c was 89% in patients with PNI compared with 79% in patients without PNI ( < .001). PNI was also associated with a higher surgical Gleason score (of those with vs without PNI, 21% vs 50% had Gleason score 3 + 3; 62% vs 41% had a Gleason score 3 + 4, 12% vs 5% had a Gleason score 4 + 3; and 5% vs 3% had a Gleason score 8-10; < .001). On univariate analysis, patients with PNI appeared to be more likely to have disease recurrence (hazard ratio: 1.7; 95% confidence interval, 1.1-2.6; = .015). However, after adjusting for other variables, there was not a significant association between PNI and recurrence (hazard ratio: 1.1; 95% confidence interval, 0.70-1.8: = .65).
We found that PNI was not an independent indicator of the risk of biochemical recurrence. Instead, PNI may be an indicator of unfavorable histology such as a high Gleason score or diffuse disease within the prostate in pT2N0 patients.
神经周围浸润（PNI）是一种组织学特征，在高达84%的前列腺癌患者中存在。PNI的预后意义存在争议，近期研究结果相互矛盾。本研究旨在评估在pT2N0M0疾病且手术切缘阴性的患者手术病理中，PNI是否是生化复发风险的独立预后指标。
我们确定了2008年1月1日至2014年12月31日期间在3个不同机构被诊断为切缘阴性的pT2N0M0前列腺癌的1549例患者。我们回顾了这些患者的电子病历并收集了临床和组织学数据。进行多变量分析以评估PNI与生化复发之间的关联。
在确定的1549例患者中，936例（60.4%）有PNI，96例（6.2%）有生化复发。复发的中位时间为16个月。未复发患者的中位随访时间为26.5个月。PNI与pT2c疾病相关。有PNI的患者中pT2c患者的比例为89%，而无PNI的患者中这一比例为79%（P <.001）。PNI还与更高的手术Gleason评分相关（有PNI与无PNI的患者中，Gleason评分为3 + 3的分别为21%和50%；评分为3 + 4的分别为62%和41%；评分为4 + 3的分别为12%和5%；评分为8 - 10的分别为5%和3%；P <.001）。单变量分析中，有PNI的患者似乎更易发生疾病复发（风险比：1.7；95%置信区间，1.1 - 2.6；P =.015）。然而，在对其他变量进行校正后，PNI与复发之间无显著关联（风险比：1.1；95%置信区间，0.70 - 1.8；P =.65）。
我们发现PNI不是生化复发风险的独立指标。相反，PNI可能是组织学不良的一个指标，如高Gleason评分或pT2N0患者前列腺内的弥漫性疾病。
