Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea; Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Radiother Oncol. 2019 Apr;133:125-131. doi: 10.1016/j.radonc.2019.01.002. Epub 2019 Jan 24.
To investigate the prognostic significance of lymphovascular space invasion (LVI) and perineural invasion (PNI) in rectal cancer.
Clinical data of 1,232 stage II-III rectal cancer patients from six tertiary institutions were analyzed. All patients were treated by long-course preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Adjuvant systemic chemotherapy was performed for 962 (78.1%) patients according to the multidisciplinary team's decision. Treatment outcomes and prognostic factors were evaluated according to the lymphovascular invasion (LVI) and perineural invasion (PNI) status.
Five-year overall survival (OS) and recurrence-free survival (RFS) rates of the entire cohort were 84.1% and 71.1%, respectively. There is a significant difference in 5-year OS among both-absent, LVI+ only, PNI+ only, and both-present groups (89.1% vs. 77.9% vs. 67.6% vs. 56.2%; p < 0.001). RFS at five years was significantly different among both-absent, LVI+ only, PNI+ only, and both-present groups (78.7% vs. 58.7% vs. 44.6% vs. 38.6%; p < 0.001). The 5-year distant failure-free survival (DFFS) rate was also significantly different among four groups (84.6% vs. 61.4% vs. 54.2% vs 48.6%; p < 0.001). Although adjuvant chemotherapy did not affect 5-year DFFS in the entire cohort, adjuvant chemotherapy significantly reduced the distant failure rate in patients with PNI+ patients (44.9% vs. 54.6%, p = 0.048), not LVI+ patients (65.0% vs. 56.1%, p = 0.487).
Compared to LVI, PNI is a more significant prognostic factor in stage II-III rectal patients treated by preoperative CRT and TME surgery. The status of PNI rather than LVI could be an indicator for identifying patients who could benefit from adjuvant systemic chemotherapy.
研究直肠肿瘤中淋巴管侵犯（LVI）和神经周围侵犯（PNI）的预后意义。
对来自 6 家三级医疗机构的 1232 例Ⅱ-Ⅲ期直肠肿瘤患者的临床资料进行分析。所有患者均接受长程术前放化疗（CRT）联合直肠全系膜切除术（TME）治疗。根据多学科团队的决定，962 例（78.1%）患者接受辅助全身化疗。根据 LVI 和 PNI 状态评估治疗结果和预后因素。
整个队列的 5 年总生存率（OS）和无复发生存率（RFS）分别为 84.1%和 71.1%。两组缺失、LVI+ 组、PNI+ 组和两者均存在组的 5 年 OS 有显著差异（89.1% vs. 77.9% vs. 67.6% vs. 56.2%；p<0.001）。两组缺失、LVI+ 组、PNI+ 组和两者均存在组的 5 年 RFS 也有显著差异（78.7% vs. 58.7% vs. 44.6% vs. 38.6%；p<0.001）。4 组间 5 年远处无失败生存率（DFFS）也有显著差异（84.6% vs. 61.4% vs. 54.2% vs. 48.6%；p<0.001）。尽管辅助化疗对整个队列的 5 年 DFFS 没有影响，但辅助化疗显著降低了 PNI+患者的远处失败率（44.9% vs. 54.6%，p=0.048），而不是 LVI+患者（65.0% vs. 56.1%，p=0.487）。
与 LVI 相比，PNI 是接受术前 CRT 和 TME 手术治疗的Ⅱ-Ⅲ期直肠肿瘤患者更显著的预后因素。PNI 的状态而不是 LVI 可能是识别可能从辅助全身化疗中获益的患者的指标。
