Hu Gang, Li Liang, Hu Kaibing
Department of General Surgery, Hefei Second People's Hospital, and Hefei Affiliated Hospital of Anhui Medical University.
Medicine (Baltimore). 2020 Apr;99(17):e19860. doi: 10.1097/MD.0000000000019860.
Perineural invasion (PNI) is a prominent characteristic of multiple solid tumors and indicates poor prognosis. Previous data concerning the impact of PNI on prognosis of patients with colorectal cancer (CRC) are conflicting, and little is known about risk factors of PNI. The aim of our study was to reveal the clinical implication of PNI on survival outcome and identify risk factors for the poor prognosis in patients with CRC.We retrospectively reviewed 627 patients who were diagnosed with CRC and underwent curative surgical resection. The differences in several clinicopathologic characteristics were compared between PNI positive and PNI negative groups. Multivariate logistic regression analysis was performed to identify predictors of CRC with PNI. Five-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method, and the difference in survival rate was assessed by the log-rank test. The variables that had prognostic potential, as indicated by univariate analyses, were subjected to multivariate analyses with the Cox proportional hazards regression model.PNIs were identified in 79 patients (12.6%). Age, T classification, N classification, M classification, UICC classification, and lymphovascular invasion were significantly associated with PNI. Multivariate logistic regression analysis demonstrated that only lymphovascular invasion was a predictor of PNI. Pathologic evidence of PNI was not associated with survival outcome (the 5-year OS [P = .560] and DFS [P = .083]). Cox proportional hazards regression model revealed that age and N2/3 classification were independent prognostic factors for poorer OS and DFS. M1 stage (95% confidence interval [CI] = 0.228-0.585, P = .000), III/IV stage (95% CI = 0.335-0.920, P = .022), and number of sampled lymph nodes (95% CI = 0.951-0.987, P = .001) were independently prognostic for poorer OS, while history of other malignancy (95% CI = 1.133-2.813, P = .012) was identified as an independent prognostic factor for poorer DFS.Our study indicates that PNI is not an independent poor prognostic factor in patients with CRC and those patients with PNI may not benefit from postoperative adjuvant chemotherapy.
神经周围浸润（PNI）是多种实体瘤的一个显著特征，提示预后不良。先前关于PNI对结直肠癌（CRC）患者预后影响的数据存在矛盾，且对PNI的危险因素知之甚少。我们研究的目的是揭示PNI对生存结局的临床意义，并确定CRC患者预后不良的危险因素。我们回顾性分析了627例诊断为CRC并接受根治性手术切除的患者。比较了PNI阳性组和PNI阴性组在几个临床病理特征方面的差异。进行多因素逻辑回归分析以确定CRC伴PNI的预测因素。采用Kaplan-Meier法计算5年总生存期（OS）和无病生存期（DFS），并通过对数秩检验评估生存率差异。单因素分析显示具有预后潜力的变量，采用Cox比例风险回归模型进行多因素分析。79例患者（12.6%）被确定存在PNI。年龄、T分期、N分期、M分期、UICC分期和淋巴管浸润与PNI显著相关。多因素逻辑回归分析表明，只有淋巴管浸润是PNI的预测因素。PNI的病理证据与生存结局无关（5年OS[P = 0.560]和DFS[P = 0.083]）。Cox比例风险回归模型显示，年龄和N2/3分期是OS和DFS较差的独立预后因素。M1期（95%置信区间[CI]=0.228 - 0.585，P = 0.000）、III/IV期（95%CI = 0.335 - 0.920，P = 0.022）和取样淋巴结数量（95%CI = 0.951 - 0.987，P = 0.001）是OS较差的独立预后因素，而其他恶性肿瘤病史（95%CI = 1.133 - 2.813，P = 0.012）被确定为DFS较差的独立预后因素。我们的研究表明，PNI不是CRC患者独立的不良预后因素，且那些有PNI的患者可能无法从术后辅助化疗中获益。
