Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China.
Hum Pathol. 2020 Oct;104:96-104. doi: 10.1016/j.humpath.2020.07.005. Epub 2020 Jul 13.
Perineural invasion (PNI) after radical prostatectomy (RP) is a common feature of prostate cancer (PCa) and has been associated with unfavorable tumor characteristics. However, its prognostic relevance is controversial. In this study, we evaluated the impact of both PNI status (PNI+ versus PNI-) and quantified number of PNI focus on the long-term prognosis of biochemical recurrence (BCR) after RP. After reevaluating PNI of a total of 721 patients with localized PCa who underwent RP at our institution between 2000 and 2002, we examined associations between PNI status or PNI focus number and clinicopathological factors including tumor stage, Gleason score, margin status, tumor location, preoperative prostate specific antigen, age, prostate weight as well as BCR outcome. PNI was present in 530 of 721 cases (73.5%) of the RP specimens and was associated with more aggressive disease. BCR occurred in 19.4% of all patients within a median follow-up period of 8.5 years. PNI+ status was associated with poor BCR prognosis in univariate analysis but lost in multivariate analysis. Based on the number of PNI focus, PNI was further divided into 2 distinct group: PNI+ a (≤3) and PNI+ b (>3). In a multivariate Cox regression model, PNI+ b (>3) was identified as an independent BCR prognostic factor. Quantification of PNI focus number beside the dichotomized status recording will not only provide more detailed information but also be a novel prognostic indicator for risk stratification. Further external validation will be needed for an optimal cut-off value of the PNI focus number. Our findings will help further research on the relevance of PNI in the pretreatment setting and support ongoing efforts to understand its role of cancer progression.
神经周围侵犯（PNI）是前列腺癌（PCa）根治性前列腺切除术后的常见特征，与肿瘤不良特征相关。然而，其预后相关性仍存在争议。本研究旨在评估PNI 状态（PNI+与 PNI-）和 PNI 灶数量对根治性前列腺切除术后生化复发（BCR）的长期预后的影响。在重新评估了 2000 年至 2002 年期间在我们机构接受根治性前列腺切除术的 721 例局限性 PCa 患者的 PNI 后，我们检查了 PNI 状态或 PNI 灶数量与肿瘤分期、Gleason 评分、切缘状态、肿瘤位置、术前前列腺特异抗原、年龄、前列腺重量以及 BCR 结果等临床病理因素之间的关系。721 例 RP 标本中，530 例（73.5%）存在 PNI，且与侵袭性更强的疾病相关。中位随访 8.5 年后，所有患者中有 19.4%发生 BCR。在单因素分析中，PNI+状态与不良 BCR 预后相关，但在多因素分析中丧失相关性。根据 PNI 灶数量，PNI 进一步分为 2 个不同的组：PNI+ a（≤3）和 PNI+ b（>3）。在多因素 Cox 回归模型中，PNI+ b（>3）被确定为独立的 BCR 预后因素。除了记录的二分类状态外，PNI 灶数量的定量分析不仅提供了更详细的信息，而且也是风险分层的新的预后指标。需要进一步的外部验证来确定 PNI 灶数量的最佳截止值。我们的发现将有助于进一步研究预处理时 PNI 的相关性，并支持目前对理解其在癌症进展中的作用的研究。
