Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
PeerJ. 2022 Mar 2;10:e12974. doi: 10.7717/peerj.12974. eCollection 2022.
BACKGROUND: Lymphangio vascular invasion (LVI) and perineural invasion (PNI) are associated with survival following resection for gastrointestinal cancer. But the relationship between LVI/PNI and survival of esophageal squamous cell carcinoma (ESCC) is still unclear. We aim to demonstrate the prognostic significance of LVI/PNI in ESCC. METHODS: A total of 195 ESCC patients underwent curative surgery from 2012 to 2018 was collected in the 2nd Affiliated Hospital of Fujian Medical University. All the patients were divided into four groups based on the status of the neurovascular invasion: (1) neither LVI nor PNI (V0N0); (2) LVI alone (V1N0); (3) PNI alone (V0N1); (4) combined LVI and PNI (V1N1). First, the analysis included the Kaplan-Meier survival estimates with the Log rank test were performed to determine median overall survival (OS) in different groups divided according to the clinical factor, respectively. And the association between OS with multi clinical factors was examined using Cox regression analysis. Next, the risk factors for recurrence in patients with V1N1 were analyzed with univariate and multivariate logistic regression analyses, respectively. RESULTS: The cases in V0N0, V1N0, V0N1, and V1N1 groups were 91 (46.7%), 62 (31.8%), 9 (4.6%) and 33 (16.9%), respectively. The OS in the four groups was different ( < 0.001). The 1-, 3- and 5-year OS in V0N0 group was higher than that in V1N1 group, respectively (1-year OS: 93.4% 75.8%, 3-year OS: 53.8 % 24.2%, 5-year OS: 48.1% 10.5%). The OS in stage I-II for patients with V1N1 was significantly lower than that in the other groups (V0N0, V1N0, V0N1) ( < 0.001). The postoperative adjuvant chemotherapy was a significant impact factor of OS for ESCC patients with V1N1 ( = 0.004). Lymphatic invasion and LVI were significantly prognosis factors associated ( = 0.036, = 0.030, respectively). The ulcerative type is a risk factor for V1N1 occurance ( = 0.040). CONCLUSIONS: The LVI and PNI are important prognosis factors for ESCC patients. ESCC patients with simultaneous lymphangio vascular and perineural invasion (V1N1) showed worse OS than patients with either lymphangio vascular or perineural invasion alone (V1N0 or V0N1) or none (V0N0). In addition, adjuvant chemotherapy may prolong the OS for ESCC patients with V1N1.
背景：淋巴管血管侵犯（LVI）和神经周围侵犯（PNI）与胃肠道癌切除术后的生存有关。但是，LVI/PNI 与食管鳞状细胞癌（ESCC）患者生存之间的关系仍不清楚。我们旨在证明 LVI/PNI 在 ESCC 中的预后意义。
方法：收集 2012 年至 2018 年期间在福建医科大学第二附属医院接受根治性手术的 195 例 ESCC 患者。所有患者根据神经血管侵犯状态分为四组：（1）既无 LVI 也无 PNI（V0N0）；（2）仅 LVI（V1N0）；（3）仅 PNI（V0N1）；（4）同时存在 LVI 和 PNI（V1N1）。首先，通过 Kaplan-Meier 生存估计和对数秩检验分别对根据临床因素进行分组的不同组的中位总生存（OS）进行分析。然后使用 Cox 回归分析检查 OS 与多临床因素之间的关联。接下来，分别使用单变量和多变量逻辑回归分析来分析 V1N1 患者复发的危险因素。
结果：V0N0、V1N0、V0N1 和 V1N1 组的病例分别为 91（46.7%）、62（31.8%）、9（4.6%）和 33（16.9%）。四组的 OS 不同（<0.001）。V0N0 组的 1、3 和 5 年 OS 均高于 V1N1 组，分别为（1 年 OS：93.4% 75.8%，3 年 OS：53.8% 24.2%，5 年 OS：48.1% 10.5%）。V1N1 患者的 I 期和 II 期 OS 明显低于其他组（V0N0、V1N0、V0N1）（<0.001）。术后辅助化疗是 ESCC 患者 V1N1 生存的显著影响因素（=0.004）。淋巴管侵犯和 LVI 是显著的预后相关因素（=0.036，=0.030）。溃疡性类型是 V1N1 发生的危险因素（=0.040）。
结论：LVI 和 PNI 是 ESCC 患者的重要预后因素。同时存在淋巴管血管和神经周围侵犯（V1N1）的 ESCC 患者的 OS 明显低于仅存在淋巴管血管侵犯（V1N0）或神经周围侵犯（V0N1）或两者均无（V0N0）的患者。此外，辅助化疗可能延长 V1N1 患者的 OS。
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