Wei Tao, Zhang Xu-Feng, He Jin, Popescu Irinel, Marques Hugo P, Aldrighetti Luca, Maithel Shishir K, Pulitano Carlo, Bauer Todd W, Shen Feng, Poultsides George A, Soubrane Oliver, Martel Guillaume, Koerkamp Bas Groot, Itaru Endo, Lv Yi, Pawlik Timothy M
Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Br J Surg. 2022 Jun 14;109(7):610-616. doi: 10.1093/bjs/znac098.
The aim of this study was to investigate the prognostic impact of perineural invasion (PNI) on tumour recurrence and survival among patients with resected intrahepatic cholangiocarcinoma (ICC).
This was a multicentre, retrospective study of patients who underwent resection with curative intent for ICC between 2000 and 2017. The relationship between PNI, clinicopathological characteristics, and long-term survival was analysed in the overall cohort and the subset of patients with early-stage ICC.
Among 1095 patients who underwent resection of ICC, PNI was present in 239 (21.8 per cent). In univariable analysis, PNI was associated with worse disease-free survival (DFS) (median 13.2 versus 16.1 months for patients with and without PNI respectively; P = 0.038) and overall survival (OS) (26.4 versus 41.5 months; P < 0.001). In multivariable analysis, PNI was an independent risk factor associated with reduced DFS (hazard ratio (HR) 1.56, 95 per cent c.i. 1.06 to 2.13; P = 0.019) and OS (HR 1.74, 1.16 to 2.60; P = 0.007). In subgroup analysis of patients with early-stage disease (AJCC T1-2, 981 patients; or N0, 249 patients), PNI remained associated with worse DFS (T1-2: median 13.7 versus 16.6 months in patients with and without PNI respectively, P = 0.019; N0: 11.7 versus 17.5 months, P = 0.022) and OS (T1-2: 28.5 versus 45.7 months, P < 0.001; N0: 34.9 versus 47.5 months, P = 0.036).
PNI is a strong independent predictor of tumour recurrence and long-term survival following resection of ICC with curative intent, even among patients with early-stage disease. The presence of PNI should be assessed routinely.
本研究旨在探讨神经周围侵犯（PNI）对肝内胆管癌（ICC）切除术后患者肿瘤复发及生存的预后影响。
这是一项多中心回顾性研究，研究对象为2000年至2017年间接受根治性切除的ICC患者。分析了整个队列以及早期ICC患者亚组中PNI、临床病理特征与长期生存之间的关系。
在1095例行ICC切除术的患者中，239例（21.8%）存在PNI。单因素分析显示，PNI与无病生存期（DFS）较差相关（有PNI和无PNI的患者中位DFS分别为13.2个月和16.1个月；P = 0.038）以及总生存期（OS）较差相关（26.4个月和41.5个月；P < 0.001）。多因素分析显示，PNI是与DFS降低相关的独立危险因素（风险比（HR）1.56，95%置信区间1.06至2.13；P = 0.019）以及OS降低相关的独立危险因素（HR 1.74，1.16至2.60；P = 0.007）。在早期疾病患者的亚组分析中（美国癌症联合委员会（AJCC）T1 - 2期，981例患者；或N0期，249例患者），PNI仍与较差的DFS相关（T1 - 2期：有PNI和无PNI的患者中位DFS分别为13.7个月和16.6个月，P = 0.019；N0期：11.7个月和17.5个月，P = 0.022）以及OS相关（T1 - 2期：28.5个月和45.7个月，P < 0.001；N0期：34.9个月和47.5个月，P = 0.036）。
PNI是根治性切除ICC术后肿瘤复发及长期生存的强有力独立预测因素，即使在早期疾病患者中也是如此。应常规评估PNI的存在情况。
