Li Juan, Mei Shiwen, Zhou Sichen, Zhao Fuqiang, Liu Qian
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Gastrointest Oncol. 2022 Apr;13(2):710-721. doi: 10.21037/jgo-22-277.
Perineural invasion (PNI) is considered a risk factor of survival but does not yet inform treatment decisions, and has not been studied separately in stage II colorectal cancer (CRC) patients whose postoperative traditional chemotherapy is controversial. This cohort study aimed to assess the association of PNI with basic clinicopathological features and patient outcomes after curative resection and the effects of PNI on responses to adjuvant chemotherapy in stage II CRC.
The clinical data of 371 stage II CRC patients who underwent curative-intent surgery at the National Cancer Center/Cancer Hospital in 2014 were retrospectively reviewed. The adjuvant chemotherapy data were acquired from follow-up information. PNI status was examined, and the overall survival (OS) and disease-free survival (DFS) rates were analyzed.
PNI was detected in 82 of the 371 patients (22.1%) and was closely correlated with preoperative serum carcinoembryonic antigen (CEA) levels (P=0.030), gross tumor type (P=0.010), tumor differentiation (P=0.010), p stage (P<0.001), and extramural vascular invasion (EMVI) (P<0.001). The median follow-up time was 71 months. The 5-year OS was 84.1% and 96.5% (P<0.001), and the 5-year DFS was 75.6% and 91.3% (P<0.001) for PNI-positive (+) and PNI-negative (-) patients, respectively. The multivariate regression analyses identified PNI as an independent negative prognostic factor for DFS [hazard ratio (HR): 2.95; 95% confidence interval (CI), 1.546-5.626; P=0.001] and OS (HR: 3.966; 95% CI, 1.642-9.575; P=0.002). Among PNI (+) patients, DFS and OS were positively correlated with CEA levels (P=0.005 and P=0.004, respectively). Postoperative chemotherapy failed to improve DFS (P=0.480 and P=0.267, respectively) and OS (P=0.940 and P=0.077, respectively) regardless of whether the patients were PNI positive or not.
In stage II CRC patients, PNI was a poor independent predictor for DFS and OS. Among PNI (+) patients, CEA levels were positively correlated with DFS and OS. Traditional postoperative adjuvant chemotherapy does not improve outcomes of PNI (+) patients. Therefore, as to the active role of PNI and vacancy for treatment in allusion to PNI, follow-up of PNI (+) patients with elevated CEA level should be strengthened and further research on drug conducted on PNI deserve to be carried on.
神经周围侵犯（PNI）被认为是生存的一个危险因素，但尚未为治疗决策提供依据，且在术后传统化疗存在争议的II期结直肠癌（CRC）患者中尚未进行单独研究。这项队列研究旨在评估PNI与根治性切除术后的基本临床病理特征及患者预后的相关性，以及PNI对II期CRC辅助化疗反应的影响。
回顾性分析2014年在国家癌症中心/癌症医院接受根治性手术的371例II期CRC患者的临床资料。辅助化疗数据来自随访信息。检查PNI状态，并分析总生存（OS）率和无病生存（DFS）率。
371例患者中有82例（22.1%）检测到PNI，且与术前血清癌胚抗原（CEA）水平（P = 0.030）、大体肿瘤类型（P = 0.010）、肿瘤分化程度（P = 0.010）、p分期（P < 0.001）和壁外血管侵犯（EMVI）（P < 0.001）密切相关。中位随访时间为71个月。PNI阳性（+）和PNI阴性（-）患者的5年OS分别为84.1%和96.5%（P < 0.001），5年DFS分别为75.6%和91.3%（P < 0.001）。多因素回归分析确定PNI是DFS的独立阴性预后因素[风险比（HR）：2.95；95%置信区间（CI），1.546 - 5.626；P = 0.001]和OS的独立阴性预后因素（HR：3.966；95% CI，1.642 - 9.575；P = 0.002）。在PNI（+）患者中，DFS和OS与CEA水平呈正相关（分别为P = 0.005和P = 0.004）。无论患者PNI是否阳性，术后化疗均未能改善DFS（分别为P = 0.480和P = 0.267）和OS（分别为P = 0.940和P = 0.077）。
在II期CRC患者中，PNI是DFS和OS的不良独立预测因素。在PNI（+）患者中，CEA水平与DFS和OS呈正相关。传统的术后辅助化疗不能改善PNI（+）患者的预后。因此，鉴于PNI的积极作用以及针对PNI治疗的空白，应加强对CEA水平升高的PNI（+）患者的随访，并对PNI进行进一步的药物研究。
