Department of Surgery, New York Presbyterian Weill Cornell Medicine, New York, NY, USA.
Department of Population Health Sciences, New York Presbyterian Weill Cornell Medicine, New York, NY, USA.
Ann Surg Oncol. 2023 Jun;30(6):3570-3577. doi: 10.1245/s10434-023-13307-8. Epub 2023 Mar 10.
Perineural invasion (PNI) is associated with aggressive tumor behavior, increased locoregional recurrence, and decreased survival in many carcinomas. However, the significance of PNI in papillary thyroid cancer (PTC) is incompletely characterized.
Patients diagnosed with PTC and PNI from 2010-2020 at a single, academic center were identified and matched using a 1:2 scheme to patients without PNI based on gross extrathyroidal extension (ETE), nodal metastasis, positive margins, and tumor size (±4 cm). Mixed and fixed effects models were used to analyze the association of PNI with extranodal extension (ENE)-a surrogate marker of poor prognosis.
In total, 78 patients were included (26 with PNI, 52 without PNI). Both groups had similar demographics and ultrasound characteristics preoperatively. Central compartment lymph node dissection was performed in most patients (71%, n = 55), and 31% (n = 24) underwent a lateral neck dissection. Patients with PNI had higher rates of lymphovascular invasion (50.0% vs. 25.0%, p = 0.027), microscopic ETE (80.8% vs. 44.0%, p = 0.002), and a larger burden [median 5 (interquartile range [IQR] 2-13) vs. 2 (1-5), p = 0.010] and size [median 1.2 cm (IQR 0.6-2.6) vs. 0.4 (0.2-1.4), p = 0.008] of nodal metastasis. Among patients with nodal metastasis, those with PNI had an almost fivefold increase in ENE [odds ratio [OR] 4.9 (95% confidence interval [CI] 1.5-16.5), p = 0.008] compared with those without PNI. More than a quarter (26%) of all patients had either persistent or recurrent disease over follow-up (IQR 16-54 months).
PNI is a rare, pathologic finding that is associated with ENE in a matched cohort. Additional investigation into PNI as a prognostic feature in PTC is warranted.
神经周围侵犯（PNI）与许多癌症的侵袭性行为、局部区域复发增加和生存时间缩短有关。然而，PNI 在甲状腺乳头状癌（PTC）中的意义尚未完全明确。
在一个学术中心，我们确定了 2010 年至 2020 年期间患有 PTC 和 PNI 的患者，并根据大体甲状腺外侵犯（ETE）、淋巴结转移、阳性切缘和肿瘤大小（±4cm）采用 1:2 方案与无 PNI 的患者进行匹配。采用混合和固定效应模型分析 PNI 与神经外侵犯（ENE）的关系，ENE 是预后不良的替代标志物。
共纳入 78 例患者（26 例有 PNI，52 例无 PNI）。两组患者术前的人口统计学和超声特征相似。大多数患者接受了中央区淋巴结清扫术（71%，n=55），31%（n=24）接受了侧颈淋巴结清扫术。有 PNI 的患者淋巴血管侵犯（50.0% vs. 25.0%，p=0.027）、显微镜下 ETE（80.8% vs. 44.0%，p=0.002）和更大的淋巴结转移[中位数 5（四分位距 [IQR] 2-13）vs. 2（1-5），p=0.010]和大小[中位数 1.2cm（IQR 0.6-2.6）vs. 0.4（0.2-1.4），p=0.008]的发生率更高。在有淋巴结转移的患者中，有 PNI 的患者发生 ENE 的风险增加近五倍[比值比（OR）4.9（95%置信区间 [CI] 1.5-16.5），p=0.008]，而无 PNI 的患者则无此风险。在随访期间（IQR 16-54 个月），超过四分之一（26%）的患者存在持续性或复发性疾病。
PNI 是一种罕见的病理发现，与匹配队列中的 ENE 相关。需要进一步研究 PNI 作为 PTC 的预后特征。
