Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy.
Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy.
Pancreatology. 2024 Jun;24(4):553-561. doi: 10.1016/j.pan.2024.03.004. Epub 2024 Mar 15.
BACKGROUND/OBJECTIVES: Perineural invasion (PNI), classified according to its presence or absence in tumor specimens, is recognized as a poor prognostic factor in pancreatic ductal adenocarcinoma (PDAC) patients. Herein, we identified five histological features of PNI and investigated their impact on survival outcomes of PDAC resected patients.
Five histopathological features of PNI (diameter, number, site, sheath involvement, and mitotic figures within perineural invasion) were combined in an additional final score (ranging from 0 to 8), and clinical data of PDAC patients were retrospectively analyzed. PNI + patients were stratified in two categories according to the median score value (<6 and ≥ 6, respectively). Impact of PNI on disease-free survival (DFS) and overall survival (OS) were analyzed.
Forty-five patients were enrolled, of whom 34 with PNI (PNI+) and 11 without PNI (PNI-). The DFS was 11 months vs. not reached (NR) (p = 0.258), while the OS was 19 months vs. NR (p = 0.040) in PNI+ and PNI- patients, respectively. A ≥6 PNI was identified as an independent predictor of worse OS vs. <6 PNI + patients (29 vs. 11 months, p < 0.001) and <6 PNI+ and PNI- patients (43 vs. 11 months, p < 0.001). PNI ≥6 was an independent negative prognostic factor of DFS vs. <6 PNI+ and PNI- patients (13 vs. 6 months, p = 0.022).
We report a PNI scoring system that stratifies surgically-treated PDAC patients in a graded manner that correlates with patient prognosis better than the current dichotomous (presence/absence) definition. However, further and larger studies are needed to support this PNI scoring system.
背景/目的：神经周围侵犯（PNI）根据肿瘤标本中是否存在 PNI 进行分类，被认为是胰腺导管腺癌（PDAC）患者预后不良的因素。在此，我们鉴定了 PNI 的 5 种组织学特征，并研究了它们对 PDAC 切除患者生存结果的影响。
将 PNI 的 5 种组织病理学特征（直径、数量、部位、鞘内侵犯和神经周围侵犯中的有丝分裂象）组合成一个附加的最终评分（范围为 0 至 8），并对 PDAC 患者的临床数据进行回顾性分析。根据中位数评分值（<6 和≥6）将 PNI+患者分为两个亚组。分析 PNI 对无病生存（DFS）和总生存（OS）的影响。
共纳入 45 例患者，其中 34 例有 PNI（PNI+），11 例无 PNI（PNI-）。PNI+和 PNI-患者的 DFS 分别为 11 个月和未达到（NR）（p=0.258），OS 分别为 19 个月和 NR（p=0.040）。≥6 的 PNI 被确定为 OS 较<6 PNI+患者（29 与 11 个月，p<0.001）和<6 PNI+和 PNI-患者（43 与 11 个月，p<0.001）更差的独立预测因子。与<6 PNI+和 PNI-患者（13 与 6 个月，p=0.022）相比，PNI≥6 是 DFS 的独立负预后因素。
我们报告了一种 PNI 评分系统，该系统以分级方式对接受手术治疗的 PDAC 患者进行分层，与目前的二分法（存在/不存在）定义相比，与患者预后的相关性更好。然而，需要进一步和更大规模的研究来支持这种 PNI 评分系统。
