Xiong Jicheng, Lu Simiao, Liang Shuoming, Chen Hainan, Wang Ziwei, Meng Hao, Zhou Yehan, Wang Qifeng, Miao Yan, Xie Qin, Liu Guangyuan, Wang Kangning, Peng Lin, Fang Qiang, Xiao Wenguang, Han Yongtao, Leng Xuefeng
Department of Clinical Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Thoracic Surgery, Sichuan Cancer Hospital, Sichuan Provincial Clinical Medical Research Center, Cancer Prevention and Control Center of Sichuan Province, Chengdu, China.
J Thorac Dis. 2025 May 30;17(5):2989-3003. doi: 10.21037/jtd-2024-2043. Epub 2025 May 28.
The prognostic role of perineural invasion (PNI) in esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to assess the prognostic effects of PNI in resectable ESCC patients.
We retrospectively examined the medical records of patients who underwent esophagectomy from January 2010 to December 2017 at Sichuan Cancer Hospital. Factors associated with PNI and the impact of PNI on prognosis and overall survival (OS) were analyzed. We also performed survive analysis associated with OS and disease-free survival (DFS).
The median follow-up period in this study was 36.7 months. PNI was present in 18.0% (404/2,247) of ESCC patients. PNI-positive was correlated with a shorter OS than PNI-negative (median OS: 31 58 months, P<0.001). And PNI-positive was also associated with shorter median DFS compared to those without PNI (median OS: 29 . 60 months, P<0.001). In lymphovascular invasion (LVI)-negative, pII/III stage, and pN0 subgroups, the OS of PNI-positive patients was generally decreased in different subgroups of patients. In the subgroup of PNI-positive patients, postoperative adjuvant therapy did not provide a survival benefit (median OS: 32 30 months, P=0.77). PNI was an independent prognostic factor (HR: 1.174, 95% CI: 1.003-1.373, P=0.046) in the multivariable survival analysis for DFS.
PNI is a potential independent prognostic factor for ESCC patients. Further study is needed to determine whether postoperative adjuvant therapy is necessary for thoracic ESCC patients who have achieved R0 resection and PNI-positive.
神经周围浸润（PNI）在食管鳞状细胞癌（ESCC）中的预后作用尚不清楚。我们旨在评估PNI对可切除ESCC患者的预后影响。
我们回顾性研究了2010年1月至2017年12月在四川省肿瘤医院接受食管切除术患者的病历。分析与PNI相关的因素以及PNI对预后和总生存期（OS）的影响。我们还进行了与OS和无病生存期（DFS）相关的生存分析。
本研究的中位随访期为36.7个月。18.0%（404/2247）的ESCC患者存在PNI。PNI阳性患者的OS短于PNI阴性患者（中位OS：31对58个月，P<0.001）。与无PNI患者相比，PNI阳性患者的中位DFS也较短（中位OS：29对60个月，P<0.001）。在无脉管浸润（LVI）、pII/III期和pN0亚组中，PNI阳性患者的OS在不同亚组患者中普遍降低。在PNI阳性患者亚组中，术后辅助治疗未带来生存获益（中位OS：32对30个月，P=0.77）。在DFS的多变量生存分析中，PNI是独立的预后因素（HR：1.174，95%CI：1.003-1.373，P=0.046）。
PNI是ESCC患者潜在的独立预后因素。对于R0切除且PNI阳性的胸段ESCC患者，是否需要术后辅助治疗还需进一步研究来确定。
