Abstract
BackgroundPerineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined. The objective of this study was to determine the association between PNI status and clinical outcomes.MethodsWe retrospectively evaluated the PNI of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. The resulting data were analyzed using Spearman’s rank correlation, the Kaplan-Meier method, Cox proportional hazards regression modeling and Harrell’s concordance index (C-index).ResultsPNI was identified in 209 of the 433 (47.7%) cases of ESCC. The correlation analysis demonstrated that PNI in ESCC was significantly correlated with tumor differentiation, infiltration depth, pN classification and stage (P < 0.05). The five-year overall survival rate was 0.570 for PNI-negative tumors versus 0.326 for PNI-positive tumors. Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001). In the subset of patients with node-negative disease, PNI was evaluated as a prognostic predictor as well (P < 0.05). In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027). The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively).ConclusionsPNI can function as an independent prognostic factor of outcomes in ESCC patients, and the PNI status in primary ESCC specimens should be considered for therapy stratification.
Highlights
Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined
Relationship between PNI and clinicopathologic features in ESCC PNI was defined as tumor cells within any layer of the peripheral nerve sheath or tumor cells in the perineural space that involved at least 33% of the nerve circumference
A further correlation analysis demonstrated that the presence of PNI was significantly correlated with tumor differentiation, infiltration depth, pN classification and ESCC stage (P < 0.05, Table 1)
Summary
Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined. As the dominant type of esophageal cancer in China, esophageal squamous cell carcinoma (ESCC) has a generally poor prognosis due to the lack of effective clinical methods for its early detection. A variety of prognostic characteristics, including tumor location, size, differentiation, infiltration depth, lymph node involvement and distant metastasis, have been proposed as relevant factors for predicting the outcomes of patients with ESCC [6]. These characteristics have been incorporated into a proposed prognostic monogram designed to predict patients’ survival [7]. The currently proposed TNM system shows conformable prognostic accuracy, a demand remains for increasing the accuracy of the existing system for predicting outcomes
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