PNI-positive Patients Research Articles

High preoperative serum ferritin predicted poor prognosis in non-metastatic colorectal cancer.

Objectives:To validate the prognostic significance of preoperative serum iron metabolism parameters in non-metastatic colorectal cancer patients treated with curative resection.Methods:We conducted a prospective cohort study in the Department of Surgical Oncology, WuXi 4th People’s Hospital, WuxiChina, between March 2010 and September 2013. The relationships of serum iron metabolism parameters with other variables were examined. The prognostic significance was evaluated using the Kaplan Meier curve and Cox proportional hazards regression model.Results:Five hundred and fourteen patients were eligible for analysis. The levels of the 3 iron metabolism parameters were interdependent. Hemoglobin level was positively correlated with serum iron and transferrin, and was negatively correlated with ferritin. Compared with peri-neural invasion (PNI)-negative patients, PNI-positive patients had higher serum iron (p=0.03) and ferritin levels (p=0.01). Compared with patients with the lowest quartile level of ferritin, patients with the highest quartile level of ferritin had a 2.21 (95% CI: 1.18-4.14) fold increased mortality risk in the univariate and 2.56 (95% CI: 1.10-5.96) in the multivariate Cox proportional hazards models. When stratified by TNM stages, it was only in stage III patients that serum ferritin remained statistically prognostically significant.Conclusions:Preoperative serum ferritin appeared as an independent adverse risk factor in non-metastatic colorectal cancer.

The role of perineural invasion in treatment decisions for oral cancer patients: A review of the literature

PurposeThe role of perineural invasion (PNI) in the management of patients with oral squamous cell carcinoma (OSSC) is still controversial, and there is no consensus regarding the most appropriate therapeutic approach. The purpose of this study is to review the findings in the literature describing OSCC as a neurotropic malignancy, with the aim of correlating perineural invasion with treatment decisions and disease prognosis. Materials and methodsA literature search was conducted of references based on the MEDLINE and Cochrane Database of Systematic Reviews, with subject keywords including four main categories: perineural invasion, perineural spread, oral squamous cell cancinoma, neurotropic carcinoma. ResultsIn this systematic review and analysis, more than 350 publications met the eligibility criteria of the authors. ConclusionPerineural invasion (PNI) is a widely recognized indicator of poor prognosis in oral cancer patients, strongly correlating with aggressive tumor behavior, disease recurrence, and increased morbidity and mortality. Elective neck dissection could be an indicator in improving neck control in PNI-positive patients, while the addition of adjuvant postoperative radiotherapy may not significantly improve survival rates. Various molecular markers have been correlated with perineural tumor spread, but further investigations are required before targeting PNI as part of advanced cancer therapies.

Influence of perineural invasion in predicting overall survival and disease-free survival in patients With locally advanced gastric cancer

BackgroundThe aim of the present study was to evaluate the prognostic significance of perineural invasion (PNI) in locally advanced gastric cancer patients who underwent D2 gastrectomy and adjuvant chemotherapy. MethodsThe records of a series of 103 patients undergoing D2 gastrectomy with curative intent combined with adjuvant chemotherapy from January 2004 to December 2014 were retrospectively reviewed. ResultsPNI was positive in 47 (45.6%) specimens. The 1-, 3-, and 5-year overall survival rates were 81%, 55%, and 42%, respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 76%, 57%, and 49%, respectively. A multivariate analysis showed that age number of positive lymph nodes, T stage, and PNI were independently associated with overall survival. Regarding DFS, the multivariate analysis showed that only PNI was independently associated with DFS. ConclusionsPNI and T stage and positive lymph nodes are independent markers of poor prognosis in patients with gastric cancer. PNI should be incorporated in the postoperative staging system for planning follow-up after surgery and in our opinion to propose more aggressive postoperative therapies in PNI-positive patients.

Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D'Amico low risk patients?

In this study, our aim was to estimate the value of perineural invasion (PNI) in prostate needle biopsy (PNB) specimens in the prediction of surgical margin positivity (SMP) and its prognostic significance (upgrade Gleason Score) in patients who had undergone radical retropubic prostatectomy (RRP) with low risk prostate cancer according to D'Amico risk assessment. We retrospectively analyzed the data of 65 patients who were diagnosed as clinical stage T1c prostate cancer (PC) and underwent RRP between January 2010 and June 2013. Pathological specimens of PNB and RRP were separately examined for the parameters of PNI, vascular invasion (VI), Gleason Score (GS) and SMP. The patients' mean age was 63.65 ± 4.93 (range 47- 75) years. PNI in PNB specimens were identified in 12 of 65 patients and 11 of 12 patients showed SMP on RRP specimens. While 53 of 65 patients had not PNI on PNB, only 11 of them demonstrated SMP on RRP specimens. SMP was 30.64-fold more frequently encountered in PNB specimens obtained from PNI-positive patients relative to PNI-negative patients. In our study, PNI detected in PNB specimens was statistically significantly associated with SMP on RRP specimens (P = 0.0001). It is well known that higher PSA values and GS were independent predictors of SMP in clinically localized prostate cancer (CLPC). We think that PNI in PNB specimens may be a useful prognostic factor for predicting SMP in cases with CLPC.

Perineural invasion correlates with postoperative distant metastasis and poor overall survival in patients with PT1-3N0M0 esophageal squamous cell carcinoma.

The aim of this study was to determine the prognostic value of perineural invasion (PNI) in patients with PT1–3N0M0 esophageal squamous cell carcinoma (ESCC) who underwent curative resection. A total of 148 patients with PT1–3N0M0 ESCC, who underwent surgery in Zhejiang Cancer Hospital (Hangzhou, People’s Republic of China), between 2006 and 2009, were evaluated in this retrospective study. The effects of PNI on distant metastasis-free survival (DMFS) and overall survival (OS) were assessed using Kaplan–Meier analysis. Independent prognostic factors were identified by multivariate Cox analysis. Positive PNI was identified in 25.0% of all the cases. The depth of invasion (PT stage) was closely associated with the PNI positivity (P<0.001). The 5-year DMFS rate and OS rate of the PNI-positive patients were significantly worse than those of the PNI-negative patients (DMFS: 37.2% vs 62.3%, P=0.009; OS: 31.3% vs 74.3%, P,0.001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor for both DMFS (hazard ratio [HR] =2.35, P=0.039) and OS (HR =3.56, P=0.002). Our results suggest that PNI was a predictor of distant metastasis and independently associated with prognosis of patients with PT1–3N0M0 ESCC.

Clinical significance of perineural invasion in stages II and III colorectal cancer

PurposeThis study aimed to determine the prognostic value of perineural invasion (PNI) in patients with colorectal cancer (CRC), particularly patients with TNM stage II and stage III. MethodsA total of 159 CRC patients who had undergone radical resection were retrospectively analyzed. Histopathological evaluation of tissue samples was conducted on hematoxylin and eosin-stained sections. PNI was considered positive when cancer cells were observed inside the nerve sheath, or when at least 33% of the nerve periphery was surrounded by cancer cells. A 3-tier grading system (PNI0, PNI1, PNI2) based on the depth of PNI was used to assess the localization of PNI in the bowel. PNI and other prognostic factors were evaluated by survival analysis. ResultsPNI status in CRC significantly affected postoperative overall survival (P<0.001). The five-year survival rates for PNI-negative and PNI-positive patients were 77% and 32%, respectively. PNI was closely correlated with tumor gross type, tumor grade, depth of invasion, lymph node metastasis, clinical stage, vessel invasion, tumor budding grade, and tumor growth pattern. Multivariate analysis revealed that PNI was an independent prognostic factor (HR=2.223, P=0.003). The survival of PNI-positive patients was significantly poorer than that of PNI-negative patients in stages II and III (P=0.003 and P=0.008, respectively). The overall survival of colorectal patients was in the descending order of PNI-negative at stage II, PNI-positive at stage II/PNI-negative at stage III, and PNI-positive at stage III (P<0.001). When the PNI status and T stage were considered together, overall survival curves of the PNI2 patients were significantly worse than those of PNI1 patients in pT4 stage (P=0.019). ConclusionsPNI is a poor independent prognostic factor for CRC. It could complement classic TNM staging classification in stratifying CRC patients in stages II and III. Assessment of the site-specific distribution of PNI may further enhance the impact of PNI contribution to the prognosis of CRC.

Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer?

The ability of perineural invasion (PNI) in radical prostatectomy (RP) specimens to predict biochemical recurrence (BCR) is unclear. This study investigates this controversial question in a large cohort. A retrospective analysis was undertaken of prospectively collected data from 1497 men who underwent RP (no neoadjuvant therapy) for clinically localized prostate cancer. The association of PNI at RP with other clinicopathological parameters was evaluated. The correlation of clinicopathological factors and BCR (defined as prostate-specific antigen [PSA] >0.2 ng/mL) was investigated with univariable and multivariable Cox regression analysis in 1159 men. PNI-positive patients were significantly more likely to have a higher RP Gleason score, pT3 disease, positive surgical margins, and greater cancer volume (p < 0.0005). The presence of PNI significantly correlated with BCR on univariable (hazard ratio 2.30, 95% confidence interval 1.50-3.55, p < 0.0005), but not multivariable analysis (p = 0.602). On multivariable Cox regression analysis the only independent prognostic factors were preoperative PSA, RP Gleason score, pT-stage, and positive surgical margin status. These findings are limited by a relatively short follow-up time and retrospective study design. PNI at RP is not an independent predictor of BCR. Therefore, routine reporting of PNI is not indicated. Future research should be targeted at the biology of PNI to increase the understanding of its role in prostate cancer progression.

Adjuvant chemotherapy for the perineural invasion of colorectal cancer

BackgroundTo evaluate the association of perineural invasion (PNI) with outcomes in patients after colorectal resection of colorectal cancer (CRC) and to assess the effect of PNI on the response to adjuvant chemotherapy. Patients and methodsData were retrospectively reviewed for 178 patients with consecutive stages I–III CRC who underwent curative surgery between January 1999 and December 2004. PNI data were examined, and the overall survival (OS) and disease-free survival rates were analyzed. ResultsPNI was detected in 36 of 178 patients (20%) and positively correlated with lymphatic invasion (P = 0.020), venous invasion (P = 0.037), and the incidence of metastasis or recurrence (P = 0.029). Five-year disease-free survival was 46% and 68% (P < 0.001) and the 5-y OS was 64% and 80% (P < 0.001) for patients with and without PNI, respectively. In stage III CRC, multiple regression analysis identified PNI as a strong negative prognostic factor of OS; among PNI-positive patients, median OS with adjuvant chemotherapy was almost twofold higher than that without adjuvant chemotherapy (6 versus 2.8 y; P = 0.017). ConclusionsPNI was a poor predictor of survival among patients with stage III CRC, and adjuvant chemotherapy may attenuate the adverse effects of PNI on survival.

Impact of perineural invasion as independent prognostic factor for local and regional failure in oral squamous cell carcinoma.

Perineural invasion (PNI) is frequent in oral squamous cell carcinoma (OSCC) and could play an important role in treatment decisions. This retrospective study used multivariate analysis to evaluate the impact of PNI on locoregional recurrence, neck metastases, and survival in 236 consecutive patients with oral cancer. There were significant differences in the local (P = .007) and regional (P = .041) failure rates in the PNI-positive group compared with the PNI-negative group. Univariate analysis demonstrated that PNI-positive patients had significantly worse locoregional control (P = .011), disease-specific survival (P = .023), and overall survival (P = .046) compared with PNI-negative patients. PNI was an independent predictor of local and regional failure in a well-defined, homogeneous population with OSCC.

OP192: Perineural invasion in T1 oral sqauamous cell carcinoma indicates the need for aggressive elective neck dissection

Purpose Management of cN0 neck remains controversial for T1-2 OSCC (oral squamous cell carcinoma). Perineural invasion (PNI) has been a poor prognostic factor for OSCC, but its significance in T1 OSCC remains unclear. This study investigated the role of PNI, focusing on the controversial issues of neck management in T1 OSCC patients. Materials and methods PNI status was re-evaluated under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients who received surgical treatment. Oncologic and survival outcomes were compared between T1 and T2 patients. Impacts of PNI in T1 OSCC were analyzed by univariate and multivariate analyses. Results The presence of PNI correlated with cervical LN metastasis in both T1 and T2 OSCC, and PNI-positive rate was significantly lower in T1 (17.1% versus 36.6%; P P P P P = 0.399 and P = 0.1478). Of the 146 patients with T1 OSCC, PNI remained independently predictive of cervical LN metastasis, neck recurrence and poor DSS. Elective neck dissection significantly reduced neck recurrence in PNI-positive ( P = 0.001) but not in PNI-negative patients ( P = 0.114). Elective neck dissection also improved the 5-year DSS rate more obvious, although not statistically significant, in PNI-positive than in PNI-negative patients (16.2% versus 5.4%). Conclusions PNI independently predicts poor prognosis in patients with T1 OSCC who are potentially curable but tend to be treated conservatively. Elective neck dissection should be performed for T1, PNI-positive patients for its efficacy in improving neck recurrence and survival.

Perineural Invasion in the pN0 Neck in OCSCC

Objective: Perineural invasion (PNI) has been defined as an intermediate risk factor in OCSCC; however, its effect in the pathologically N0 (pN0) neck remains unclear. The objective of this study is to understand 1) the effect of PNI in pN0 OCSCC patients on outcomes, and 2) the role of adjuvant radiation (XRT). Method: Retrospective analysis of 90 OCSCC patients treated surgically with pN0 necks after neck dissection at a tertiary care center from 1999-2008. Overall 22% (20/90) were PNI-positive and 40% (36/90) underwent adjuvant XRT. Of those with PNI, 70% (14/20) underwent adjuvant XRT. Primary outcomes were OS, DSS, DFI, and LRC. Results: There were no differences between the PNI-positive and PNI-negative groups for age, gender, smoking or alcohol status, T-class, margin control, or median follow-up. PNI-positive patients had significantly worse DSS, DFI, and LRC than PNI-negative patients ( P = .049, P = .046, and P = .026, respectively), but there was no difference in OS between the 2 groups ( P = .15). Multivariate analysis verified PNI to be associated with worse DFI and LRC ( P = .02 and P = .006, respectively). Amongst PNI-positive patients, those who received adjuvant XRT demonstrated significantly improved DFI and LRC (mean 6.5 years vs 1.7 years; P = .012 and mean 6.7 years vs 1.9 years; P = .047, respectively). There was no improvement in OS or DSS in those receiving adjuvant XRT. Conclusion: Perineural invasion portends a worse DSS, DFI, and LRC in this cohort of patients with pN0 OCSCC. Adjuvant radiation significantly lengthens the DFI and improves LRC. Thus, it should be strongly considered for patients with PNI-positive pN0 OCSCC.

P-0041 The Prognostic Significance of Perineural Invasion in Patients of Gastric Cancer

IntroductionPerineural invasion (PNI) is the process of neoplastic invasion of nerves and is an under-recognized route of metastatic spread. Data from a large retrospective research suggest that PNI could function as an independent prognostic factor of outcomes in colorectal cancer (CRC) and PNI status should be considered in primary CRC specimens for therapy stratification. In this study we try to evaluate the prognostic significance of PNI in gastric cancer patients. MethodsThis study included gastric cancer patients who had undergone curative gastrectomy in our institution from January 2000 to December 2006. Pathological sections were stained with hematoxylin and eosin. Tumors were re-reviewed for PNI by a pathologist blinded to the patients' outcomes. PNI was assessed as positive when cancer cells in close proximity to nerve and involving at least 33% of its circumference or tumor cells within any of the 3 layers of the nerve sheath. The relationship between PNI positivity and other clinicopathological factors were analyzed using Chi-square test. Survival analysis and curves were established according to the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis to assess the role of PNI and other clinicopathological features as prognostic factors were performed by the Cox regression analysis. ResultsPNI was positive in 121 of the 292 patients (41.44%). pTNM stage, tumor size, tumor differentiation, Borrmann classification and blood vessel invasion were closely associated with the presence of PNI. However, PNI was not related to age, sex, tumor location and resection type. The 5-year overall survival rate was 41.3% for PNI-positive tumors versus 77.8% for PNI-negative tumors (P<0.05). In patients with negative-lymph node, the 5-year overall survival rate was 68.8% for PNI-positive ones versus 96.5% for PNI-negative ones (P<0.05). Univariate analysis showed that overall survival was affected by many factors including perineural invasion. However, on multivariate analysis, PNI was not indicated as an independent prognostic factor for overall survival. ConclusionFor the whole group of patients and the node-negative patients, the overall survival of PNI positive patients was significantly shorter than that of PNI negative patients. PNI is an indicator of cancer aggressiveness. However, multivariate analysis did not show PNI was an independent prognostic factor for gastric cancer patients with curative gastrectomy. [Display omitted]

Prognostic implications of perineural invasion following radical cystectomy for urothelial carcinoma.

e15014 Background: Perineural invasion(PNI) with urothelial carcinoma may be identified in radical cystectomy specimens, and its prognostic significance is controversial. We sought to determine the incidence and prognostic implications of PNI in a cohort of patients undergoing radical cystectomy for primary bladder cancer. Methods: From January 1996 to June 2011, 440 patients underwent radical cystectomy for urothelial bladder cancer with curative intent. Presence of PNI was determined in the cystectomy specimens, in addition to other histopathologic variables (grade, stage, surgical margins, lymphovascular invasion, concomitant variant secondary histologic subtypes, and presence of carcinoma-in-situ). Recurrence and survival data were analyzed to determine the prognostic significance of PNI in this cohort. Results: PNI was identified in 101 patients (23%) in our series. Those with extravesical primary tumors (61/128, 48%) and node-positive disease (34/86, 40%) were more likely to have PNI than organ-confined tumors (&lt;pT2; 10/183, 5%) (p&lt;0.001). Median follow-up was 2 years (range: 0.1 to 12.5 years). Compared to those with no evidence of PNI, recurrence-free survival was worse in the PNI-positive extravesical (p=0.01) and node-positive (p=0.02) tumors. Overall survival was also worse for PNI-positive patients (p&lt;0.001). On multivariate analysis, PNI was an independent risk factor for recurrence after radical cystectomy (p=0.01, RR=2.8: 95% CI 2.0-10.0). In the setting of PNI, adjuvant chemotherapy significantly improved overall survival(p=0.01). When analyzing PNI and lymphovascular invasion(LVI), there appears to be a worse recurrence-free survival for those who have both PNI and LVI than those with either alone(p&lt;0.001). Conclusions: PNI with urothelial carcinoma may be associated with a worse prognosis, especially for extravesical and node-positive disease following radical cystectomy. Adjuvant chemotherapy may benefit those patients who have PNI. Patients who have both PNI and LVI may be at higher risk for disease recurrence.

Treatment for T1-2 Oral Squamous Cell Carcinoma with or Without Perineural Invasion: Neck Dissection and Postoperative Adjuvant Therapy

Although perineural invasion (PNI) has been a poor prognostic factor for head and neck cancers, few studies have focused on oral squamous cell carcinoma (OSCC). The independent significance of PNI in early T1-2 OSCC and the benefit of treatment modification based on PNI status have not been assessed. This study investigated the role of PNI in T1-2 OSCC patients, with focus on the controversial issues of neck management and postoperative adjuvant therapy. PNI status was re-reviewed under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients. Oncologic and survival outcomes were analyzed by univariate and multivariate analyses. PNI was identified in 84 (27.4%) patients, correlating with several established poor prognostic factors. In multivariate analysis, PNI remained an independent predictor for neck metastasis, neck recurrence, and a worse 5-year disease-specific survival. Elective neck dissection contributed to a significantly better 5-year disease-specific survival only in cN0 patients with PNI-positive tumors (P = 0.0071) but not in those with PNI-negative tumors (P = 0.3566). In low-risk patients who were treated by surgery alone, including neck dissection, the 5-year disease-specific survival rates were almost the same in those with PNI-positive tumors and those with PNI-negative tumors (92.0 vs. 92.9%; P = 0.9104). Elective neck dissection is indicated for cN0 patients with PNI-positive tumors for the efficacy of improving disease-specific survival as well as neck control. However, low-risk PNI-positive patients who undergo neck dissection do not need postoperative adjuvant therapy, because the residual risk from PNI is minimal.

Clinical study of perineural invasion in patients with rectal cancer

To investigate the clinical significance of perineural invasion(PNI) in rectal cancer. Clinical data of 204 patients undergoing resection of low rectal cancer from January 2003 to January 2005 at the First People's Hospital of Chenzhou were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent resection of low rectal cancer were stained with HE. PNI-positive was defined as infiltration of carcinoma cell into the perineurium or neural fascia. The association of PNI with clinicopathologic features and prognosis of rectal cancer was analyzed. PNI was positive in 31.9%(65/204) of the patients. The tumor size, depth of invasion, lymph node metastasis, TNM stage, tumor growth pattern, histologic grade, tumor resection were significantly associated with PNI. The overall survival time of the PNI-positive patients was shorter than that of the PNI-negative patients[(43.8±1.5) months vs.(57.2±1.5) months, P<0.01]. Furthermore, the overall survival time of the PNI-positive stage II( patients was shorter than that of the stage III( patients [(46.5±3.2) months vs. (55.7±1.2) months, P<0.05]. PNI can be used as one of the indicators to predict the prognosis of patients with rectal cancer.

Analysis of clinical characteristics and prognosis of perineural invasion in patients with gastric carcinoma

To investigate the association between perineural invasion(PNI) and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma. A total of 178 patients with gastric carcinoma from January 2004 to May 2008 were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent gastric resection were stained with laminin. PNI-positive was defined as infiltration of carcinoma cells into the perineurium or neural fascicles. The association of PNI with clinicopathologic features and prognosis of gastric carcinoma was studied. PNI was positive in 78 of 178 patients(43.8%). The proportions of T stage, lymph node metastasis and TNM stage were significantly higher in PNI-positive group than those in PNI-negative group(all P<0.01). The PNI positive rate was correlated with the depth of gastric mural invasion and clinical stage. The overall survival in PNI-positive group was significantly lower than that in PNI-negative group by univariate analysis(P<0.01). The mean survival of PNI-positive patients(28.6 months) was significantly shorter than that of PNI-negative patients (44.3 months, P<0.01), which was also influenced by pN stage, pT stage, and clinical stage(P<0.01). By multivariable Cox proportional hazards model of overall survival, the positivity of PNI appeared to be an independent prognostic factor (hazards ratio=2.257, 95% CI:1.268-4.019, P=0.006). PNI is associated with the degree of malignancy in gastric cancer. PNI can be a candidate of new prognostic factor.

Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection

The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection. We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis. PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12-3.13) as were classical clinicopathological features. Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.

Prognostic Value of Perineural Invasion in Patients with Stage II Colorectal Cancer

Perineural invasion (PNI) may influence the prognosis after resection of colorectal cancer (CRC); whether this is a definite prognostic factor remains controversial. This study determined the clinicopathologic factors associated with oncologic outcome after radical resection of stage II CRC, focusing on PNI. We retrospectively reviewed 341 consecutive patients who underwent curative surgery for stage II CRC between January 2001 and December 2006. Of these, 278 patients (81.5%) received postoperative 5-fluorouracil-based chemotherapy. The oncologic outcomes and the risk factors for recurrence were analyzed. PNI was detected in 57 of 341 patients (16.7%) and was significantly associated with depth of tumor invasion (P = .035) and positive lymphovascular invasion (P < .001). Multivariate analyses revealed that PNI was a significant independent prognostic factor for disease-free survival, not for overall survival. With a median follow-up period of 57.6 months, the 5-year disease-free and overall survival rates of the patients were 80.2 and 82.6%, respectively. The 5-year disease-free survival of the PNI-negative group was significantly higher than that of the PNI-positive group (P < .001). Within the PNI-positive patients, those receiving chemotherapy had significantly higher 5-year disease-free survival than the others (P = .023). This study illustrates the value of PNI as a prognostic factor for stage II CRC. Moreover, PNI-positive patients should be considered for postoperative chemotherapy.

The Effect of Perineural Invasion on Overall Survival in Patients with Gastric Carcinoma

AimsThe availability of different treatment options for gastric carcinoma has reopened the question of correct definition of high-risk categories, which may help in identifying patients with high risk for poor prognosis who would benefit more from adjuvant therapy after operation. Perineural invasion (PNI) seems to provide useful information for management. Therefore, we examined the effect of PNI on overall survival (OS) in patients with gastric carcinoma and the association between PNI and other clinical and pathological factors. Patients and MethodsA total of 1,632 patients with gastric carcinoma from 2000 to 2005 were analyzed retrospectively. Paraffin sections of surgical specimens from all patients who underwent gastric resection were stained with laminin. If carcinoma cells infiltrated into the perineurium or neural fascicles, PNI was assessed as positive. Survival analysis was done in 1,372 patients with T1–T4 tumors who underwent curative resection. ResultPNI was positive in 518 of the 1,632 patients (31.7%). The size of tumors, T stage, differentiation of tumor, and clinical stage were significantly related to PNI positivity. The proportion of large tumors was significantly higher in PNI-positive patients than in PNI-negative patients (P < 0.01). As the depth of gastric mural invasion or clinical stage increased, the positive rate of PNI also increased. The OS of the PNI-positive patients was significantly shorter than that of the PNI-negative patients in the univariate analysis (P < 0.01). At multivariate Cox proportional hazards model of OS analysis, the positivity of PNI appeared to be an independent prognostic factor for OS (hazards ratio [HR] = 3.23, 95%CI = 2.6–8.11, P < 0.01), which was also influenced by tumor differentiation, T stage, and clinical stage (P < 0.01). ConclusionOur results suggested that the incidence of PNI was high in gastric carcinoma and that it corresponded to the progression of disease. It could provide additional information for identifying patients who are at high risk for poor prognosis. PNI can be a candidate for a new kind of prognostic parameters.

Perineural invasion has no prognostic value in patients with invasive breast carcinoma

No studies examining the relationship between perineural invasion (PNI) and clinicopathological factors in invasive breast cancer have been published. Therefore, we investigated this association and analyzed the effect of PNI on disease-free survival (DFS) in patients with invasive breast carcinoma. PNI evaluation was performed on hematoxylin- and eosin-stained tissue sections of surgical specimens from 377 patients. PNI was assessed as positive when cancer cells were seen in the perineurium or neural fascicles. PNI was found in 97 out of 377 patients (25.7%). PNI positivity was 13.9% in T1 tumors and 69.7% in T4 tumors (P<0.001). The incidence of PNI was higher in ductal and mixed type carcinomas than in other histologic types (P=0.013). Vascular invasion, axillary lymph node and progesterone receptor positivity ratios were significantly higher in PNI-positive patients than in PNI-negative ones (P<0.001, P=0.001 and 0.006, respectively). There was no difference between PNI-positive and -negative patients regarding DFS. In conclusion, in invasive breast carcinomas, PNI incidence is lower in small and axilla-negative tumors, and higher in ductal and mixed type and hormone-sensitive tumors; PNI has no prognostic importance.