Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer

MacDermid

et al. 2019

ANZ Journal of Surgery

Background Positive circumferential resections are associated with local disease recurrence and reduced survival in rectal cancer. We studied a cohort of consecutive rectal cancer resections to assess for clinicopathological differences and survival in patients with positive and negative circumferential margins. Methods Rectal cancers were identified from a retrospective histopathology database of colorectal resections performed at five western Sydney hospitals from 2010 to 2016. Univariate and multivariate analysis with binary logistic regression were performed on histopathology data matched with survival times from the New South Wales Registry of Births Deaths and Marriages. Results A total of 502 rectal cancer patients were identified including 66 (13.1%) with involved circumferential margins. Patients with positive and negative circumferential margins had a similar distribution of age, gender and use of neoadjuvant radiotherapy. Tumours with involved circumferential margin comprised 98.5% T3 and T4 disease of which 51.5% received neoadjuvant radiotherapy. These were significantly associated with metastatic disease, increasing tumour size, circumferential and perforated tumours on univariate analysis. Multivariate analysis identified abdomino‐perineal resection (odds ratio (OR) 3.35; P = 0.003), en‐bloc multivisceral resection (OR 2.56; P = 0.032), T4 stage (OR 6.99; P < 0.001), perineural (OR 5.61; P < 0.001) and vascular invasion (OR 2.46; P = 0.022) as independent risk factors. Five‐year survival was significantly worse for patients with involved circumferential margins (26% versus 69%; P < 0.001). Conclusion Circumferential margin status reflects not only technical success but also aggressive disease phenotypes which require adjuvant therapy. Further work is needed to determine whether omission of radiotherapy has had an effect on long‐term outcomes in some of our at‐risk patients.

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinicopathological factors associated with positive circumferential margins in rectal cancers

MacDermid

et al. 2019

ANZ Journal of Surgery

“…It has been reported that PNI was significantly associated with recurrence and poor survival outcome in pancreatic cancer, prostate cancer and colorectal cancer 11–14. Furthermore, there have been several studies evaluating the prognostic significance of PNI for GC patients, but the results were conflicting.…”

Section: Introductionmentioning

confidence: 99%

Perineural invasion as a predictive factor for survival outcome in gastric cancer patients: a systematic review and meta-analysis

Zhao

Mei

et al. 2020

J Clin Pathol

AimsThe prognostic significance of perineural invasion (PNI) for gastric cancer (GC) patients was under debate. This study aimed to review relevant studies and evaluate the impact of PNI on the survival outcome of GC patients.MethodsSystematic literature search was performed using PubMed and Embase databases. The relevant data were extracted, and the association between PNI and clinicopathological characteristics or survival outcome in GC patients were evaluated using a fixed-effect model or random-effect model.ResultsA total 13 studies involving 7004 GC patients were included in this meta-analysis. The positive rate of PNI was 35.9% (2512/7004) in GC patients, ranging from 6.9% to 75.6%. There were significant relationships between PNI and a series of unfavourable clinicopathological factors including undifferentiated histology type (OR: 1.78, 95% CI 1.37 to 2.33, p<0.001; I2=75.3%), diffuse type (OR: 1.96, 95% CI 1.07 to 3.60, p=0.029; I2=79.5%), lymphatic invasion (OR: 7.00, 95% CI 3.76 to 13.03, p<0.001; I2=83.6%), vascular invasion (OR: 5.79, 95% CI 1.59 to 21.13, p=0.008; I2=95.8%), deeper tumour invasion (OR: 4.79, 95% CI 3.65 to 6.28, p<0.001; I2=65.0%) and lymph node metastasis (OR: 3.60, 95% CI 2.37 to 5.47, p<0.001; I2=89.6%). In addition, PNI was significantly associated with worse survival outcome in GC patients (HR: 1.69, 95% CI 1.38 to 2.06, p<0.001; I2=71.0%).ConclusionPNI was frequently detected in surgically resected specimens of GC patients, and it was a predictive factor for survival outcomes in these patients.

Journal of Surgical Oncology

“…To address this, efforts have been made to identify factors beyond the standard Tumor, Node, and Metastasis classification to stratify risks of recurrence and mortality. As a result, pathological and molecular features including poorly differentiated cancers, lymphovascular invasion, perineural invasion, and microsatellite instability have been validated as risk factors …”

Section: Introductionmentioning

confidence: 99%

Impact of intramural and extramural vascular invasion on stage II‐III colon cancer outcomes

Leijssen

Dinaux

Amri

et al. 2019

Background and Objectives: Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II-III colon cancer. Methods: All stage II-III colon cancer patients who underwent surgery between 2004–2015 were reviewed. We divided the study group into patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n=923). Results: EMVI was associated with other high-risk features, including T4, N+ disease, lymphatic, and perineural invasion (P<0.001). EMVI+ patients had considerably higher rates of locoregional and distant recurrence and subsequently disease-specific mortality (stage-II: odds ratio (OR) 3.64, P=0.001, stage-III OR:1.94, P=0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR:1.21, P=0.764, OR:1.28, P=0.607, respectively). The adjusted hazard ratios for EMVI+ patients on disease-free survival, and disease-specific survival were 2.07 (P<0.001), 1.67 (P=0.027), respectively. Moreover, EMVI+ stage-II patients fared worse than EMVI– stage-III patients, even after adjusting for adjuvant chemotherapy. Conclusion: EMVI is a strong predictor for worse oncologic outcomes in stage II-III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.