Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy

doi:10.19401/j.cnki.1007-3639.2022.12.011

Abstract

Abstract:

Background and purpose: Perineural invasion is a prognostic factor in colorectal cancer. It is unclear whether perineural invasion is a prognostic factor in in node-negative (ypⅠ-Ⅱ) rectal cancer patients who received neoadjuvant radiotherapy because there may be varying degrees of tumor regression. This study aimed to investigate prognostic value of perineural invasion in node-negative rectal cancer patients who received neoadjuvant radiotherapy. Methods: A total of 5 222 patients who received neoadjuvant radiotherapy and were diagnosed with stage ypⅠ-Ⅱ rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018 were identified and clinicopathological features and cancer-specific survival outcomes were retrospectively analyzed. Chi-square analysis was used to compare clinicopathological features between two groups. Kaplan-Meier survival analysis and the log-rank test were used to estimate the 5-year cancer-specific survival. Multivariable Cox regression analyses were used to identify the independent prognostic factor. Results: Compared with patients without perineural invasion, patients with perineural invasion were more likely to be black, have elevated carcinoembryonic antigen (CEA), stage Ⅱ disease, tumor<5 cm and poorer differentiated tumors (P<0.05). Patients without perineural invasion had superior cancer-specific survival than those with perineural invasion (5-years survival rate: 85.3% vs 68.9%). The survival difference was more evident in patients with stage ypⅡ cancer. Multivariable Cox regression analyses demonstrated that perineural invasion was an independent prognostic factor in node-negative rectal cancer patients who received neoadjuvant radiotherapy. Conclusion: Perineural invasion is associated with oncological outcomes of node-negative rectal cancer patients who received neoadjuvant radiotherapy, thus it could serve as a prognostic factor in these patients.

Key words: Perineural invasion, Rectal cancer, Neoadjuvant radiotherapy, Node-negative, Prognostic factor

CLC Number:

R735.3+7

WANG Jun, HE Ping. Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy[J]. China Oncology, 2022, 32(12): 1229-1234.

Figures/Tables 5

Tab. 1

Fig. 1

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Fig. 3

Tab. 2

References 9

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Variable	Positive (n=329)	Negative (n=4 893)	P value	Variable	Positive (n=329)	Negative (n=4 893)	P value
Age/year	60.5±11.8	61.2±11.8	0.261	Tumor size/cm			0.004
Gender			0.397	<5	194 (59.0)	2 491 (50.9)
Male	198 (60.2)	3 059 (62.5)		≥5	93 (28.3)	1 455 (29.7)
Female	131 (39.8)	1 834 (60.2)		Unknown	42 (12.8)	947 (19.4)
Race			0.002	Histological type			0.767
White	253 (76.9)	4 003 (81.8)		Adenocarcinoma	270 (82.1)	3 962 (81.0)
Black	44 (13.4)	386 (7.9)		Mucinous adenocarcinoma	16 (4.9)	224 (4.6)
Other	32 (9.7)	504 (10.3)		Signet ring carcinoma	2 (0.6)	18 (0.4)
Marital status			0.723	Unknown	41 (12.5)	689 (14.1)
Single/divorced	126 (38.3)	1 807 (36.9)		Grade			0.001
Married	191 (58.1)	2 867 (58.6)		Well	14 (4.3)	355 (7.3)
Unknown	12 (3.6)	219 (4.5)		Moderate	241 (73.3)	3 525 (72.0)
CEA level			<0.001	Poor	40 (12.2)	339 (6.9)
Normal	104 (31.6)	1 997 (40.8)		Undifferentiated	4 (1.2)	47 (1.0)
Elevated	118 (35.9)	1 291 (26.4)		Unknown	30 (9.1)	627 (12.8)
Unknown	107 (32.5)	1 605 (32.8)
Stage			<0.001
Ⅰ	30 (9.1)	1 186 (24.2)
Ⅱ	299 (90.9)	3 707 (75.8)

Variable	Univariate analysis		Multivariable analysis
Variable	HR (95% CI)	P value	HR (95% CI)	P value
Age	1.026 (1.020-1.032)	<0.001	1.027 (1.021-1.033)	<0.001
Gender
Male	Reference		Reference
Female	0.841 (0.731-0.967)	0.015	0.781 (0.677-0.901)	0.001
Race
White	Reference		-
Black	1.165 (0.928-1.463)	0.187
Others	0.802 (0.632-1.018)	0.070
Marital status
Single/divorced	Reference		Reference
Married	0.695 (0.606-0.797)	<0.001	0.679 (0.591-0.780)	<0.001
Unknown	-		-
CEA level
Normal	Reference		Reference
Elevated	1.585 (1.348-1.863)	<0.001	1.469 (1.248-1.728)	<0.001
Unknown	-
Stage
Ⅰ	Reference		Reference
Ⅱ	1.344 (1.136-1.591)	0.001	1.200 (1.011-1.426)	0.037
Tumor size/cm
<5	Reference		Reference
≥5	1.278 (1.100-1.484)	0.001	1.213 (1.043-1.411)	0.012
Unknown	-		-
Histological type
Adenocarcinoma	Reference		Reference
Mucinous adenocarcinoma	1.746 (1348-2.260).	<0.001	1.614 (1.245-2.093)	<0.001
Signet ring carcinoma	6.060 (3.421-10.734)	<0.001	5.651 (3.144-10.157)	<0.001
Unknown	-		-
Grade
Well	Reference		Reference
Moderate	1.024 (0.779-1.347)	0.865	1.030 (0.782-1.355)	0.835
Poor	1.711 (1.232-2.376)	0.001	1.482 (1.064-2.065)	0.020
Undifferentiated	2.325 (1.315-4.111)	0.004	2.247 (1.269-3.978)	0.005
Unknown	-		-
Perineural invasion
Negative	Reference		Reference
Positive	2.492 (2.042-3.042)	<0.001	2.454 (2.005-3.004)	<0.001

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