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神经侵犯在新辅助放疗后ypⅠ~Ⅱ期直肠癌中的预后预测价值
Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy
- 中国癌症杂志 2022年32卷第12期 页码：1229-1234
- 作者机构：
1. 南昌市第一医院北院普外科，江西 南昌 330006
2. 南昌市第一医院普外科，江西 南昌 330008
- 作者简介：
[ "王俊（ORCID: 0000-0003-4513-6561），学士学位，主治医师。" ]
何平（ORCID: 0000-0002-3548-2607），硕士学位，副主任医师。
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2022.12.011
中图分类号： R735.3+7收稿：2021-10-18，
修回：2022-11-30，
纸质出版：2022-12-30
- 稿件说明：
移动端阅览
王俊, 何平. 神经侵犯在新辅助放疗后ypⅠ~Ⅱ期直肠癌中的预后预测价值[J]. 中国癌症杂志, 2022,32(12):1229-1234.
Jun WANG, Ping HE. Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy[J]. China Oncology, 2022, 32(12): 1229-1234.
王俊, 何平. 神经侵犯在新辅助放疗后ypⅠ~Ⅱ期直肠癌中的预后预测价值[J]. 中国癌症杂志, 2022,32(12):1229-1234. DOI： 10.19401/j.cnki.1007-3639.2022.12.011.
Jun WANG, Ping HE. Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy[J]. China Oncology, 2022, 32(12): 1229-1234. DOI： 10.19401/j.cnki.1007-3639.2022.12.011.
摘要
背景与目的：
神经侵犯在结直肠癌中有一定的预后价值。对于局部进展期直肠癌，在接受过新辅助放疗及根治性外科手术且经术后病理学检查证实淋巴结为阴性（ypⅠ~Ⅱ）的直肠癌患者中，肿瘤可能存在不同程度的退缩，而此时神经侵犯是否还有预后价值目前尚未见报道。本研究旨在探讨神经侵犯在新辅助放疗后淋巴结阴性的直肠癌中的预后价值。
方法：
回顾性分析美国癌症监测、流行病学和最终结果（the Surveillance
Epidemiology
and End Results，SEER）数据库2000年—2018年5 222例接受新辅助放疗术后经病理学检查证实为ypⅠ~Ⅱ期的直肠癌患者的临床病理学资料和直肠癌特异性生存资料，采用卡方检验比较有无神经侵犯两组患者之间的基线资料差异，用Kaplan-Meier法和log-rank检验比较两组之间的生存差异，运用多因素Cox回归模型分析对患者肿瘤特异性生存有影响的因素。
结果：
该人群中有神经侵犯者329例，无神经侵犯者4 893例。与无神经侵犯的患者相比，有神经侵犯的患者中，黑种人、癌胚抗原（carcinoembryonic antigen，CEA）升高、Ⅱ期病灶、肿瘤小于5 cm和低分化的比例更高（
P
<
0.05）。无神经
侵犯的直肠癌患者的肿瘤特异性生存显著优于有神经侵犯的直肠癌患者（5年生存率：85.3%
vs
68.9%），且此种生存差异在ypⅡ期直肠癌患者中更显著。多因素Cox回归模型提示有神经侵犯是新辅助放疗后淋巴结阴性直肠癌患者的独立预后因子。
结论：
神经侵犯与新辅助放疗后淋巴结阴性的直肠癌患者的生存密切相关，可作为此类患者的预后评判因子。
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 rect
al 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.
关键词
Keywords
references
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