Top

Annals of Surgical Oncology

Published in:

01-08-2010 | Colorectal Cancer

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

Authors: Jung Wook Huh, MD, Hyeong Rok Kim, MD, Young Jin Kim, MD

Published in: Annals of Surgical Oncology | Issue 8/2010

Abstract

Background

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.

Materials and Methods

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.

Results

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).

Conclusion

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.

O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96:1420–5.CrossRefPubMed

Engstrom PF, Benson AB III, Chen YJ, Choti MA, Dilawari RA, Enke CA, et al. Colon cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2005;3:468–91.PubMed

Norum J. Adjuvant chemotherapy in Dukes’ B and C colorectal cancer has only a minor influence on psychological distress. Support Care Cancer. 1997;5:318–21.CrossRefPubMed

Ambiru S, Miyazaki M, Ito H, Nakagawa K, Shimizu H, Kato A, et al. Resection of hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer. 1998;82:274–8.CrossRefPubMed

Fujita S, Nakanisi Y, Taniguchi H, Yamamoto S, Akasu T, Moriya Y, et al. Cancer invasion to Auerbach’s plexus is an important prognostic factor in patients with pT3-pT4 colorectal cancer. Dis Colon Rectum. 2007;50:1860–6.CrossRefPubMed

Di Fabio F, Nascimbeni R, Villanacci V, Baronchelli C, Bianchi D, Fabbretti G, et al. Prognostic variables for cancer-related survival in node-negative colorectal carcinomas. Dig Surg. 2004;21:128–33.CrossRefPubMed

Ueno H, Hase K, Mochizuki H. Criteria for extramural perineural invasion as a prognostic factor in rectal cancer. Br J Surg. 2001;88:994–1000.CrossRefPubMed

Burdy G, Panis Y, Alves A, Nemeth J, Lavergne-Slove A, Valleur P. Identifying patients with T3-T4 node-negative colon cancer at high risk of recurrence. Dis Colon Rectum. 2001;44:1682–8.CrossRefPubMed

Mamounas E, Wieand S, Wolmark N, Bear HD, Atkins JN, Song K, et al. Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol. 1999;17:1349–55.PubMed

10.

Sakamoto J, Ohashi Y, Hamada C, Buyse M, Burzykowski T, Piedbois P. Efficacy of oral adjuvant therapy after resection of colorectal cancer: 5-year results from three randomized trials. J Clin Oncol. 2004;22:484–92.PubMed

11.

Benson AB III, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22:3408–19.CrossRefPubMed

12.

Newland RC, Dent OF, Chapuis PH, Bokey L. Survival after curative resection of lymph node negative colorectal carcinoma. A prospective study of 910 patients. Cancer. 1995;76:564–71.CrossRefPubMed

13.

Merkel S, Wein A, Gunther K, Papadopoulos T, Hohenberger W, Hermanek P. High-risk groups of patients with Stage II colon carcinoma. Cancer. 2001;92:1435–43.CrossRefPubMed

14.

Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Landmann RG, et al. Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum. 2008;51:503–7.CrossRefPubMed

15.

Tsai HL, Cheng KI, Lu CY, Kuo CH, Ma CJ, Wu JY, et al. Prognostic significance of depth of invasion, vascular invasion and numbers of lymph node retrievals in combination for patients with stage II colorectal cancer undergoing radical resection. J Surg Oncol. 2008;97:383–7.CrossRefPubMed

16.

Caplin S, Cerottini JP, Bosman FT, Constanda MT, Givel JC. For patients with Dukes’ B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer. 1998;83:666–72.CrossRefPubMed

17.

Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC. Prognostic factors in stage T3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum. 1999;42:167–73.CrossRefPubMed

18.

Mulcahy HE, Toner M, Patchett SE, Daly L, O’Donoghue DP. Identifying stage B colorectal cancer patients at high risk of tumor recurrence and death. Dis Colon Rectum. 1997;40:326–31.CrossRefPubMed

19.

Huh JW, Oh BR, Kim HR, Kim YJ. Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol. 2010 [Epub ahead of print].

20.

Gill S, Loprinzi CL, Sargent DJ, Thome SD, Alberts SR, Haller DG, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22:1797–806.CrossRefPubMed

21.

Yun HR, Kim HC, Lee WY, Cho YB, Yun SH, Chun HK. The necessity of chemotherapy in T3N0M0 colon cancer without risk factors. Am J Surg. 2009;198:354–8.CrossRefPubMed

22.

Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg. 2002;235:458–63.CrossRefPubMed

23.

Wong JH, Bowles BJ, Bueno R, Shimizu D. Impact of the number of negative nodes on disease-free survival in colorectal cancer patients. Dis Colon Rectum. 2002;45:1341–8.CrossRefPubMed

24.

Murphy J, Pocard M, Jass JR, O’Sullivan GC, Lee G, Talbot IC. Number and size of lymph nodes recovered from dukes B rectal cancers: correlation with prognosis and histologic antitumor immune response. Dis Colon Rectum. 2007;50:1526–34.CrossRefPubMed

25.

McLeod HL, Murray GI. Tumour markers of prognosis in colorectal cancer. Br J Cancer. 1999;79:191–203.CrossRefPubMed

26.

Huh JW, Kim HR, Lee JH, Kim YJ. Comparison of cyclooxygenase-2 and CD44 mRNA expression in colorectal cancer and its relevance for prognosis. Virchows Arch. 2009;454:381–7.CrossRefPubMed

27.

Huh JW, Kim HR, Kim YJ, Lee JH, Park YS, Cho SH, et al. Expression of standard CD44 in human colorectal carcinoma: association with prognosis. Pathol Int. 2009;59:241–6.CrossRefPubMed

28.

Huh JW, Kim HR, Kim YJ. Proliferating cell nuclear antigen as a prognostic factor after total mesorectal excision of stage II-III rectal cancer. Ann Surg Oncol. 2009;16:1494–500.CrossRefPubMed

29.

Allegra CJ, Paik S, Colangelo LH, Parr AL, Kirsch I, Kim G, et al. Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes’ B and C colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study. J Clin Oncol. 2003;21:241–50.CrossRefPubMed

30.

Watanabe T, Wu TT, Catalano PJ, Ueki T, Satriano R, Haller DG, et al. Molecular predictors of survival after adjuvant chemotherapy for colon cancer. N Engl J Med. 2001;344:1196–206.CrossRefPubMed

Title: Prognostic Value of Perineural Invasion in Patients with Stage II Colorectal Cancer
Authors: Jung Wook Huh, MD
Hyeong Rok Kim, MD
Young Jin Kim, MD
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 8/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-0982-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2010

Adherence to the National Quality Forum (NQF) Breast Cancer Measures Within Cancer Clinical Trials: A Review From ACOSOG Z0010

Laparoscopic Right Hemihepatectomy for Hepatocellular Carcinoma

Positive Expression of L1-CAM is Associated with Perineural Invasion and Poor Outcome in Pancreatic Ductal Adenocarcinoma

Histological Regression of Squamous Esophageal Carcinoma Assessed by Percentage of Residual Viable Cells after Neoadjuvant Chemoradiation is an Important Prognostic Factor

Bevacizumab Improves Pathological Response of Colorectal Cancer Liver Metastases Treated with XELOX/FOLFOX

Sentinel Node Positive Melanoma Patients: Prediction and Prognostic Significance of Nonsentinel Node Metastases and Development of a Survival Tree Model