Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Colorectal Cancer

Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer

Authors: Abdulrahman Muaod Alotaibi, MD, Jong Lyul Lee, MD, Jihun Kim, MD, PhD, Seok-Byung Lim, MD, PhD, Chang Sik Yu, MD, PhD, Tae Won Kim, MD, PhD, Jong Hoon Kim, MD, PhD, Jin Cheon Kim, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

Login to get access

Abstract

Background

The presence of perineural invasion (PNI) in colorectal cancer (CRC) indicates a more aggressive phenotype, resulting in a poor prognosis. The aims of this study were to evaluate the oncologic outcome of PNI+ tumors and to investigate whether PNI status affects patient survival.

Methods

The study retrospectively enrolled 3807 patients from a single institution who underwent surgery for colorectal adenocarcinoma between January 2006 and December 2010. The patients were classified into two groups based on PNI status: PNI+ and PNI−.

Results

The PNI+ group included 565 patients (14.8 %) and had significantly more involved circumferential resection margins (p = 0.001) and a more advanced TNM stage (p = 0.001) than the PNI− group. Compared with the PNI− group, the PNI+ group had worse 5-year overall survival (65 vs. 88 %; p = 0.001) and 5-year disease-free survival (63 vs. 85 %; p = 0.001). Among PNI+ patients with stage IIA disease, those who received adjuvant therapy had significantly greater 5-year overall survival than those who did not (89.3 vs. 50.8 %; p = 0.001). In multivariate analyses, PNI+ was an independent negative prognostic factor for 5-year overall survival (hazard ratio [HR] 1.518, 95 % confidence interval [CI] 1.175–1.961; p = 0.001) and 5-year disease-free survival (HR 1.495, 95 % CI 1.237–1.806; p = 0.001).

Conclusions

PNI positivity is an independent predictor of aggressive behavior and unfavorable prognosis in CRC. Further evaluation is needed to confirm the impact of PNI status on survival in stage IIA CRC.
Appendix
Available only for authorised users
Literature
1.
Barresi V, Reggiani Bonetti L, Ieni A, Caruso RA, Tuccari G. Histological grading in colorectal cancer: new insights and perspectives. Histol Histopathol. 2015;30:1059–67.PubMed
2.
Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology. 2007;50:113–30.CrossRefPubMed
3.
Knijn N, Mogk SC, Teerenstra S, Simmer F, Nagtegaal ID. Perineural invasion is a strong prognostic factor in colorectal cancer: a systematic review. Am J Surg Pathol. 2016;40:103–12.CrossRefPubMed
4.
Betge J, Langner C. Vascular invasion, perineural invasion, and tumour budding: predictors of outcome in colorectal cancer. Acta Gastroenterol Belg. 2011;74:516–29.PubMed
5.
6.
Liebig C, Ayala G, Wilks JA, Berger DH, Albo D. Perineural invasion in cancer: a review of the literature. Cancer. 2009;115:3379–91.CrossRefPubMed
7.
Huh JW, Lee JH, Kim HR, Kim YJ. Prognostic significance of lymphovascular or perineural invasion in patients with locally advanced colorectal cancer. Am J Surg. 2013;206:758–63.CrossRefPubMed
8.
Peng J, Sheng W, Huang D, et al. Perineural invasion in pT3N0 rectal cancer: the incidence and its prognostic effect. Cancer. 2011;117:1415–21.CrossRefPubMed
9.
10.
Huh JW, Kim HR, Kim YJ. Prognostic value of perineural invasion in patients with stage II colorectal cancer. Ann Surg Oncol. 2010;17:2066–72.CrossRefPubMed
11.
Labianca R, Nordlinger B, Beretta GD, et al. Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl. 6):vi64–vi72.PubMed
12.
Fang SH, Efron JE, Berho ME, Wexner SD. Dilemma of stage II colon cancer and decision making for adjuvant chemotherapy. J Am Coll Surg. 2014;219:1056–69.CrossRefPubMed
13.
Yang Y, Huang X, Sun J, et al. Prognostic value of perineural invasion in colorectal cancer: a meta-analysis. J Gastrointest Surg. 2015;19:1113–22.CrossRefPubMed
14.
Lee JL, Yu CS, Kim TW, et al. Rate of pulmonary metastasis varies with location of rectal cancer in the patients undergoing curative resection. World J Surg. 2015;39:759–68.CrossRefPubMed
15.
Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum. 1983;26:613–7.CrossRefPubMed
16.
Bellis D, Marci V, Monga G. Light microscopic and immunohistochemical evaluation of vascular and neural invasion in colorectal cancer. Pathol Res Pract. 1993;189:443–7.CrossRefPubMed
17.
Shirouzu K, Isomoto H, Kakegawa T. Prognostic evaluation of perineural invasion in rectal cancer. Am J Surg. 1993;165:233–7.CrossRefPubMed
18.
Zhou Y, Wang H, Gong H, Cao M, Zhang G, Wang Y. Clinical significance of perineural invasion in stages II and III colorectal cancer. Pathol Res Pract. 2015;211:839–44.CrossRefPubMed
19.
Poeschl EM, Pollheimer MJ, Kornprat P, et al. Perineural invasion: correlation with aggressive phenotype and independent prognostic variable in both colon and rectum cancer. J Clin Oncol. 2010;28:e358-60; author reply e61-2.
20.
Ueno H, Shirouzu K, Eishi Y, et al. Characterization of perineural invasion as a component of colorectal cancer staging. Am J Surg Pathol. 2013;37:1542–9.CrossRefPubMed
21.
Moertel CG, O’Fallon JR, Go VL, O’Connell MJ, Thynne GS. The preoperative carcinoembryonic antigen test in the diagnosis, staging, and prognosis of colorectal cancer. Cancer. 1986;58:603–10.CrossRefPubMed
22.
Walther A, Houlston R, Tomlinson I. Association between chromosomal instability and prognosis in colorectal cancer: a meta-analysis. Gut. 2008;57:941–50.CrossRefPubMed
23.
Popat S, Houlston RS. A systematic review and meta-analysis of the relationship between chromosome 18q genotype, DCC status and colorectal cancer prognosis. Eur J Cancer. 2005;41:2060–70.CrossRefPubMed
24.
Fujita S, Shimoda T, Yoshimura K, Yamamoto S, Akasu T, Moriya Y. Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol. 2003;84:127–31.CrossRefPubMed
25.
Kim JC, Han MS, Lee HK, et al. Distribution of carcinoembryonic antigen and biologic behavior in colorectal carcinoma. Dis Colon Rectum. 1999;42:640–8.CrossRefPubMed
26.
Stewart D, Yan Y, Mutch M, et al. Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy. Colorectal Dis. 2008;10:879–86.CrossRefPubMed
27.
Tsai HL, Chu KS, Huang YH, et al. Predictive factors of early relapse in UICC stage I-III colorectal cancer patients after curative resection. J Surg Oncol. 2009;100:736–43.CrossRefPubMed
28.
29.
30.
Bentzen SM, Balslev I, Pedersen M, et al. Time to loco-regional recurrence after resection of Dukes’ B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis. Br J Cancer. 1992;65:102–7.CrossRefPubMedPubMedCentral
31.
Sveen A, Nesbakken A, Agesen TH, et al. Anticipating the clinical use of prognostic gene expression-based tests for colon cancer stage II and III: is Godot finally arriving? Clin Cancer Res. 2013;19:6669–77.CrossRefPubMed
Metadata
Title
Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer
Authors
Abdulrahman Muaod Alotaibi, MD
Jong Lyul Lee, MD
Jihun Kim, MD, PhD
Seok-Byung Lim, MD, PhD
Chang Sik Yu, MD, PhD
Tae Won Kim, MD, PhD
Jong Hoon Kim, MD, PhD
Jin Cheon Kim, MD, PhD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5748-4

Other articles of this Issue 6/2017

Annals of Surgical Oncology 6/2017 Go to the issue

Health Services Research and Global Oncology

External Validation of a Survival Nomogram for Non-Small Cell Lung Cancer Using the National Cancer Database

Urologic Oncology

Anticipatory Positive Urine Tests for Bladder Cancer

Pancreatic Tumors

Type of Resection (Whipple vs. Distal) Does Not Affect the National Failure to Provide Post-resection Adjuvant Chemotherapy in Localized Pancreatic Cancer

Breast Oncology

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database

Gynecologic Oncology

Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group

Bone and Soft Tissue Sarcomas

Surveillance Imaging Patterns and Outcomes Following Radiation Therapy and Radical Resection for Localized Extremity and Trunk Soft Tissue Sarcoma