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The prognostic effect of perineural invasion in esophageal squamous cell carcinoma.

Chen JW, Xie JD, Ling YH, Li P, Yan SM, Xi SY, Luo RZ, Yun JP, Xie D, Cai MY - BMC Cancer (2014)

Bottom Line: Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001).In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027).The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively).

View Article: PubMed Central - HTML - PubMed

Affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. caimuyan@hotmail.com.

ABSTRACT

Background: Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined. The objective of this study was to determine the association between PNI status and clinical outcomes.

Methods: We retrospectively evaluated the PNI of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. The resulting data were analyzed using Spearman's rank correlation, the Kaplan-Meier method, Cox proportional hazards regression modeling and Harrell's concordance index (C-index).

Results: PNI was identified in 209 of the 433 (47.7%) cases of ESCC. The correlation analysis demonstrated that PNI in ESCC was significantly correlated with tumor differentiation, infiltration depth, pN classification and stage (P < 0.05). The five-year overall survival rate was 0.570 for PNI-negative tumors versus 0.326 for PNI-positive tumors. Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001). In the subset of patients with node-negative disease, PNI was evaluated as a prognostic predictor as well (P < 0.05). In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027). The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively).

Conclusions: PNI can function as an independent prognostic factor of outcomes in ESCC patients, and the PNI status in primary ESCC specimens should be considered for therapy stratification.

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The status of perineural invasion (PNI) in ESCC specimens. Tumor cells located within any of the endoneurium (A), perineurium (B) and epineurium (C) of the peripheral nerve sheath are clear examples of PNI. When tumor cells are not located inside of the nerve sheath but are in close proximity to the nerve in the perineural environment, at least 33% of the circumference of the nerve should be surrounded by tumor cells to diagnose PNI (D); anything less than 33% represents focal abutment and not invasion (E). When tumor cells are not in close proximity to the nerve in the perineural environment (F), it represents negative finding (hematoxylin-eosin staining, ×100).
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Figure 1: The status of perineural invasion (PNI) in ESCC specimens. Tumor cells located within any of the endoneurium (A), perineurium (B) and epineurium (C) of the peripheral nerve sheath are clear examples of PNI. When tumor cells are not located inside of the nerve sheath but are in close proximity to the nerve in the perineural environment, at least 33% of the circumference of the nerve should be surrounded by tumor cells to diagnose PNI (D); anything less than 33% represents focal abutment and not invasion (E). When tumor cells are not in close proximity to the nerve in the perineural environment (F), it represents negative finding (hematoxylin-eosin staining, ×100).

Mentions: PNI was defined as tumor cells within any layer of the peripheral nerve sheath or tumor cells in the perineural space that involved at least 33% of the nerve circumference. The patterns of PNI in ESCC specimens were shown in Figure 1. PNI was identified in 209 (47.7%) of the 433 patients. A further correlation analysis demonstrated that the presence of PNI was significantly correlated with tumor differentiation, infiltration depth, pN classification and ESCC stage (P < 0.05, Table 1). There was no significant association between the presence of PNI and other clinicopathologic features, such as the patient’s age, gender and location and size of the tumor (P > 0.05, Table 1).


The prognostic effect of perineural invasion in esophageal squamous cell carcinoma.

Chen JW, Xie JD, Ling YH, Li P, Yan SM, Xi SY, Luo RZ, Yun JP, Xie D, Cai MY - BMC Cancer (2014)

The status of perineural invasion (PNI) in ESCC specimens. Tumor cells located within any of the endoneurium (A), perineurium (B) and epineurium (C) of the peripheral nerve sheath are clear examples of PNI. When tumor cells are not located inside of the nerve sheath but are in close proximity to the nerve in the perineural environment, at least 33% of the circumference of the nerve should be surrounded by tumor cells to diagnose PNI (D); anything less than 33% represents focal abutment and not invasion (E). When tumor cells are not in close proximity to the nerve in the perineural environment (F), it represents negative finding (hematoxylin-eosin staining, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016635&req=5

Figure 1: The status of perineural invasion (PNI) in ESCC specimens. Tumor cells located within any of the endoneurium (A), perineurium (B) and epineurium (C) of the peripheral nerve sheath are clear examples of PNI. When tumor cells are not located inside of the nerve sheath but are in close proximity to the nerve in the perineural environment, at least 33% of the circumference of the nerve should be surrounded by tumor cells to diagnose PNI (D); anything less than 33% represents focal abutment and not invasion (E). When tumor cells are not in close proximity to the nerve in the perineural environment (F), it represents negative finding (hematoxylin-eosin staining, ×100).
Mentions: PNI was defined as tumor cells within any layer of the peripheral nerve sheath or tumor cells in the perineural space that involved at least 33% of the nerve circumference. The patterns of PNI in ESCC specimens were shown in Figure 1. PNI was identified in 209 (47.7%) of the 433 patients. A further correlation analysis demonstrated that the presence of PNI was significantly correlated with tumor differentiation, infiltration depth, pN classification and ESCC stage (P < 0.05, Table 1). There was no significant association between the presence of PNI and other clinicopathologic features, such as the patient’s age, gender and location and size of the tumor (P > 0.05, Table 1).

Bottom Line: Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001).In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027).The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively).

View Article: PubMed Central - HTML - PubMed

Affiliation: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. caimuyan@hotmail.com.

ABSTRACT

Background: Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined. The objective of this study was to determine the association between PNI status and clinical outcomes.

Methods: We retrospectively evaluated the PNI of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. The resulting data were analyzed using Spearman's rank correlation, the Kaplan-Meier method, Cox proportional hazards regression modeling and Harrell's concordance index (C-index).

Results: PNI was identified in 209 of the 433 (47.7%) cases of ESCC. The correlation analysis demonstrated that PNI in ESCC was significantly correlated with tumor differentiation, infiltration depth, pN classification and stage (P < 0.05). The five-year overall survival rate was 0.570 for PNI-negative tumors versus 0.326 for PNI-positive tumors. Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001). In the subset of patients with node-negative disease, PNI was evaluated as a prognostic predictor as well (P < 0.05). In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027). The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively).

Conclusions: PNI can function as an independent prognostic factor of outcomes in ESCC patients, and the PNI status in primary ESCC specimens should be considered for therapy stratification.

Show MeSH
Related in: MedlinePlus