直肠癌神经浸润预后研究

Affact of perineural invasion on the prognosis of patients with rectum cancer

目的分析神经浸润对评估直肠癌病人预后的作用。方法对安徽省亳州市人民医院2000～2007年213例直肠癌行全直肠系膜切除(TME)的病例资料进行回顾性分析。对手术切除标本进行石蜡切片并层黏连蛋白染色来判定肿瘤神经周围浸润(PNI)情况。分析PNI和其他临床或病理参数之间的关系。结果213例直肠癌中共有62例(29.1%)病理结果显示为PNI阳性。肿瘤的大小、肿瘤的浸润深度和肿瘤的临床分期和PNI密切相关。PNI阳性的直肠癌病例的平均生存时间为(23.04±9.95)个月明显低于PNI阴性的病例[(52.10±14.61)个月,P<0.01]。同时,根据COX比例风险回归模型分析提示PNI和肿瘤的大小、淋巴结转移、远处转移和临床分期是影响直肠癌病人预后独立的风险因素。结论PNI对直肠癌的分级、分期和病人预后评估有着重要的作用,可以作为一个独立的预后预测指标。

Objective To analyze the effect of perineural invasion on evaluating the prognosis of patients with rectal cancer. Methods The clinical data of 213 patients with rectum cancer performed total mesorectal excision （TME） from 2000 to 2007 at Bozhou People＇ s Hospital were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent TME were stained with laminin. The effect of PNI on overall survival （OS） in patients with rectum cancer and the association between PNI and other clinical and pathological parameters were analyzed. Results PNI was positive in 62 of all the 213 patients （29.11%）. The size of tumors, T stage and clinical stage were related to PNI significantly. The OS of the PNI-positive patients [（23.04 ±9.95）months] was shorter than that of the PNI-negative patients [（52.10±14.61 ）months] in the univariate analysis significantly （P〈0.01）. And at multivariate Cox proportional hazards model of OS analysis, the positivity of PNI appeared to be an independent prognostic factor to OS , which was also influenced by tumor size, lymph node metastasis and clinical stage （P〈0.01）. Conclusion The incidence of PNI plays an important role in evaluation of the tumor classification, stage and the prognosis of rectum cancer and it could serve as an independent predictor of prognosis of rectum cancer.