PNI预测不同部位、不同分期结直肠癌患者预后价值的初步研究

Perineural invasion predicts prognosis of patients with colorectal cancer at different locations and of different stages: a preliminary study

目的探讨周围神经侵犯(PNI)预测不同部位、不同分期结直肠癌(CRC)预后的价值。方法回顾性分析本院2012年4月至2018年6月收治的1 013例结直肠癌患者的临床资料,所有患者均经病理学检查确诊为结直肠癌且临床资料完整。根据有无PNI将患者分为PNI阳性组(520例,占51.3%)和PNI阴性组(493例,占48.7%),收集两组患者的一般资料、病理资料、基因检测结果等临床资料进行统计学分析,并采用Kaplan-Meier法绘制生存曲线,使用Log-rank法进行差异性检验比较两组生存差异。结果两组患者年龄、性别、肿瘤部位、微卫星状态、Ras基因突变情况比较差异均无统计学意义(均P> 0.05);两组患者不同肿瘤分期PNI情况比较差异有统计学意义(P <0.05),分期越晚合并PNI的患者的比例越高。生存分析结果显示,有PNI的Ⅱ~Ⅲ期、微卫星状态稳定、肿瘤位于横结肠及升结肠的结直肠癌患者总生存时间均较短(均P <0.05)。结论 PNI与CRC患者肿瘤分期关系密切,可作为Ⅱ~Ⅲ期、微卫星状态稳定、肿瘤位于横结肠及升结肠的结直肠癌患者预后预测的重要指标之一。

Objectives To investigate whether perineural invasion(PNI) could predict prognosis of patients with colorectal cancer at different locations and of different stages. Methods This was a retrospective analysis of clinical data of 1013 patients with colorectal cancer treated in our hospital between April 2012 and June 2018. All patients were diagnosed with colorectal cancer by pathology and had complete clinical data. Patients were divided into with(n = 520, 51.3%) or without(n = 493, 48.6%)PNI. Patient characteristics, pathology report, and genetic report were collected. Kaplan-Meier survival curves were drawn and survival was compared between the two groups by Log-rank test. Results There was no significant difference between the two groups in age, sex, location of tumor, microsatellite testing, and mutation of Ras gene(P > 0.05). There was significant betweengroup difference in tumor stages(P < 0.05), with patient with more advanced stages having higher percentage of PNI. Overall survival was significantly shorter in patients with PNI of stage Ⅱ~Ⅲ cancer, microsatellite-stable cancer, and tumor located at transverse and ascending colon(P < 0.05). Conclusion PNI is associated with tumor stages in patients with colorectal cancer.It can be used as an important prognostic factors for patients with stage Ⅱ~Ⅲ and microsatellite-stable cancer, and with tumor located at transverse and ascending colon.