结直肠癌切除术病人嗜神经侵袭情况及其与预后的相关性研究

Neurotropic invasion in patients with colorectal cancer resection and its correlation with prognosis

目的 探讨结直肠癌切除术病人嗜神经侵袭(PNI)情况及其与预后的相关性。方法 前瞻性选取2018年9月~2019年8月我院行结直肠癌切除术的病人200例,根据是否发生PNI分为PNI组和无PNI组,比较两组病人一般资料、临床特征等,记录所有病人术后总生存时间(OS)以评估预后情况,采用Kaplan-Meier法分析不同特征病人预后。采用Cox回归分析结直肠癌病人切除术后预后影响因素。结果 200例病人中,39例出现PNI为PNI组,其余161例为无PNI组;PNI组肿瘤直径较非PNI组大,T分期T3~T4比例高、转移淋巴结比例高、术后辅助治疗比例较非PNI组多,差异有统计学意义(P<0.05);Kaplan-Meier曲线显示,病理分期T3~T4病人3年总生存期显著低于病理分期T1~T2期者(Log-rankχ^(2)=3.936,P=0.047);PNI阳性者3年生存率低于PNI阴性者(Log-rankχ^(2)=10.629,P<0.001);术后辅助治疗3年生存率显著高于术后未辅助治疗者(Log-rankχ^(2)=8.362,P=0.003);术后辅助治疗中,PNI阳性者3年生存率高于PNI阴性者(Log-rankχ^(2)=28.824,P<0.001);术后未辅助治疗中,PNI阴性者3年总生存期显著高于PNI阳性者(Log-rankχ^(2)=6.509,P=0.011);Cox多因素回归分析显示,T3~T4期(HR=3.228,95%CI 1.813~5.747)、转移淋巴结比例高(HR=3.304,95%CI 1.996~5.469)、肿瘤直径大(HR=2.571,95%CI 1.161~5.694)、PNI阳性(HR=2.792,95%CI 1.669~4.669)是结直肠癌切除术后预后的危险因素(P<0.05)。结论 结直肠癌切除术病人存在PNI现象,且PNI与预后有关。

Objective To investigate the status of neurotropic invasion(PNI) in patients with colorectal cancer resection and its correlation with prognosis.Methods A total of 200 patients who underwent colorectal cancer resection in our hospital from September 2018 to August 2019 were prospectively selected as research objects,and divided into PNI group and no PNI group according to whether PNI occurred.The general data such as clinical characteristics and condition of the two groups were compared,and the postoperative overall survival time(OS) of all patients was recorded to evaluate the prognosis.The Kaplan-Meier method was used to analyze the prognosis of patients with different characteristics;Cox regression was used to analyze the prognostic factors of colorectal cancer patients after resection.Results Among the 200 patients,39(19.50%) had PNI and were classified as PNI group,and the remaining 161 patients were classified as non-PNI group;Compared with non-PNI group,the tumor diameter in PNI group was larger,the proportion of T stage T3 to T4,the proportion of metastatic lymph nodes and the proportion of postoperative adjuvant therapy were higher(P<0.05);Kaplan-Meier curve showed that the 3-year overall survival time of patients with pathological stages T3 to T4 was significantly lower than that of patients with pathological stages T1 to T2(Log-rankχ^(2)=3.936,P=0.047).The 3-year overall survival of PNI positive patients was significantly lower than that of PNI negative patients(Log-rankχ^(2)=10.629,P<0.001).The 3-year overall survival time after adjuvant treatment was significantly higher than that without adjuvant treatment(Log-rankχ^(2)=8.362,P=0.003).The 3-year overall survival of PNI positive patients was significantly higher than that of PNI negative patients(Log-rankχ^(2)=28.824,P<0.001).Without adjuvant treatment,the 3-year overall survival time of PNI-negative patients was significantly higher than that of PNI-positive patients(Log-rankχ^(2)=6.509,P=0.011).Cox multivariate regression analysis showed that:T3~T4(HR=3.228,95%CI 1.813~5.747),proportion of metastatic lymph nodes(HR=3.304,95%CI 1.996~5.469),large tumor diameter(HR=2.571,95%CI 1.161~5.694),positive PNI(HR=2.792,95%CI 1.669~4.669) was a risk factor for prognosis after colorectal cancer resection(all P<0.05).Conclusion PNI phenomenon exists in patients undergoing colorectal cancer resection,and PNI is related to prognosis.