神经侵犯在新辅助放疗后ypⅠ~Ⅱ期直肠癌中 的预后预测价值. (Chinese)

Prognostic value of perineural invasion in ypⅠ-Ⅱ rectal cancer patients who received neoadjuvant radiotherapy. (English)

Background and purpose: Perineural invasion is a prognostic factor in colorectal cancer. It is unclear whether perineural invasion is a prognostic factor in in node-negative (ypⅠ-Ⅱ) rectal cancer patients who received neoadjuvant radiotherapy because there may be varying degrees of tumor regression. This study aimed to investigate prognostic value of perineural invasion in node-negative rectal cancer patients who received neoadjuvant radiotherapy. Methods: A total of 5 222 patients who received neoadjuvant radiotherapy and were diagnosed with stage ypⅠ-Ⅱ rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018 were identified and clinicopathological features and cancer-specific survival outcomes were retrospectively analyzed. Chi-square analysis was used to compare clinicopathological features between two groups. Kaplan- Meier survival analysis and the log-rank test were used to estimate the 5-year cancer-specific survival. Multivariable Cox regression analyses were used to identify the independent prognostic factor. Results: Compared with patients without perineural invasion, patients with perineural invasion were more likely to be black, have elevated carcinoembryonic antigen (CEA), stage Ⅱ disease, tumor＜5 cm and poorer differentiated tumors (P＜0.05). Patients without perineural invasion had superior cancer-specific survival than those with perineural invasion (5-years survival rate: 85.3% vs 68.9%). The survival difference was more evident in patients with stage ypⅡ cancer. Multivariable Cox regression analyses demonstrated that perineural invasion was an independent prognostic factor in node-negative rectal cancer patients who received neoadjuvant radiotherapy. Conclusion: Perineural invasion is associated with oncological outcomes of node-negative rectal cancer patients who received neoadjuvant radiotherapy, thus it could serve as a prognostic factor in these patients. [ABSTRACT FROM AUTHOR]

背景与目的：神经侵犯在结直肠癌中有一定的预后价值。对于局部进展期直肠癌，在接受过新辅助放疗及根治性 外科手术且经术后病理学检查证实淋巴结为阴性（ypⅠ~Ⅱ）的直肠癌患者中，肿瘤可能存在不同程度的退缩，而此时神 经侵犯是否还有预后价值目前尚未见报道。本研究旨在探讨神经侵犯在新辅助放疗后淋巴结阴性的直肠癌中的预后价值。 方法：回顾性分析美国癌症监测、流行病学和最终结果（the Surveillance, Epidemiology, and End Results，SEER）数据库 2000年—2018年5 222例接受新辅助放疗术后经病理学检查证实为ypⅠ~Ⅱ期的直肠癌患者的临床病理学资料和直肠癌特异 性生存资料，采用卡方检验比较有无神经侵犯两组患者之间的基线资料差异，用Kaplan-Meier法和log-rank检验比较两组之 间的生存差异，运用多因素Cox回归模型分析对患者肿瘤特异性生存有影响的因素。结果：该人群中有神经侵犯者329例， 无神经侵犯者4 893例。与无神经侵犯的患者相比，有神经侵犯的患者中，黑种人、癌胚抗原（carcinoembryonic antigen， CEA）升高、Ⅱ期病灶、肿瘤小于5 cm和低分化的比例更高（P＜0.05）。无神经侵犯的直肠癌患者的肿瘤特异性生存显 著优于有神经侵犯的直肠癌患者（5年生存率：85.3% vs 68.9%），且此种生存差异在ypⅡ期直肠癌患者中更显著。多因素 Cox回归模型提示有神经侵犯是新辅助放疗后淋巴结阴性直肠癌患者的独立预后因子。结论：神经侵犯与新辅助放疗后淋 巴结阴性的直肠癌患者的生存密切相关，可作为此类患者的预后评判因子。 [ABSTRACT FROM AUTHOR]

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