Clinical Significance of Perineural Invasion in Colorectal Cancer

Transcription

1 Clinical Significance of Perineural Invasion in Colorectal Cancer Department of Surgery, Soonchunhyang University College of Medicine, Korea. Hyung Wook Lee, Tae Sung Ahn, Sung Woo Cho, Eung Jin Shin, Nae Kyung Park, Moon Soo Lee, Chang Ho Kim, Moo Jun Baek 30 Hyung Wook Lee Tae Sung Ahn Sung Woo Cho Eung Jin Shin Nae Kyung Park Moon Soo Lee Chang Ho Kim Moo Jun Baek

2 Korean Journal of Clinical Oncology Summer 2012;Vol.8,NO.1: A B C Fig. 1. (A) Show the Normal nerve bundle. (B) Show the Cancer cell and nerve bundle without perineural invasion. (C) : Show the Cancer cell and nerve bundle with perineural invasion Clinical Significance of Perineural Invasion in Colorectal Cancer 31

3 Table 1. Patient charicteristics PNI + PNI n=148 31(20.9%) 117(79.1%) Gender Male 17(21.2%) 63(78.8%) 80 Female 14(20.5%) 54(79.5%) 68 Age 60 14(14.7%) 79(85.3%) (32%) 36(68%) 53 Location Ascending colon 7(21.8%) 25(78.2%) 32 Tansverse colon 0(0%) 9(100%) 9 Descending colon 0(0%) 4(100%) 4 Sigmoid colon 7(18.4%) 31(81.6%) 38 Rectosigmoid junction 6(20.7%) 23(79.3%) 29 Rectum 11(30.6%) 25(69.4%) Hyung Wook Lee Tae Sung Ahn Sung Woo Cho Eung Jin Shin Nae Kyung Park Moon Soo Lee Chang Ho Kim Moo Jun Baek

4 Korean Journal of Clinical Oncology Summer 2012;Vol.8,NO.1: Table 2. Relatation between PNI of another prognostic factors PNI* positive PNI negative P value n/(%) n=31 n/(%) n=117 T- stage T1 0(0) 11(100) T2 2(10.5) 17(89.5) T3 22(22.9) 74(77.1) T4 7(31.8) 15(68.2) N-stage <0.001 N0 8(8.6) 85(91.4) N1 12(36.4) 21(63.6) N2 11(50) 11(50) LVI LVI negative 12(12.2) 86(87.8) LVI positive 19(38) 31(62) Stage <0.001 Stage 1(4) 24(96) Stage 7(10.9) 57(89.1) Stage 21(42.9) 28(87.1) Stage 2(20) 8(80) Distant metastasis NS M0 29(21) 109(79) M1 2(20) 8(80) Differenciation Well 0(0) 15(100) Moderatly 29(23.6) 94(76.4) Poorly 2(20.9) 8(79.1) *PNI : perineural invasion LVI : lymphovascular invasion Clinical Significance of Perineural Invasion in Colorectal Cancer 33

5 REFERENCES 1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, CA Cancer J Clin 2008 Mar-Apr;58(2): Kyu-Won Jung, Sohee Park, Hyun-joo Kong, Yong-joo Won, Joo Young Lee, Hong Gwan Seo, et al. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2009Cancer Res Treat 2012;44(1): Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N, et al. Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer, J Clin Oncol 2009 Nov 1;27(31): Ohtani H. Stromal reaction in cancer tissue: pathophysiologic significance of the expression of matrix-degrading enzymes in relation to matrix turnover and immune/inflammatory reactions. Pathol Int. 1998;48: Liebig C, Ayala G, Wilks JA, Berger DH, Albo D. Perineural invasion in cancer: a review of the literature. Cancer. 2009;115: Batsakis JG. Nerves and neurotropic carcinomas. Ann Otol Rhinol Laryngol. 1985;94: Veness MJ. Perineural spread in head and neck skin cancer. Australas J Dermatol. 2000;41: Rubin MA, Mucci NR, Manley S, Sanda M, Cushenberry E, Strawderman M, et al.. PREDICTORS OF GLEASON PATTERN 4/5 PROSTATE CANCER ON PROSTATECTOMY SPECIMENS: CAN HIGH GRADE TUMOR BE PREDICTED PREOPERATIVELY? J UROL. 2001;165: FAGAN JJ, COLLINS B, BARNES L, D AMICO F, MYERS EN, JOHNSON JT. PERINEURAL INVASION IN SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK. ARCH OTOLARYNGOL HEAD NECK SURG. 1998;124: Shirouzu K, Isomoto H, Kakegawa T. Prognostic evaluation of perineural invasion in rectal cancer. Am J Surg. 1993;165: Fujita S, Nakanisi Y, Taniguchi H, Yamamoto S, Akasu T, Moriya Y et al. CANCER INVASION TO Auerbach s plexus is an important prognostic factor in patients with pt3-pt4 colorectal cancer. Dis Colon Rectum. 2007;50: Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N, et al. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol. 2009;27: Dalal R, Djakiew D: Molecular characterization of neurotrophin expression and the corresponding tropomyosin receptor kinases (trks) in epithelial and stromal cells of the human prostate. Mol 34 Hyung Wook Lee Tae Sung Ahn Sung Woo Cho Eung Jin Shin Nae Kyung Park Moon Soo Lee Chang Ho Kim Moo Jun Baek

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7 Clinical Significance of Perineural Invasion in Colorectal Cancer Department of Surgery, Soonchunhyang University College of Medicine, Korea Hyung Wook Lee, Tae Sung Ahn, Sung Woo Cho, Eung Jin Shin, Nae Kyung Park, Moon Soo Lee, Chang Ho Kim, Moo Jun Baek Purpose : Perineural invasion (PNI) is widely known to be correlated with poor survival in many type of malignancy but the connection between perineural invasion of colorectal cancer and the prognosis has not yet been clearly confirmed. Therefore, we examined perineural invasion in colorectal cancers and investigated its relationship to clinicopathological features such as tumor staging, lymph node metastasis, vascular invasion, lymphatic invasion and patient s prognosis in this study Methods : The subjects were 148 colorectal cancer patients who underwent surgical resection in OOO. The pathologists who were not aware of the prognosis of the patients reexamined the existing biopsy results and reevaluated the perineural invasion. The presence of perineural invasion and the other clinicopathological factors were compared and the statistical significance of the correlation between these was examined. Results : Perineural invasion was confirmed in less than 10% of the patients in the initial biopsy results. However, it was confirmed in 20.9% of the patients reevaluating the biopsy. Perineural invasion in colorectal cancer was found to be unrelated to the T stage of the patients (p=0.114). On the other hand, perineural invasion appeared to be strongly related to lymph node metastasis of colorectal cancer (p<0.001) and lymphatic and vascular invasion was more common in the patients with perineural invasion (p=0.001). Moreover, perineural invasion seemed to be related to the stage of cancer (p<0.001) and patient s survival (p<0.05). Nevertheless, it was neither correlated to the level of differentiation nor to the distant metastasis since perineural invasion was expressed in 21% of the patients with distant metastasis and in 20% of the patients without distant metastasis. Conclusion : The correlation of perineural invasion in colorectal cancer to the clinicopathologic factors such as lymph node metastasis, lymphatic invasion, vascular invasion and the stage of disease were confirmed. And perineural invasion was significantly correlated with patient s survival. This is thought to be that perineural invasion can be a prognostic factor of colorectal cancer and it should be utilized planning adjuvant therapy for colorectal cancer patients. 36 Hyung Wook Lee Tae Sung Ahn Sung Woo Cho Eung Jin Shin Nae Kyung Park Moon Soo Lee Chang Ho Kim Moo Jun Baek