Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer
Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients. We identified 2...
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| Veröffentlicht in: | Journal of clinical oncology 2009-11, Vol.27 (31), p.5131-5137 |
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| container_title | Journal of clinical oncology |
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| creator | Liebig, Catherine Ayala, Gustavo Wilks, Jonathan Verstovsek, Gordana Liu, Hao Agarwal, Neeti Berger, David H Albo, Daniel |
| description | Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients.
We identified 269 consecutive patients who had CRC resected at our institution. Tumors were re-reviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test.
PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival.
PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment. |
| doi_str_mv | 10.1200/JCO.2009.22.4949 |
| format | Article |
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We identified 269 consecutive patients who had CRC resected at our institution. Tumors were re-reviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test.
PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival.
PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2009.22.4949</identifier><identifier>PMID: 19738119</identifier><language>eng</language><publisher>Alexandria, VA: American Society of Clinical Oncology</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Biological and medical sciences ; Chemotherapy, Adjuvant ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Combined Modality Therapy ; Digestive System Surgical Procedures ; Disease-Free Survival ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Invasiveness - pathology ; Neoplasm Staging ; Original Reports ; Peripheral Nerves - pathology ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Treatment Outcome ; Tumors</subject><ispartof>Journal of clinical oncology, 2009-11, Vol.27 (31), p.5131-5137</ispartof><rights>2009 INIST-CNRS</rights><rights>2009 by American Society of Clinical Oncology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c569t-3c00904d1cfa373b36ec7187370d2fdd6c2876fa6f8dc8c9ff836eb1b58530d23</citedby><cites>FETCH-LOGICAL-c569t-3c00904d1cfa373b36ec7187370d2fdd6c2876fa6f8dc8c9ff836eb1b58530d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3715,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22087658$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19738119$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liebig, Catherine</creatorcontrib><creatorcontrib>Ayala, Gustavo</creatorcontrib><creatorcontrib>Wilks, Jonathan</creatorcontrib><creatorcontrib>Verstovsek, Gordana</creatorcontrib><creatorcontrib>Liu, Hao</creatorcontrib><creatorcontrib>Agarwal, Neeti</creatorcontrib><creatorcontrib>Berger, David H</creatorcontrib><creatorcontrib>Albo, Daniel</creatorcontrib><title>Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients.
We identified 269 consecutive patients who had CRC resected at our institution. Tumors were re-reviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test.
PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival.
PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Chemotherapy, Adjuvant</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Combined Modality Therapy</subject><subject>Digestive System Surgical Procedures</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Staging</subject><subject>Original Reports</subject><subject>Peripheral Nerves - pathology</subject><subject>Prognosis</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkb1v2zAQxYkiQeMk3TsFWtJMcvghitRSoBCS1kEAe0iBbgRNkTYDiXRJKUX_-5xhI2mXu4G_e3x3D6HPBM8Jxfj2oV3OoTdzSudVUzUf0IxwKkohOD9BMywYLYlkv87Qec7PGJNKMv4RnZFGMElIM0PLlU0-2CnpvliEF519DMUiFxpq6OzOQgljsUq282aMqYiuWE6jiYMtfCja2MdkzQjTrQ7Gpkt06nSf7adjv0A_7--e2h_l4_L7ov32WBpeN2PJDLjGVUeM00ywNautEUQKJnBHXdfVhkpRO1072RlpGuckIGuy5pIzQNgF-nrQ3U3rwXYGTMIKapf8oNNfFbVX_78Ev1Wb-KKoEKwSe4EvR4EUf082j2rw2di-18HGKau6ritMaAMgPoAmxZyTdW-fEKz2KShIQe1TUJSqfQowcvWvufeB49kBuD4COhvduwS38_mNoxTD9lwCd3Pgtn6z_eOTVXnQfQ-yVD2bSIViRHHCCHsFDomeRg</recordid><startdate>20091101</startdate><enddate>20091101</enddate><creator>Liebig, Catherine</creator><creator>Ayala, Gustavo</creator><creator>Wilks, Jonathan</creator><creator>Verstovsek, Gordana</creator><creator>Liu, Hao</creator><creator>Agarwal, Neeti</creator><creator>Berger, David H</creator><creator>Albo, Daniel</creator><general>American Society of Clinical Oncology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20091101</creationdate><title>Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer</title><author>Liebig, Catherine ; Ayala, Gustavo ; Wilks, Jonathan ; Verstovsek, Gordana ; Liu, Hao ; Agarwal, Neeti ; Berger, David H ; Albo, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c569t-3c00904d1cfa373b36ec7187370d2fdd6c2876fa6f8dc8c9ff836eb1b58530d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Chemotherapy, Adjuvant</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Combined Modality Therapy</topic><topic>Digestive System Surgical Procedures</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Neoplasm Staging</topic><topic>Original Reports</topic><topic>Peripheral Nerves - pathology</topic><topic>Prognosis</topic><topic>Radiotherapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liebig, Catherine</creatorcontrib><creatorcontrib>Ayala, Gustavo</creatorcontrib><creatorcontrib>Wilks, Jonathan</creatorcontrib><creatorcontrib>Verstovsek, Gordana</creatorcontrib><creatorcontrib>Liu, Hao</creatorcontrib><creatorcontrib>Agarwal, Neeti</creatorcontrib><creatorcontrib>Berger, David H</creatorcontrib><creatorcontrib>Albo, Daniel</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liebig, Catherine</au><au>Ayala, Gustavo</au><au>Wilks, Jonathan</au><au>Verstovsek, Gordana</au><au>Liu, Hao</au><au>Agarwal, Neeti</au><au>Berger, David H</au><au>Albo, Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer</atitle><jtitle>Journal of clinical oncology</jtitle><addtitle>J Clin Oncol</addtitle><date>2009-11-01</date><risdate>2009</risdate><volume>27</volume><issue>31</issue><spage>5131</spage><epage>5137</epage><pages>5131-5137</pages><issn>0732-183X</issn><eissn>1527-7755</eissn><abstract>Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients.
We identified 269 consecutive patients who had CRC resected at our institution. Tumors were re-reviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test.
PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival.
PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.</abstract><cop>Alexandria, VA</cop><pub>American Society of Clinical Oncology</pub><pmid>19738119</pmid><doi>10.1200/JCO.2009.22.4949</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Society of Clinical Oncology Online Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adult Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Biological and medical sciences Chemotherapy, Adjuvant Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Combined Modality Therapy Digestive System Surgical Procedures Disease-Free Survival Female Gastroenterology. Liver. Pancreas. Abdomen Humans Kaplan-Meier Estimate Male Medical sciences Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness - pathology Neoplasm Staging Original Reports Peripheral Nerves - pathology Prognosis Radiotherapy Radiotherapy, Adjuvant Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Treatment Outcome Tumors |
| title | Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer |
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