ASO Author Reflections: Perineural Invasion in pN0M0 Esophageal Squamous Cell Carcinoma: Let Pathology Strengthen the Cl
- PDF / 227,360 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 77 Downloads / 235 Views
ASO AUTHOR REFLECTIONS
ASO Author Reflections: Perineural Invasion in pN0M0 Esophageal Squamous Cell Carcinoma: Let Pathology Strengthen the Clinical Oncology Practice Yuan-ning Guo, MD, MSc
, and Min Su, MD, MSc
Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
PAST Perineural invasion (PNI) is a poor prognostic factor in multiple malignancies.1,2 TNM staging for esophageal squamous cell carcinoma (ESCC) includes tumor grade, location, invasion depth, lymph node metastasis, and distant metastasis, with the last two factors often beginning as a result of lymphovascular invasion.3 In patients without lymph node or distant metastasis (pathological N0M0 [pN0M0]), ESCC can be more locally disseminated and invasive. In contrast, in patients with metastasis, PNI helps cancer cells proliferate and spread to nearby tissues and organs,1,2 thereby becoming the major factor worsening pN0M0 patient survival. Most ESCC cases occur in lower income and developing countries,4 where a large number of pN0M0 patients do not have pre- or postoperative adjuvant therapy because of economic problems and/or insufficient emphasis from doctors; even they have locally advanced tumors. There is insufficient evidence supporting neoadjuvant therapy for ESCC with T3–4N0M0, in clinical practice and guidelines prior to 2018.5,6 With the recent development of endoscopic technology, an increasing number of patients are diagnosed and treated before ESCC
ASO Author Reflections is a brief invited commentary on the article ‘‘Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma’’, Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08667-4. Ó Society of Surgical Oncology 2020 First Received: 21 May 2020 M. Su, MD, MSc e-mail: [email protected]
metastasizes. However, no specific studies have been conducted on the significance and role of PNI in clinicopathology and adjuvant therapy for pN0M0 ESCC. In clinical pathology and previous studies, hematoxylin and eosin (H&E) staining is usually employed to evaluate PNI; however, compared with immunohistochemistry, H&E staining usually underestimates the accuracy and detection rate of PNI by half,2,3,7 often leading to ignorance of PNI existence in ESCC. Moreover, to date, because of inconsistent results in previous studies on PNI in ESCC,2,3,7 clinical guidelines have not recommended adjuvant therapy for patients with PNI.6 PRESENT In this study,8 we found that PNI existed widely in pN0M0 ESCC. Additionally, PNI, rather than lymphovascular invasion, was significantly associated with poor survival. The immunohistochemistry-based scoring method of PNI (neural invasion index [NII], defined as the ratio of the number of tumor-invaded nerves to the total number of nerves per tumor microsection) was the most consistent measure of PNI (p = 0.006; hazard ratio [HR] = 6.892 [1.731–27.428]), which always performed better than positive–n
Data Loading...
