Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indic
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma Yuan-ning Guo, MD, MSc1 , Dong-ping Tian, MD, PhD1 , Qing-yun Gong, MD1 , Hao Huang, MD1 , Peng Yang, MPH1 , Shao-bin Chen, MD2, Salem Billan, MD3, Jia-yu He, MD1 , Hai-Hua Huang, MD, PhD4, Pan Xiong, MD1 , Wen-ting Lin, BSc1, Dan Guo, BSc1, Moshe Marom, PhD5, Ziv Gil, MD, PhD6 , and Min Su, MD, MSc1 1
Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China; Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China; 3The Radiation Oncology Institute, The Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel; 4Department of Pathology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China; 5Guangdong Dynavolt Renewable Energy Technology, Shantou, China; 6The Laboratory for Applied Cancer Research, The Head and Neck Center, Department of Otolaryngology Head and Neck Surgery, Technion – Israel Institute of Technology, Haifa, Israel
2
ABSTRACT Background. Esophageal squamous cell carcinoma (ESCC) at pN0M0 can be more locally aggressive and disseminated than those with lymph node and distant metastasis. Perineural invasion (PNI) is reported as a poor prognostic factor in cancer and is thought to be related to regional tumor spread and metastasis. However, its clinicopathological role and meaning for treatment in pN0M0 ESCC are unknown. Patients and Methods. We applied scoring methods of PNI and lymphatic and vascular invasion (LI, VI) based on immunohistochemistry staining on tumor tissues of pN0M0 ESCC patients. ROC analyses, Kaplan–Meier analyses,
Yuan-ning Guo and Dong-ping Tian have contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08667-4) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 5 January 2020 Z. Gil, MD, PhD e-mail: [email protected] M. Su, MD, MSc e-mail: [email protected]
Cox regression, and v2 test were performed for survival analysis, comparison of PNI with LI and VI, and exploration of the relevance between PNI and other clinicopathological features. Results. Presence of PNI was significantly associated with poor survival in pN0M0 patients, whereas LI and VI were not predictive of outcome (P [ 0.05). Neural invasion index (NII), defined as the ratio of the number of tumorinvaded nerves to the total number of nerves per tumor microsection, was the most consistent measure of PNI (P = 0.006, HR = 6.892, 1.731–27.428). Postoperative radiotherapy significantly improved survival in high-NII patients (P = 0.035, HR = 0.390, 0.163–0.936). Conclusions. PNI is an important risk factor for the outcome of pN0M0 ESCC patients. NII can be used for risk assessment and to tailor adjuvant radiotherapy in this
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