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Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The presence of perineural invasion (PNI) in colorectal cancer (CRC) indicates a more aggressive phenotype, resulting in a poor prognosis. The aims of this study were to evaluate the oncologic outcome of PNI+ tumors and to investigate whether PNI status affects patient survival.

Methods

The study retrospectively enrolled 3807 patients from a single institution who underwent surgery for colorectal adenocarcinoma between January 2006 and December 2010. The patients were classified into two groups based on PNI status: PNI+ and PNI−.

Results

The PNI+ group included 565 patients (14.8 %) and had significantly more involved circumferential resection margins (p = 0.001) and a more advanced TNM stage (p = 0.001) than the PNI− group. Compared with the PNI− group, the PNI+ group had worse 5-year overall survival (65 vs. 88 %; p = 0.001) and 5-year disease-free survival (63 vs. 85 %; p = 0.001). Among PNI+ patients with stage IIA disease, those who received adjuvant therapy had significantly greater 5-year overall survival than those who did not (89.3 vs. 50.8 %; p = 0.001). In multivariate analyses, PNI+ was an independent negative prognostic factor for 5-year overall survival (hazard ratio [HR] 1.518, 95 % confidence interval [CI] 1.175–1.961; p = 0.001) and 5-year disease-free survival (HR 1.495, 95 % CI 1.237–1.806; p = 0.001).

Conclusions

PNI positivity is an independent predictor of aggressive behavior and unfavorable prognosis in CRC. Further evaluation is needed to confirm the impact of PNI status on survival in stage IIA CRC.

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Acknowledgement

This work was supported by grants to Jin Cheon Kim from the Korea Research Foundation (2013R1A2A2A03070986), Ministry of Science, ICT (Information and Communications Technologies) and Future Planning, the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), and the Center for Development and Commercialization of Anti-Cancer Therapeutics (HI10C2014), Ministry of Health and Welfare, Republic of Korea.

Disclosures

Abdulrahman Muaod Alotaibi, Jong Lyul Lee, Jihun Kim, Seok-Byung Lim, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim, and Jin Cheon Kim declare no competing interests in relation to this study.

Author Contributions

AMA made substantial contributions to the study conception and design; data acquisition, analysis, and interpretation; drafting of a critical revision to the manuscript; and approving the final version of the article. JLL made substantial contributions to the study conception and design; data acquisition, analysis, and interpretation; drafting of a critical revision to the manuscript; and approving the final version of the article. AMA and JLL contributed equally to the article. JHK contributed to the study design, provided data from his patients, helped revise parts of the manuscript related to pathology, and approved the final version of the article. S-BL contributed to the study design, provided data from his patients, helped write the manuscript, and approved the final version of the article. CSY contributed to the study design, provided data from his patients, helped write the manuscript, and approved the final version of the article. TWK contributed to the study design, provided data from his patients, helped revise parts of the manuscript related to medical oncology, and approved the final version of the article. JHK contributed to the study design, provided data from his patients, helped revise parts of the manuscript related to radiation oncology, and approved the final version of the article. JCK made substantial contributions to the study conception and design; data acquisition, analysis, and interpretation; drafting of a critical revision of the manuscript; and approved the final version of the text as the corresponding author.

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    Authors and Affiliations

    1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

      Abdulrahman Muaod Alotaibi MD, Jong Lyul Lee MD, Seok-Byung Lim MD, PhD, Chang Sik Yu MD, PhD & Jin Cheon Kim MD, PhD

    2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

      Jihun Kim MD, PhD

    3. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

      Tae Won Kim MD, PhD

    4. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

      Jong Hoon Kim MD, PhD

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    1. Abdulrahman Muaod Alotaibi MD
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    Correspondence to Jin Cheon Kim MD, PhD.

    Additional information

    Abdulrahman Muaod Alotaibi and Jong Lyul Lee contributed equally to this work.

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    Supplement Fig. 1

    Overall survival (a–c) and disease-free survival (d–f) outcomes for patients with stage II, III, and IV colorectal cancer, based on the perineural invasion status of the tumor. Survival outcomes were compared using the Kaplan-Meier method and the log-rank test. OS overall survival, DFS disease-free survival, PNI perineural invasion. (TIFF 1.75 mb)

    Supplement Fig. 2

    Overall survival (a) and disease-free survival (b) outcomes for patients with colorectal cancer, based on the tumor location. Overall survival (c, d) of the patients with stage IIA colon cancer according to the perineural invasion (PNI) status of the tumor and administration of adjuvant chemotherapy. Survival outcomes were compared using the Kaplan-Meier method and the log-rank test. OS overall survival, DFS disease-free survival, PNI perineural invasion. (TIFF 1.34 mb)

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    Alotaibi, A.M., Lee, J.L., Kim, J. et al. Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer. Ann Surg Oncol 24, 1626–1634 (2017). https://doi.org/10.1245/s10434-016-5748-4

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    • DOI: https://doi.org/10.1245/s10434-016-5748-4

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