J Cancer 2019; 10(10):2243-2249. doi:10.7150/jca.31473

Research Paper

Perineural and lymphovascular invasion predicts for poor prognosis in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery

Quanquan Sun1,2,*, Tongxin Liu1,2,*, Peng Liu1,2, Jialin Luo1,2, Na Zhang1,2, Ke Lu1,2, Haixing Ju3, Yuping Zhu3, Wei Wu4, Lingnan Zhang5, Yongtian Fan3, Yong Liu3, Dechuan Li3, Yuan Zhu1,2, Luying Liu1,2✉

1. Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
2. Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
3. Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
4. Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
5. Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
* These authors contributed equally to this work

Abstract

Background: Perineural invasion (PNI) and lymphovascular invasion (LVI) are associated with poor prognosis in colorectal cancer, but their clinical significance is still controversial for patients with locally advanced rectal cancer (LARC) who had received neoadjuvant chemoradiotherapy (nCRT) and surgical resection. The aim of this study was to confirm the correlation between PNI and/or LVI and clinical prognosis and to further confirm whether PNI and/or LVI can be used as potential prognostic indicators of adjuvant chemotherapy after nCRT and surgery in LARC.

Methods: From February 2002 to December 2012, a total of 181 patients with LARC who had received nCRT and surgical resection were retrospectively reviewed. Overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method, log-rank test, and Cox proportional hazard regression model.

Results: The median follow-up time was 48 months (range, 3 to 162 months). All the PNI-positive and/or LVI-positive patients showed adverse DFS and OS (P<0.001). In multivariate analysis, PNI and LVI were independent prognostic factors for DFS. PNI, rather than LVI, was also an independent prognostic factor for OS. In a subgroup analysis, PNI-positive, rather than LVI-positive, may benefit from adjuvant chemotherapy.

Conclusion: For patients with LARC undergoing nCRT and surgery, PNI-positive and/or LVI positive were associated with poorer DFS and OS. And PNI-positive, rather than LVI-positive, may benefit from adjuvant chemotherapy.

Keywords: locally advanced rectal cancer, perineural invasion, lymphovascular invasion, neoadjuvant therapy

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How to cite this article:
Sun Q, Liu T, Liu P, Luo J, Zhang N, Lu K, Ju H, Zhu Y, Wu W, Zhang L, Fan Y, Liu Y, Li D, Zhu Y, Liu L. Perineural and lymphovascular invasion predicts for poor prognosis in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery. J Cancer 2019; 10(10):2243-2249. doi:10.7150/jca.31473. Available from http://www.jcancer.org/v10p2243.htm