Abstract
Background
Recent observational studies have reported that perineural invasion (PNI) may be a negative prognostic factor in cervical cancer.
Objectives
The purpose of this meta-analysis is to systematically analyse the effect of PNI on overall survival and disease-free survival.
Search strategy
The PubMed and Cochrane clinical trials databases were searched for articles with publication dates up to September 2013.
Selection criteria
Retrospective observational studies with survival analysis for perineural invasion after radical hysterectomy plus lymphadenectomy of cervical cancer were selected.
Data collection and analysis
Trial characteristics and outcomes and quality measures based on the Newcastle–Ottawa scale (NOS) were independently extracted. The overall survival and disease-free survival of patients with PNI were measured using a hazard ratio (HR) for time to event outcomes.
Main results
The meta-analysis of these studies demonstrated that cervical cancer with PNI was associated with a lower overall survival rate (HR 2.21, 95 % CI 1.36–3.59, P = 0.001). Although the disease-free survival was lower in the PNI group (HR 1.35, 95 % CI 0.78–2.31, P = 0.28), the results were not statistically significant.
Conclusion
Patients with PNI-positive cervical cancer have a poor overall survival rate; therefore, we can conclude that perineural invasion (PNI) is an adverse prognostic factor in cervical cancer. Based on these results, PNI should be an independent prognostic factor for cervical cancer and the decision to proceed with adjuvant therapy after surgery.
Similar content being viewed by others
References
Neumann E (1862) Secondare cancroid infiltration des nervus mentalis bei einem. Arch Pathol Anat 24:201–201
Liebig C, Ayala G, Wilks JA, Berger DH, Albo D (2009) Perineural invasion in cancer: a review of the literature. Cancer 115(15):3379–3391
Carter RL, Foster CS, Dinsdale EA, Pittam MR (1983) Perineural spread by squamous carcinomas of the head and neck: a morphological study using antiaxonal and antimyelin monoclonal antibodies. J Clin Pathol 36:269–275
Soo KC, Carter RL, O’Brien CJ et al (1986) Prognostic implications of perineural spread in squamous carcinomas of the head and neck. Laryngoscope 96:1145–1148
Maru N, Ohori M, Kattan MW et al (2001) Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens. Hum Pathol 32:828–833
Ayala GE, Dai H, Ittmann M et al (2004) Growth and survival mechanisms associated with perineural invasion in prostate cancer. Cancer Res 64:6082–6090
Matsushima T, Mori M, Kido A et al (1998) Preoperative estimation of neural invasion in rectal carcinoma. Oncol Rep 5:73–76
Ross A, Rusnak C, Weinerman B et al (1999) Recurrence and survival after surgical management of rectal cancer. Am J Surg 177:392–395
Pour PM, Bell RH, Batra SK (2003) Neural invasion in the staging of pancreatic cancer. Pancreas 26:322–325
Hirai I, Kimura W, Ozawa K et al (2002) Perineural invasion in pancreatic cancer. Pancreas 24:15–25
Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44(2):265–272
Peters WA III, Liu PY, Barrett RJ II, Stock RJ, Monk BJ, Berek JS et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18(8):1606–1613
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecol Oncol 73(2):177–183
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. www.ohri.ca/programs/clinical_epidemiology/oxford.asp, Accessed 25 Nov 2012
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 11:16. doi:10.1186/1745-6215-8-16
Memarzadeh S, Natarajan S, Dandade DP, Ostrzega N, Saber PA, Busuttil A et al (2003) Lymphovascular andperineural invasion in the parametria: a prognostic factor for early-stage cervical cancer. Obstet Gynecol 102(3):612–619
OzanH OzuysalS (2009) Ediz B. Perineural invasion in early-stage cervical carcinoma. Eur J Gynaecol Oncol 30(4):379–383
Meinel A, Fischer U, Bilek K, Hentschel B, Horn LC (2011) Morphological parameters associated with perineural invasion (PNI) in carcinoma of the cervix uteri. Int J Surg Pathol 19(2):159–163. doi:10.1177/1066896910381898 Epub 2010 Nov
Horn LC, Meinel A, Fischer U, Bilek K, Hentschel B (2010) Perineural invasion in carcinoma of the cervix uteri—prognostic impact. J Cancer Res Clin Oncol 136(10):1557–1562
Elsahwi KS, Barber E, Illuzzi J, Buza N, Ratner E, Silasi DA (2011) The significance of perineural invasion in early-stage cervical cancer. Gynecol Oncol 123(3):561–564
Cho HC, Kim H, Cho HY, Kim K, No JH, Kim YB (2013) Prognostic significance of perineural invasion in cervical cancer. Int J Gynecol Pathol 32(2):228–233
Su CH, Tsay SH, Wu CC, Shyr YM, King KL, Lee CH et al (1996) Factors influencing postoperative morbidity, mortality, and survival after resection forhilar cholangiocarcinoma. Ann Surg 223(4):384–394
Beard CJ, Chen MH, Cote K, Loffredo M, Renshaw AA, Hurwitz M et al (2004) Perineural invasion is associated with increased relapse after external beam radiotherapy for men with low-risk prostate cancer and may be a marker for occult, high-grade cancer. Int J Radiat Oncol. Biol Phys 58(1):19–24
Duraker N, Sisman S, Can G (2003) The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today 33(2):95–100
Ozaki H, Hiraoka T, Mizumoto R, Matsuno S, Matsumoto Y, Nakayama T et al (1999) The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today 29(1):16–22
Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240(2):260–268
Limawararut V, Leibovitch I, Sullivan T, Selva D (2007) Periocular squamous cell carcinoma. Clin Experiment Ophthalmol 35(2):174–185
Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44(2):265–272
Peters WA III, Liu PY, Barrett RJ II, Stock RJ, Monk BJ, Berek JS et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18(8):1606–1613
Raspagliesi F, Ditto A, Kusamura S, Fontanelli R, Spatti G, Solima E et al (2003) Nerve-sparing radical hysterectomy: a pilot study. Tumori 89(5):497–501
MagrinaJ F, Pawlina W, Kho RM, Magtibay PM (2011) Robotic nerve-sparing radical hysterectomy: feasibility and technique. Gynecol Oncol 121(3):605–609
Li B, Li W, Sun YC, Zhang R, Zhang GY, Yu GZ et al (2011) Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer. Chin Med J (Engl) 124(12):1807–1812
Skret A, Nowakowski B, Skret-Magierlo J, Baranowski W (2008) Nerve sparing radical hysterectomy. Ginekol Pol 79(2):92–98
Raspagliesi F, Ditto A, Hanozet F, Martinelli F, Solima E, Zanaboni F et al (2007) Nerve-sparing radical hysterectomy in cervical cancer: evolution of concepts. Gynecol Oncol 107(Suppl 1):S119–S121
Acknowledgments
We would like to acknowledge Dr. Tan Chunlu, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China, for consultation and inspiration.
Conflict of interest
The authors declare no conflicts of interest.
Ethical standard
Ethical approval is not required as this is a systematic review of published manuscripts.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cui, L., Shi, Y. & Zhang, G.N. Perineural invasion as a prognostic factor for cervical cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 292, 13–19 (2015). https://doi.org/10.1007/s00404-015-3627-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3627-z