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Perineural Invasion is a Major Prognostic and Predictive Factor of Response to Adjuvant Chemotherapy in Stage I–II Colon Cancer

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

Abstract

Background

Perineural invasion (PNI) in colon cancer (CC) has been associated with poorer prognosis even in stage II disease (T3–4 N0 M0). The aim of this study is to analyze prognostic histopathologic factors in stage II colon cancer in patients treated with curative surgery as established in National Comprehensive Cancer Network guidelines.

Methods

From a prospective database of CC cases, 507 patients with stage I–II disease who had undergone curative resection from January 2000 and December 2012 were identified. Of these patients, 17 % received 5-flurouracil-based adjuvant chemotherapy. Together with demographic and anatomic variables, we also studied perineural and lymphovascular invasion, degree of differentiation, and their correlation with disease-free survival.

Results

Perineural invasion was identified in 57 patients (11.2 %) and lymphovascular invasion (LVI) in 82 (16.2 %) of the 507 patients. Perineural invasion was associated with LVI, the depth of invasion of the wall of the colon, and location of the tumor. Overall and disease-free survival of the complete series at 5 and 10 years was 89.5, 85.2, 83.2 and 81.6 %, respectively. In the PNI positive patients, disease-free survival at 5 years was significantly lower than in those without PNI (73.5 vs 88.6 %; p = 0.02). Multivariate analysis showed the presence of PNI to be a significant independent prognostic factor for disease-free survival (p = 0.025). Adjuvant chemotherapy reversed the impact of PNI on 5- to 10-year disease-free survival.

Conclusions

PNI a major prognostic and predictive factor in stage II colon cancer, and our results support the use of adjuvant chemotherapy in patients with PNI.

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All authors the have read and approved the manuscript and it is not under consideration for publication elsewhere. The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of the manuscript

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Authors and Affiliations

  1. Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain

    J. A. Cienfuegos MD, PhD, P. Martínez MD, J. Baixauli MD, PhD, S. Rosenstone MD, BA & J. L. Hernández-Lizoáin MD, PhD

  2. Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Spain

    C. Beorlegui MD

  3. Department of Pathology, Hospital San Pedro, Logroño (La Rioja), Spain

    J. J. Sola MD, PhD

  4. Department of Oncology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain

    J. Rodríguez MD, PhD

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  1. J. A. Cienfuegos MD, PhD
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Correspondence to J. A. Cienfuegos MD, PhD.

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Cienfuegos, J.A., Martínez, P., Baixauli, J. et al. Perineural Invasion is a Major Prognostic and Predictive Factor of Response to Adjuvant Chemotherapy in Stage I–II Colon Cancer. Ann Surg Oncol 24, 1077–1084 (2017). https://doi.org/10.1245/s10434-016-5561-0

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