Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiation and Surgery

Priyanka Chablani, Phuong Nguyen, Xueliang Pan, Andrew Robinson, Steve Walston, Christina Wu, Wendy L. Frankel, Wei Chen, Tanios Bekaii-Saab, Arnab Chakravarti, Evan Wuthrick, Terence M. Williams

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: The benefit of adjuvant chemotherapy in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and surgery is controversial. We examined the association of perineural invasion (PNI) with outcomes to determine whether PNI could be used to risk-stratify patients. Materials and Methods: We performed a retrospective study of 110 patients treated with nCRT and surgery for LARC at our institution from 2004 to 2011. Eighty-seven patients were identified in our final analysis. We evaluated the association of PNI with locoregional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival, using log-rank and Cox proportional hazard modeling. Results: Fourteen patients (16%) were PNI+ and 73 patients (84%) were PNI-. The median follow-up was 27 months (range, 0.9 to 84 mo). The median DMFS was 13.5 months for PNI+ and median not reached (>40 mo) for PNI- (P<0.0001). The median DFS was 13.5 months for PNI+ and 39.8 months for PNI- (P<0.0001). In a multivariate model including 7 pathologic variables, type of surgery, time to surgery from end of nCRT, and use of adjuvant chemotherapy, PNI remained a significant independent predictor of DMFS (hazard ratio 9.79; 95% confidence interval, 3.48-27.53; P<0.0001) and DFS (hazard ratio 5.72; 95% confidence interval, 2.2-14.9; P=0.0001). Conclusions: For patients with LARC treated with nCRT, PNI found at the time of surgery is significantly associated with worse DMFS and DFS. Our data support testing the role of adjuvant chemotherapy in patients with PNI and perhaps other high-risk features.

Original languageEnglish (US)
Pages (from-to)561-568
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume40
Issue number6
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Rectal Neoplasms
Neoplasm Metastasis
Chemoradiotherapy
Disease-Free Survival
Adjuvant Chemotherapy
Survival
Confidence Intervals
Retrospective Studies

Keywords

  • chemotherapy
  • neoadjuvant therapy
  • perineural invasion
  • radiation
  • rectal cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiation and Surgery. / Chablani, Priyanka; Nguyen, Phuong; Pan, Xueliang; Robinson, Andrew; Walston, Steve; Wu, Christina; Frankel, Wendy L.; Chen, Wei; Bekaii-Saab, Tanios; Chakravarti, Arnab; Wuthrick, Evan; Williams, Terence M.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 40, No. 6, 01.01.2017, p. 561-568.

Research output: Contribution to journalArticle

Chablani, Priyanka ; Nguyen, Phuong ; Pan, Xueliang ; Robinson, Andrew ; Walston, Steve ; Wu, Christina ; Frankel, Wendy L. ; Chen, Wei ; Bekaii-Saab, Tanios ; Chakravarti, Arnab ; Wuthrick, Evan ; Williams, Terence M. / Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiation and Surgery. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2017 ; Vol. 40, No. 6. pp. 561-568.
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abstract = "Objectives: The benefit of adjuvant chemotherapy in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and surgery is controversial. We examined the association of perineural invasion (PNI) with outcomes to determine whether PNI could be used to risk-stratify patients. Materials and Methods: We performed a retrospective study of 110 patients treated with nCRT and surgery for LARC at our institution from 2004 to 2011. Eighty-seven patients were identified in our final analysis. We evaluated the association of PNI with locoregional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival, using log-rank and Cox proportional hazard modeling. Results: Fourteen patients (16{\%}) were PNI+ and 73 patients (84{\%}) were PNI-. The median follow-up was 27 months (range, 0.9 to 84 mo). The median DMFS was 13.5 months for PNI+ and median not reached (>40 mo) for PNI- (P<0.0001). The median DFS was 13.5 months for PNI+ and 39.8 months for PNI- (P<0.0001). In a multivariate model including 7 pathologic variables, type of surgery, time to surgery from end of nCRT, and use of adjuvant chemotherapy, PNI remained a significant independent predictor of DMFS (hazard ratio 9.79; 95{\%} confidence interval, 3.48-27.53; P<0.0001) and DFS (hazard ratio 5.72; 95{\%} confidence interval, 2.2-14.9; P=0.0001). Conclusions: For patients with LARC treated with nCRT, PNI found at the time of surgery is significantly associated with worse DMFS and DFS. Our data support testing the role of adjuvant chemotherapy in patients with PNI and perhaps other high-risk features.",
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AU - Chablani, Priyanka

AU - Nguyen, Phuong

AU - Pan, Xueliang

AU - Robinson, Andrew

AU - Walston, Steve

AU - Wu, Christina

AU - Frankel, Wendy L.

AU - Chen, Wei

AU - Bekaii-Saab, Tanios

AU - Chakravarti, Arnab

AU - Wuthrick, Evan

AU - Williams, Terence M.

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