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  • Perineural invasion predicts for locoregional failure in patients with oesophageal adenocarcinoma treated with neoadjuvant chemoradiotherapy

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Original research
Perineural invasion predicts for locoregional failure in patients with oesophageal adenocarcinoma treated with neoadjuvant chemoradiotherapy
  1. Ankur K Patel1,
  2. Xueliang Pan2,
  3. Diana M Vila1,
  4. Wendy L Frankel3,
  5. Wei Chen3,
  6. Kyle A Perry4,
  7. Robert E Merritt5,
  8. Desmond M D'Souza5,
  9. Evan J Wuthrick1,
  10. Terence M Williams1
  1. 1 Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, Ohio, USA
  2. 2 Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, Ohio, USA
  3. 3 Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  4. 4 Division of General and Gastrointestinal Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  5. 5 Division of Thoracic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  1. Correspondence to Dr Terence M Williams, Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, OH 43210, USA; Terence.Williams{at}osumc.edu

Abstract

Aim The prognostic significance of perineural invasion (PNI) in oesophageal adenocarcinoma (EAC) is unclear. We examined the association of PNI with clinical outcomes in patients treated with neoadjuvant chemoradiotherapy (nCRT) and surgery.

Methods We performed a single institutional retrospective study. We evaluated the association of PNI with locoregional recurrence-free survival (LRFS), distant metastasis-free survival, disease-free survival (DFS) and overall survival using log-rank and Cox proportional hazard modelling.

Results 29 out of 73 patients (40%) had PNI at the time of surgery. The median follow-up was 20.1 months. The median DFS was 18.4 months for patients with PNI vs 41.3 months for patients without PNI (p<0.05). The median LRFS was 23.3 months for patients with PNI and median not reached for patients without PNI (p<0.01). In a multivariate model including age and pathological variables, PNI remained a significant independent predictor of LRFS (HR 0.20, 95% CI 0.07 to 0.60; p=0.004).

Conclusions For patients with EAC treated with nCRT, PNI found at the time of surgery is significantly associated with worse LRFS. Our data support attempts to validate this finding and perhaps testing the role of adjuvant therapy in patients with PNI.

  • oncology
  • oesophagus
  • cancer
  • surgical pathology

https://doi.org/10.1136/jclinpath-2020-206424

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    Footnotes

    • Handling editor Dhirendra Govender.

    • Contributors AP, DMV, EJW and TW participated in project conceptualisation. AP, DMV and XP participated in data curation, methodology and formal analysis. AP participated in writing the original draft. WLF and WAC participated in methodology, and writing, including review and editing. TW, EJW, KAP, REM and DMDS participated in writing, including review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This retrospective review was approved by the institutional review board with a waiver of informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.