Rectal cancer with lymphovascular or perineural invasion is a recognized poor prognostic signal, although the importance of this finding has been inconsistently studied. Patients with rectal cancer who had preoperative chemoradiation followed by curative resection were analyzed to determine the predictive significance of lymphovascular and perineural invasion. The tertiary cancer center is where this research was conducted. Patients with locally advanced or metastatic rectal cancer who had preoperative chemoradiation treatment between January 2000 and December 2010 and underwent curative surgery. Freedom from sickness and overall survival were the main measures of success. Kaplan-Meier analysis was used to determine survival rates, and a log-rank test was used to compare the groups. There were 1,156 total patients, with 109 (9.4%) showing signs of lymphovascular invasion and 137 (11.9%) showing signs of perineural invasion. Preoperative chemoradiotherapy was linked with a decrease in T and N staging in cases with lymphovascular and perineural invasion (P<0.001). Disease-free survival rates at 5 years were 70.8% for those with lymphovascular invasion and 78.5% for those without (P=0.150) among ypN0 patients. Disease-free survival rates at 5 years were lower (59.0% vs. 80.2%, P=0.001) in the perineural invasion group than in the absence group. Patients with ypN+ with either lymphovascular invasion or absence of illness at 5 years had 36.9% and 44.4% 5-year disease-free survival rates, respectively (P=0.2211). A lower 5-year rate of disease-free survival was seen in the perineural invasion group compared to the absence group (29.7% vs. 46.7%; P=0.011). Perineural invasion was associated with a decreased likelihood of life free of illness in multivariate analyses (HR 1.412, 95% CI 1.082-1.843; P=0.011) and in ypN0 subgroup analysis (HR 1.717, 95% CI 1.093-2.697; P=0.019). In patients with rectal cancer who have had preoperative chemoradiotherapy, perineural invasion is an independent and highly predictive factor of disease recurrence in patients with rectal cancer who have had preoperative chemoradiotherapy. Even if a patient’s ypN status is 0, further monitoring may be warranted if there is evidence of perineural invasion.

 

Source: journals.lww.com/dcrjournal/Abstract/2022/11000/Clinical_Implication_of_Perineural_and.8.aspx