The prognostic significance of perineural invasion in early-stage cervical cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LONG Ying ¹ ,  YAO Desheng ¹ , Wei Yousheng ²

1. Department of Oncology Gynecology, Cancer Hospital of Guangxi Medical University, Nangning, 530021, P.R.China;
2. Department of Gynecology, The Second People's Hospital of Nanning, Nangning, 530031, P.R.China;

Corresponding?author：

YAO Desheng, Email: yds201610@126.com

Keywords：

Perineural invasion; Prognosis; Cervical cancer; Case-control study; Meta-analysis

DOI：

10.7507/1672-2531.201611046

Video：

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Objective To systematically review the prognostic value of perineural invasion (PNI) for patients with early-stage cervical cancer. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, WanFang Data, CBM and VIP databases to collect case-control studies about prognostic value of PNI in cervical cancer from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results Seven case-control studies from eight articles involving 1 218 patients were included. The results of meta-analysis showed that: (1) On Cox's model multivariate analysis, PNI was not identified as an independent risk factor for disease free survival (DFS) (HR=0.73, 95%CI 0.33 to 1.58,P=0.42) or overall survival (OS) (HR=0.89, 95%CI 0.41 to 1.94,P=0.77) with no significant difference; (2) On Kaplan-Meier-curves, DFS (HR=1.86, 95%CI 1.20 to 2.88,P=0.006) and OS (HR=2.43, 95%CI 1.63 to 3.62,P<0.000 1) were both significantly decreased in patients with PNI positive group. Conclusion PNI represents a decreasing disease-free survival and overall survival in patients with early-stage cervical cancer, and is one of the poor prognosis factors which be informed management decisions regarding adjuvant therapy. However, there is no evidence that PNI is an independent factor affecting the prognosis. In view of the limitation of the studies, a large sample prospective controlled trial is warranted to verify the above conclusion.

Citation： LONG Ying, YAO Desheng, Wei Yousheng. The prognostic significance of perineural invasion in early-stage cervical cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(3): 334-339. doi: 10.7507/1672-2531.201611046 Copy

1.	?Rapidis AD, Givalos N, Gakiopoulou H,et al. Adenoid cystic carcinoma of the head and neck. Clinicopathological analysis of 23 patients and review of the literature. Oral Oncol, 2005, 41(3): 328-335.
2.	Harnden P, Shelley MD, Clements H,et al. The prognostic significance of perineural invasion in prostatic cancer biopsies: a systematic review. Cancer, 2007, 109(1): 13-24.
3.	Deng J, You Q, Gao Y,et al. Prognostic value of perineural invasion in gastric cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(2): e88907.
4.	Dantas AN, Morais EF, Macedo RA,et al. Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review. Braz J Otorhinolaryngol, 2015, 81(3): 329-335.
5.	Wei YS, Yao DS, Long Y. Evaluation of the association between perineural invasion and clinical and histopathological features of cervical cancer. Mol Clin Oncol, 2016, 5(3): 307-311.
6.	Skret-Magierlo JE, Soja PJ, Skret A,et al. Perineural space invasion in cervical cancer (FIGO IB1-IIB) accompanied by high-risk factors for recurrence. J Cancer Res Ther, 2014, 10(4): 957-961.
7.	Cho HC, Kim H, Cho HY,et al. Prognostic significance of perineural invasion in cervical cancer. Int J Gynecol Pathol, 2013, 32(2): 228-233.
8.	Elsahwi KS, Barber E, Illuzzi J,et al. The significance of perineural invasion in early-stage cervical cancer. Gynecol Oncol, 2011, 123(3): 561-564.
9.	張國楠, 陽燕, 朱熠等. 嗜神經侵襲對早期子宮頸癌患者預后的影響. 中華婦產科雜志, 2015, (9): 673-678.
10.	Horn LC, Meinel A, Fischer U,et al. Perineural invasion in carcinoma of the cervix uteri--prognostic impact. J Cancer Res Clin Oncol, 2010, 136(10): 1557-1562.
11.	Wells GA, Shea B, O’Connell D,et al. The Newcastle-Ottawa Scale (NOS) for assessing the qualityof nonrandomized studies in meta-analysis. [Accessed 25 Nov 2012] Available at: www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12.	丁珊珊, 楊冰. 神經周圍浸潤在早期宮頸癌中的意義. 實用醫學雜志, 2015, 31(24): 4105-4107.
13.	韋有生, 姚德生. 宮頸癌神經周圍浸潤的研究進展. 現代婦產科進展, 2015, 24(11): 870-872.
14.	岳慧敏, 薛秀華, 張萍. 宮頸癌神經侵襲與其預后的相關性分析. 中華臨床醫師雜志(電子版), 2015, 9(5): 731-734.
15.	倪茗, 張婧. 初治宮頸癌患者神經周浸潤與病情及預后的關系. 中國實用神經疾病雜志, 2015, 18(5): 91-93.
16.	Cui L, Shi Y, Zhang GN. Perineural invasion as a prognostic factor for cervical cancer: a systematic review and meta-analysis. Arch Gynecol Obstet, 2015, 292(1): 13-19.
17.	張國楠, 崔玲. 宮頸癌神經周浸潤: 應該重視的病理預后因素. 腫瘤預防與治療, 2013, 26(4): 183-186.
18.	Meinel A, Fischer U, Bilek K,et al. Morphological parameters associated with perineural invasion (PNI) in carcinoma of the cervix uteri. Int J Surg Pathol, 2011, 19(2): 159-163.
19.	Ozan H, Ozuysal S, Ediz B. Perineural invasion in early-stage cervical carcinoma. Eur J Gynaecol Oncol, 2009, 30(4): 379-383.
20.	Memarzadeh S, Natarajan S, Dandade DP,et al. Lymphovascular and perineural invasion in the parametria: a prognostic factor for early-stage cervical cancer. Obstet Gynecol, 2003, 102(3): 612-619.
21.	夏芳, 薛秀華, 張萍. 神經周圍浸潤的發生機制及對早期宮頸癌的影響. 國際腫瘤學雜志, 2015, 42(11): 869-872.
22.	柯毓敏. III、IV 期宮頸癌患者神經周浸潤與 5 年生存率的關系. 醫藥前沿, 2014, (15): 268.
23.	韋有生, 姚德生, 龍穎. 嗜神經浸潤與宮頸癌臨床病理特征的關系及其意義. 廣西醫學, 2015, (11): 1562-1565.
24.	Tierney JF, Stewart LA, Ghersi D,et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.

1. ?Rapidis AD, Givalos N, Gakiopoulou H,et al. Adenoid cystic carcinoma of the head and neck. Clinicopathological analysis of 23 patients and review of the literature. Oral Oncol, 2005, 41(3): 328-335.
2. Harnden P, Shelley MD, Clements H,et al. The prognostic significance of perineural invasion in prostatic cancer biopsies: a systematic review. Cancer, 2007, 109(1): 13-24.
3. Deng J, You Q, Gao Y,et al. Prognostic value of perineural invasion in gastric cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(2): e88907.
4. Dantas AN, Morais EF, Macedo RA,et al. Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review. Braz J Otorhinolaryngol, 2015, 81(3): 329-335.
5. Wei YS, Yao DS, Long Y. Evaluation of the association between perineural invasion and clinical and histopathological features of cervical cancer. Mol Clin Oncol, 2016, 5(3): 307-311.
6. Skret-Magierlo JE, Soja PJ, Skret A,et al. Perineural space invasion in cervical cancer (FIGO IB1-IIB) accompanied by high-risk factors for recurrence. J Cancer Res Ther, 2014, 10(4): 957-961.
7. Cho HC, Kim H, Cho HY,et al. Prognostic significance of perineural invasion in cervical cancer. Int J Gynecol Pathol, 2013, 32(2): 228-233.
8. Elsahwi KS, Barber E, Illuzzi J,et al. The significance of perineural invasion in early-stage cervical cancer. Gynecol Oncol, 2011, 123(3): 561-564.
9. 張國楠, 陽燕, 朱熠等. 嗜神經侵襲對早期子宮頸癌患者預后的影響. 中華婦產科雜志, 2015, (9): 673-678.
10. Horn LC, Meinel A, Fischer U,et al. Perineural invasion in carcinoma of the cervix uteri--prognostic impact. J Cancer Res Clin Oncol, 2010, 136(10): 1557-1562.
11. Wells GA, Shea B, O’Connell D,et al. The Newcastle-Ottawa Scale (NOS) for assessing the qualityof nonrandomized studies in meta-analysis. [Accessed 25 Nov 2012] Available at: www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12. 丁珊珊, 楊冰. 神經周圍浸潤在早期宮頸癌中的意義. 實用醫學雜志, 2015, 31(24): 4105-4107.
13. 韋有生, 姚德生. 宮頸癌神經周圍浸潤的研究進展. 現代婦產科進展, 2015, 24(11): 870-872.
14. 岳慧敏, 薛秀華, 張萍. 宮頸癌神經侵襲與其預后的相關性分析. 中華臨床醫師雜志(電子版), 2015, 9(5): 731-734.
15. 倪茗, 張婧. 初治宮頸癌患者神經周浸潤與病情及預后的關系. 中國實用神經疾病雜志, 2015, 18(5): 91-93.
16. Cui L, Shi Y, Zhang GN. Perineural invasion as a prognostic factor for cervical cancer: a systematic review and meta-analysis. Arch Gynecol Obstet, 2015, 292(1): 13-19.
17. 張國楠, 崔玲. 宮頸癌神經周浸潤: 應該重視的病理預后因素. 腫瘤預防與治療, 2013, 26(4): 183-186.
18. Meinel A, Fischer U, Bilek K,et al. Morphological parameters associated with perineural invasion (PNI) in carcinoma of the cervix uteri. Int J Surg Pathol, 2011, 19(2): 159-163.
19. Ozan H, Ozuysal S, Ediz B. Perineural invasion in early-stage cervical carcinoma. Eur J Gynaecol Oncol, 2009, 30(4): 379-383.
20. Memarzadeh S, Natarajan S, Dandade DP,et al. Lymphovascular and perineural invasion in the parametria: a prognostic factor for early-stage cervical cancer. Obstet Gynecol, 2003, 102(3): 612-619.
21. 夏芳, 薛秀華, 張萍. 神經周圍浸潤的發生機制及對早期宮頸癌的影響. 國際腫瘤學雜志, 2015, 42(11): 869-872.
22. 柯毓敏. III、IV 期宮頸癌患者神經周浸潤與 5 年生存率的關系. 醫藥前沿, 2014, (15): 268.
23. 韋有生, 姚德生, 龍穎. 嗜神經浸潤與宮頸癌臨床病理特征的關系及其意義. 廣西醫學, 2015, (11): 1562-1565.
24. Tierney JF, Stewart LA, Ghersi D,et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.

Chinese Journal of Evidence-Based Medicine

The prognostic significance of perineural invasion in early-stage cervical cancer: a meta-analysis

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