摘要目的：探讨周围神经侵犯（PNI）与结直肠癌临床病理因素及预后的关系。方法回顾性收集2011年1月至2012年6月期间于哈尔滨医科大学附属第二医院结直肠肿瘤外科行根治性手术治疗的372例结直肠癌患者的临床病理资料及术后标本。病理标本经苏木精-伊红染色后，将肿瘤细胞侵犯神经鞘任意一层或肿瘤细胞沿神经生长包绕超过神经周径1／3定为PNI阳性。采用字2检验或Fisher确切概率法分析PNI与结直肠癌临床病理因素的关系；绘制Kaplan-Meier生存曲线并采用Log-rank检验对PNI阳性与阴性患者的3年生存率进行比较。结果全组372例结直肠癌患者共133例（35．8％）存在PNI阳性。其中PNI阳性患者中男性63例，女性70例；年龄＞60岁者76例，≤60岁者57例；肿瘤位于回盲部6例，升结肠33例，横结肠7例，降结肠8例，乙状结肠22例，直肠57例；肿瘤直径＞4 cm者83例，≤4 cm者50例；中高分化者48例，低分化者85例；肿瘤浸润深度T1期者2例，T2期者7例，T3期者93例，T4期者31例；淋巴结转移N0期者56例，N1期者41例，N2期者36例；肿瘤分期Ⅰ期者2例，Ⅱ期者40例，Ⅲ期者75例，Ⅳ期者16例。PNI阳性与肿瘤位置（字2＝11．20，P ＝0．048）、肿瘤大小（字2＝21．80，P ＝0．000）、分化程度（字2＝60．90，P ＝0．000）、浸润深度（字2＝19．00，P＝0．000）、淋巴结转移（字2＝19．70，P＝0．000）及肿瘤分期（字2＝70．80， P＝0．000）有关，差异均有统计学意义，而与患者性别、年龄及脉管侵犯情况无关（均P＞0．05）。全组中位随访时间48（8～62）月，PNI阳性患者的3年生存率为52．6％，明显低于PNI阴性患者的78．3％（P＝0．000）。进一步对Ⅱ期和Ⅲ期结直肠癌患者进行亚组分析显示，Ⅱ期和Ⅲ期PNI阳性患者的3年生存率分别为62．3％和43．5％，均明显低于Ⅱ期和Ⅲ期PNI阴性患者的91．7％和79．4％，差异均有统计学意义（均P＝0．000）。结论 PNI阳性可能提示结直肠癌患者的预后不良。Ⅱ期和Ⅲ期结直肠癌患者PNI状态的检测对判断预后有重要意义。

abstractsObjective To investigate the association of peripheral nerve invasion (PNI) with clinicopathological factors and prognosis of colorectal cancer. Methods Clinicopathological data and Surgical specimens of 372 colorectal cancer patients who underwent radical resection from January 2011 to June 2012 in The Second Affiliated Hospital of Harbin Medical University were collected. Histopathological evaluation of tissue samples was conducted with hematoxylin and eosin-stained sections. PNI was considered positive when cancer cells were observed inside the nerve sheath , or when at least 33% of the nerve periphery was surrounded by cancer cells. The relationship between PNI and clinicopathological factors of colorectal cancer was analyzed by χ2 test or Fisher′s exact test. Three-year overall survivals of PNI positive and negative patients were determined using the Kaplan-Meier method. Detection results were compared using log-rank test. Results Of 372 colorectal cancer patients, 133 (35.8%) were PNI positive. Among the PNI positive patients, 63 cases were male and 70 cases female;76 cases were more than 60 years old and 57 cases less than 60 years old; tumors of 6 cases located in the ileocecal colon, of 33 cases in the ascending colon, of 7 cases in the transverse colon, of 8 cases in the descending colon, of 22 cases in the sigmoid colon, and of 57 cases in the rectum; tumor diameter was greater than 4 cm in 83 cases, and less than 4 cm in 50 cases; tumors of 48 cases were moderately or highly differentiated, and of 85 cases poorly-differentiation; tumor invasion depth in 2 cases, T2 in 7 cases, T3 in 93 cases, T4 in 31 cases; lymphatic metastasis was N0 phase in 56 cases, N1 in 41 cases, and N2 in 36 cases; tumors were stageⅠ in 2 cases, stage Ⅱ in 40 cases, of stageⅢ in 75 cases and stage Ⅳ in 16 cases. The positive rate of PNI was significantly associated with tumor location (χ2=11.20, P=0.048), tumor size (χ2=21.80, P=0.000), differentiation (χ2=60.90, P=0.000), depth of invasion (χ2=19.00, P=0.000), lymph node metastasis (χ2= 19.70, P=0.000) and TNM staging (χ2=70.80, P=0.000), but not with sex, age or vascular invasion (P >0.05). The median follow-up time was 48 (8 to 62) months. Kaplan-Meier survival curve showed that the 3-year survival rate of PNI positive patients was 52.6%, significantly lower than that of PNI negative patients (78.3%, P=0.000). Further analysis of patients with stageⅡ and Ⅲ colorectal cancer showed that the 3-year survival rates of PNI positive patients were 62.3% and 43.5%, respectively, which were significantly lower than those of PNI negative patients with stageⅡ and Ⅲ(91.7% and 79.4%), and the differences were statistically significant (P=0.000). Conclusions PNI is a poor prognostic factor of colorectal cancer. It may be a complement of the classic TNM staging classification in stratifying colorectal cancer patients, especially in stages Ⅱ and Ⅲ.