Research progress of perineural invasion in gallbladder cancer / 中华消化外科杂志

As a special mode of tumor metastasis, perineural invasion has been paid more and more attention. It is closely related to prognosis, recurrence and metastasis of tumor after surgery. As the most common malignancy of the biliary tract, perineural invasion is also an inde-pendent prognostic risk factor for gallbladder cancer due to its anatomical location, lymphatic reflux, blood perfusion and innervation. However, there are few studies on perineural invasion in gallbla-dder cancer, especially on its mechanism. By analyzing the general situation and recent progress of perineural invasion in gallbladder cancer, the authors mainly introduce the perineural invasion mechanism, perineural invasion rate of gallbladder cancer, relationship between perineural invasion and the clinical pathologic characteristic, the correlation with the prognosis, relationship with surgi-cal procedures and postoperative adjuvant therapy.

Prognostic importance of microvessel density, VEGF expression and perineural invasion in laryngeal cancer treated with adjuvant radiotherapy

Background and Aims: We aimed to investigate the prognostic importance of the microvessel density (MVD) value, the vascular endothelial growth factor (VEGF) expression, and the presence of perineural invasion (PNI) in laryngeal cancer (LSCC) patients. Methods: Pathological specimens of 62 LSCC patients were assessed for the evaluation of the MVD value, the VEGF expression level, and the presence of PNI of the tumors. The tumor characteristics and prognostic effects of these parameters on local control (LC) and overall survival (OS) were analyzed. Statistical Analysis: Descriptive analyses were done using frequencies for the demographic variables. The survival estimates were calculated by the Kaplan–Meier survival curves. The effects of the parameters on LC and OS were investigated by using the log-rank test comparing the survival rates. Cox regression analysis was used for multivariable analysis. Results: The 5-year LC and OS rates of the 62 LSCC patients were 64.5 and 53.9%, respectively. Twenty-two patients (35.5%) had PNI and the frequency of PNI was higher in the patients with a high-grade disease (P = 0.01). The MVD value was higher in the tumors of older patients (P = 0.035) and was correlated with the VEGF expression (P = 0.009). A higher tumor grade was related to a higher VEGF expression (P = 0.01) and the increase in the VEGF expression was associated with a significant decrease in the OS (P = 0.03). Conclusion: The VEGF expression, the MVD value, and the presence of PNI had no prognostic significance on the LC in the LSCC patients while only the VEGF expression was associated with the OS.

Transição epitélio-mesenquimal em portadores de câncer de pênis sem metástases linfonodais / Epithelium-mesenchymal transition in penile cancer patients without lymph node metastases

Introdução: O carcinoma escamoso do pênis é uma neoplasia rara, mas sua incidência e mortalidade específica vêm aumentando. No Brasil, o câncer de pênis constitui 2,1% das neoplasias em homens. O acometimento dos linfonodos inguinais é o fator prognóstico mais importante. Comparados aos pacientes com linfonodos positivos, aqueles com linfonodos histologicamente negativos (pN0) têm o melhor prognóstico; entretanto, a ausência de metástases linfonodais não garante a cura, haja vista que uma proporção destes apresenta recorrência locorregional ou progressão tumoral após o tratamento. Poucos estudos examinaram populações de pacientes com pN0 ou clinicamente negativos (cN0). Objetivos: Avaliar o impacto da expressão imuno-histoquímica da E-caderina e da vimentina como fatores prognósticos para sobrevida global, sobrevida câncer específica e sobrevida livre de doença em pacientes com carcinoma escamoso do pênis clinicamente ou histologicamente negativos para metástase linfonodal. Material e Métodos: Coorte retrospectiva de 116 pacientes cN0 e pN0 com carcinoma escamoso do pênis consecutivamente tratados no A.C.Camargo Cancer Center entre 1953-2017. As variáveis registradas incluíram idade, estadiamento TNM, subtipo histológico, grau de diferenciação tumoral, invasão vascular microscópica, invasão perineural, padrão microscópico da fronte de invasão tumoral (expansivo/infiltrativo) e expressão imuno-histoquímica das proteínas E-caderina e vimentina. As amostras de tumor foram analisadas no centro do tumor e na fronte de invasão tumoral. As análises de sobrevida foram realizadas usando curvas de Kaplan-Meier e testes de log-rank. O modelo de riscos proporcionais de Cox foi usado para determinar quais variáveis influenciaram as taxas de sobrevida global, câncer específica e livre de doença. Resultados: O tempo de seguimento médio foi de 176 meses. A presença de invasão perineural foi associada à alta expressão de vimentina no centro tumoral (p = 0,013), à perda da expressão de Ecaderina no centro do tumor (p = 0,026) e na fronte de invasão tumoral (p = 0,02). A perda da expressão imuno-histoquímica da E-caderina na fronte de invasão e a presença de invasão perineural foram independentemente associadas à sobrevida livre de doença. Conclusões: A perda da expressão imuno-histoquímica da E-caderina na fronte de invasão tumoral e a presença de invasão perineural no tumor primário foram associadas a uma menor sobrevida livre de doença. Alta expressão de vimentina no centro do tumor, perda da expressão da Ecaderina no centro do tumor e na fronte de invasão do tumor foram associadas à presença de invasão perineural no tumor primário.

Introduction: Penile squamous cell carcinoma is a rare neoplasm, but its incidence and specific mortality have been increasing. In Brazil, penile squamous cell carcinoma constitutes 2.1% of neoplasms in men. The involvement of inguinal lymph nodes is the most important prognostic factor. Compared to patients with positive lymph nodes, histologically negative patients (pN0) have the best prognosis; however, the absence of lymph node metastases does not guarantee a cure. Some pN0 patients exhibit locoregional recurrence or tumor progression after treatment. Few studies have examined patient populations with histologically negative (pN0) or clinically negative (cN0) lymph nodes. Objectives: To evaluate the impact of E-cadherin and vimentin expression as prognostic factors for overall survival, cancer-specific survival, and disease-free survival in patients with penile squamous cell carcinoma who were clinically or histologically negative for lymph node metastasis. Material and Methods: Retrospective cohort of 116 patients (cN0 and pN0) treated at A. C. Camargo Cancer Center from 1953 to 2017. Recorded variables included age, TNM staging, histological subtype, degree of tumor differentiation, microscopic vascular invasion, perineural invasion, microscopic pattern of the tumor invasion front (pushing/infiltrating) and vimentin and E-cadherin immunohistochemical expression. Tumor samples were analyzed at the tumor center and at the tumor invasion front. Survival analyses were performed using Kaplan-Meier curves and log-rank testing. Cox's proportional hazards model was used to determine which variables influenced overall survival, disease-free survival, or cancer specific survival. Results: The median follow-up time was 176 months. Perineural invasion was associated with high vimentin expression at tumor center (p = 0.013), loss of E-cadherin expression in the tumor center (p = 0.026) and at the front invasion (p = 0.02). Loss of immunohistochemical E-cadherin expression at the front invasion and the presence of perineural were independently associated with disease-free survival. Conclusions: Lower disease-free survival was associated with loss of immunohistochemical E-cadherin expression at the tumor invasion front, and the presence of perineural invasion. High vimentin expression in the tumor center, loss of E-cadherin expression in the tumor center and in the tumor invasion front were associated with the presence of perineural invasion in the primary tumor.

Prognosis analysis and relationship between perineural invasion and gastric cancer and other clinicopathological risk factors / 中华内分泌外科杂志

Objective:To analyze the relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer.Methods:The clinicopathological data of 665 patients with gastric cancer were retrospectively analyzed. According to the presence of perineural invasion, the patients were divided into perineural invasion positive group and perineural invasion negative group. The relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer were analyzed. After eliminating the potential confusion bias between the two groups by propensity score matching (PSM) , the differences of 5-year cumulative survival rate between the two groups of gastric cancer patients were compared.Results:The incidence of perineural invasion was 17.0% (113 cases) . The binary logistic regression analysis showed that the depth of tumor invasion and vascular tumor thrombus were independent factors influencing the occurrence of gastric cancer perineural invasion (all P<0.001) . Univariate analysis showed that age (>60 years) , tumor diameter (>4 cm) , borrmann classification, depth of invasion, lymph node metastasis, TNM stage, degree of differentiation, vascular tumor thrombus, perineural invasion, tumor nodule, tumor site, resection site, and surgical operation were the influencing factors for the prognosis of patients with gastric cancer ( P<0.05) , but multivariate analysis showed that age (>60 years) , tumor diameter (>4cm) , depth of invasion, lymph node metastasis, and positive vascular tumor thrombi were independent risk factors affecting the prognosis of gastric cancer patients ( P<0.05) .However, perineural invasion cannot be an independent factor influencing the poor prognosis of gastric cancer in a multivariate analysis. Survival analysis was performed after propensity matching scores, and it was found that there was no statistically significant difference in the five-year survival rate between the perineural invasion positive group and the perineural invasion negative group (34.6% vs 43.0%; χ2=1.713; P=0.191) ,and there was no significant difference in the survival curve analysis between the two. Conclusion:Most patients with gastric cancer of perineural invasion have poor prognosis, but perineural invasion cannot be an independent prognostic factor for the prognosis of gastric cancer.

Application value of intravoxel incoherent motion imaging in preoperative evaluating the perineural invasion of esophageal squamous cell carcinoma: a prospective study / 中华消化外科杂志

Objective:To investigate the application value of intravoxel incoherent motion (IVIM) imaging in preoperative evaluating perineural invasion (PNI) of esophageal squamous cell carcinoma (ESCC).Methods:The prospective study was conducted. The clinicopathological data of 63 ESCC patients who underwent IVIM imaging before surgery in the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital from January 2016 to April 2019 were selected. Patients underwent routine magnetic resonance imaging scan and IVIM sequence examination. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*) and pseudodiffusion fraction (f) values were measured. Observation indicators: (1) situations of enrolled patients; (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The interclass correlation coefficient (ICC) was used to evaluate cosistency of results. The receiver operating characrteristic curve was used to evaluate diagnostic efficiency. Results:(1) Situations of enrolled patients. A total of 63 patients were selected for eligibility. There were 41 males and 22 females, aged 60(range, 43?74)years. Of the 63 ESCC patients, 17 cases had PNI and 46 cases had no PNI. Cases with well differentiated tumor, moderate differentiated tumor or low differentiated tumor, cases in stage T1, T2, T3, T4 of infiltra-tion depth, cases with or without lymph node metastasis were 0, 6, 11, 0, 3, 13, 1, 15, 2 in patients with PNI, versus 6, 24, 16, 1, 22, 23, 0, 12, 34 in patients without PNI, showing significant differences between them ( Z=?2.32, ?2.49, χ2=19.58, P<0.05). (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. The ADC, D, D*, f values were (2.21±0.33)×10 ?3 mm 2/s, (1.46±0.31)×10 ?3 mm 2/s, 32.50 (15.55,46.75)×10 ?3 mm 2/s, (0.34±0.09)×10 ?3 mm 2/s in patients with PNI, versus (2.45±0.45)×10 ?3 mm 2/s, (1.72±0.38)×10 ?3 mm 2/s, 34.85(23.43,51.20)×10 ?3 mm 2/s, (0.42±0.13)×10 ?3 mm 2/s in patients without PNI, showing significant differences in the ADC, D and f values between them ( t=?2.03, ?2.52, ?2.34, P<0.05) and no significant difference in the D* value between them ( Z=?0.84, P>0.05). The cosistency of ADC, D, D* and f values in the 63 ESCC patients measured by 2 radiologists was good, with the ICC as 0.96, 0.92, 0.89 and 0.95. The receiver operating characrteristic curve demons-trated the best cut-off value of ADC, D and f values were 2.50×10 ?3 mm 2/s, 1.68×10 ?3 mm 2/s and 0.41, with the areas under the curve as 0.67 (95% confidence interval as 0.54?0.79), 0.70 (95% confidence interval as 0.58?0.81) and 0.69 (95% confidence interval as 0.57?0.80), respectively. The combina-tion of D and f value for diagnosing PNI of ESCC had the area under the curve as 0.74 (95% confidence interval as 0.62?0.84), with the cut-off value as 0.20, sensitivity and specificity as 94.1% and 56.5%. Conclusions:IVIM parameters D and f values can evaluate and predict the PNI of ESCC preopera-tively. The combination of D and f values can further improve the diagnostic efficiency.

Treatment and prognosis analysis of perineural invasion on sinonasal adenoid cystic carcinoma / 中华肿瘤杂志

Objective: To analyze the efficacy of sinonasal adenoid cystic carcinoma (ACC) with perineural invasion (PNI), and explore the prognostic value of PNI on sinonasal adenoid cystic carcinoma. Methods: The clinical data of 105 patients with sinonasal ACC admitted to Cancer Hospital, Chinese Academy of Medical Sciences from January 2000 to December 2016 were retrospectively reviewed. All patients were restaged according to American Joint Committee on Cancer 8th edition. Follow-up visits were conducted to obtain information of treatment failure and survival outcome. The Log rank test was used for univariate analysis of prognostic factors, and Cox regression model was used for multivariate prognostic analysis. Results: The maxillary sinus (n=59) was the most common primary site, followed by the nasal cavity (n=38). There were 93 patients with stage Ⅲ-Ⅳ. The treatment modalities included surgery alone (n=14), radiotherapy alone (n=13), preoperative radiotherapy plus surgery (n=10), and surgery plus postoperative radiotherapy (n=68). The median follow-up time was 91.8 months, the 5-year local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 72.6%, 73.0%, 52.9% and 78.0%, respectively. There were 33 patients (31.4%) with PNI-positive. The 5-year DMFS, PFS, and OS rates of PNI-positive group were 53.7%, 29.4% and 56.5%, respectively, which were significantly inferior to those of PNI-negative group (80.8%, 63.0% and 86.8%, respectively, P<0.05), while there was no significant difference in the 5-year LC rate between both groups (64.5% vs 76.5%, P=0.273). The multivariate Cox regression analysis showed PNI was one of the poor prognostic factors of DMFS (HR=3.514, 95%CI: 1.557-7.932), PFS (HR=2.562, 95%CI: 1.349-4.866) and OS (HR=2.605, 95%CI: 1.169-5.806). Among patients with PNI-positive, the 5-year LC, PFS and OS rates of patients received surgery combined with radiotherapy were 84.9%, 41.3% and 72.7%, respectively, which were significantly higher than 23.3%, 10.0% and 26.7% of patients receiving surgery or radiotherapy alone (P<0.05). Conclusion: The presence of PNI increases the risk of distant metastasis in patients with sinonasal ACC. Compared with patients with PNI-negative, the prognosis of patients with PNI-positive is relatively poor, and surgery combined with radiotherapy for PNI-positive sinonasal ACC results in good clinical outcomes.

Impacto de la invasión perineural en pacientes con cáncer de lengua tratados en el Instituto Nacional de Oncología y Radiobiología / Impact of perineural invasion in patients with tongue cancer treated at the National Institute of Oncology and Radiobiology / Impacto da invasão perineural em pacientes com câncer de língua tratados no National Institute of Oncology and Radiobiology

RESUMEN El conocimiento de los factores pronósticos del carcinoma escamoso de cabeza y cuello es de gran importancia, pues ayudan a predecir el futuro evolutivo de la enfermedad y a comprender hechos de su fisiopatología también, permiten comparar tratamientos, agrupar a los pacientes con pronóstico semejante, diseñar ensayos clínicos incluso, seleccionar el tratamiento ideal para cada paciente. Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo con el objetivo de evaluar el impacto de la invasión perineural en pacientes con cáncer de lengua tratados en el Instituto de Oncología y Radiobiología (INOR) con un universo de 62 pacientes. Se tuvieron en cuenta variables como: edad, sexo, color de la piel, grado histológico, etapa clínica, tipo de lesión, técnica quirúrgica utilizada y factores pronósticos mayores. Se establecieron 2 grupos uno sin presencia de invasión perineural y otro con invasión perineural. El mayor número de casos se presentó en el grupo de 55-64 años en ambos grupos, con mayor incidencia del sexo masculino y color de la piel blanca. El carcinoma epidermoide bien diferenciado prevaleció en ambos grupos con 54,3 % y 50,0. La técnica quirúrgica más utilizadas en el grupo de pacientes con presencia de invasión perineural fue las glosectomías parciales más disección selectiva de cuello, los bordes de sección quirúrgicos positivos fue el factor pronóstico mayor más frecuente en los pacientes con invasión perineural con 56,3 % y significación estadística p=0,021. Las recaídas, local, regional y a distancia, estuvieron presentes en todos los pacientes que presentaron la invasión perineural estadísticamente significativo p=0,010.

ABSTRACT Knowledge of the prognostic factors of squamous cell carcinoma of the head and neck is of great importance, as they help to predict the future evolution of the disease and to understand facts about its pathophysiology, they also allow comparing treatments, grouping patients with a similar prognosis, designing trials clinicians even select the ideal treatment for each patient. An observational, descriptive, longitudinal and retrospective study was carried out with the objective of evaluating the impact of perineural invasion in patients with tongue cancer treated at the Institute of Oncology and Radiobiology (INOR) with a universe of 62 patients. Variables such as: age, sex, skin color, histological grade, clinical stage, type of lesion, surgical technique used and major prognostic factors were taken into account. Two groups were established, one without the presence of perineural invasion and the other with perineural invasion. The highest number of cases occurred in the 55-64 age group in both groups, with a higher incidence of males and white skin color. Well-differentiated squamous cell carcinoma prevailed in both groups with 54.3% and 50.0. The surgical technique most used in the group of patients with the presence of perineural invasion was partial glosectomies plus selective neck dissection, positive surgical section margins were the most frequent major prognostic factor in patients with perineural invasion with 56.3% and statistical significance p = 0.021. Relapses, local, regional and distant, were present in all patients who presented statistically significant perineural invasion p = 0.010.

RESUMO O conhecimento dos fatores prognósticos do carcinoma espinocelular de cabeça e pescoço é de grande importância, pois ajudam a prever a evolução futura da doença e a compreender fatos sobre sua fisiopatologia, permitem também comparar tratamentos, agrupar pacientes com prognósticos semelhantes, delinear ensaios os médicos até selecionam o tratamento ideal para cada paciente. Foi realizado um estudo observacional, descritivo, longitudinal e retrospectivo com o objetivo de avaliar o impacto da invasão perineural em pacientes com câncer de língua atendidos no Instituto de Oncologia e Radiobiologia (INOR) com um universo de 62 pacientes. Foram consideradas variáveis ​​como: idade, sexo, cor da pele, grau histológico, estádio clínico, tipo de lesão, técnica cirúrgica utilizada e principais fatores prognósticos. Dois grupos foram estabelecidos, um sem presença de invasão perineural e outro com invasão perineural. O maior número de casos ocorreu na faixa etária de 55 a 64 anos em ambos os grupos, com maior incidência no sexo masculino e na cor da pele branca. O carcinoma espinocelular bem diferenciado prevaleceu em ambos os grupos com 54,3% e 50,0. A técnica cirúrgica mais utilizada no grupo de pacientes com presença de invasão perineural foi glosectomias parciais mais esvaziamento cervical seletivo, margens de secção cirúrgica positivas foram o principal fator prognóstico mais frequente em pacientes com invasão perineural com 56,3% e significância estatística p = 0,021. As recidivas, locais, regionais e à distância, estiveram presentes em todos os pacientes que apresentaram invasão perineural estatisticamente significativa p = 0,010.

Relationship between perineural invasion scores based on multidetector computed tomography and extrapancreatic perineural invasion in pancreatic ductal adenocarcinoma / 中华胰腺病杂志

Objective:To investigate the relationship between the perineural invasion score based on multidetector computed tomography (MDCT) and extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical, radiological, and pathological data of 374 patients pathologically diagnosed as pancreatic cancer who underwent radical resection in the First Affiliated Hospital of Naval Medical University from March 2018 to May 2020 were analyzed retrospectively. Patients were divided into EPNI negative group ( n=111) and EPNI positive group (n=263) based on the pathological presence of EPNI. The perineural invasion score was performed for each patient based on radiological images. Univariate and multivariate logistic regression models were used to analyze the association between the perineural invasion score based on MDCT and EPNI in PDAC. Results:There were significant statistical differences between EPNI negative group and positive group on both pathological characteristics (T stage, N stage, invasion of common bile duct, and positive surgical margin) and radiological characteristics (tumor size, vascular invasion, lymph node metastasis, perineural invasion score based on MDCT, pancreatic border, parenchymal atrophy, invasion of duodenum, invasion of spleen and splenic vein and invasion of common bile duct) (all P value <0.05). Univariate analysis revealed that the tumor size, vascular invasion, lymph node metastasis, perineural invasion score based on MDCT, pancreatic border, pancreatic atrophy, invasion of duodenum, invasion of spleen and splenic vein and invasion of common bile duct were independently associated with EPNI. Multivariate analyses revealed that the perineural invasion based on MDCT was an independent risk factor for EPNI in pancreatic cancer (score=1, OR=2.93, 95% CI 1.61-5.32, P<0.001; score=2, OR=5.92, 95% CI 2.68-13.10, P<0.001). Conclusions:The perineural invasion score based on MDCT was an independent risk factor for EPNI in pancreatic cancer and can be used as an evaluation indicator for preoperative prediction of EPNI in PDAC.

Comparative Study between the Effect of Perineural versus Intravascular Dexmedetomidine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background:Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block.Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20ml) in supraclavicular BPB; group I (Control group): add 1mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μg.kg 1dexmedetomidine perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μg.kg-1 dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min.Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed.Results:Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II.Conclusion:Perineural dexmedetomidine (1 μg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 μg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia

Técnica de infi ltración perineural en heridas complejas (PIT) / Perineural infiltration technique (PIT) in complex wounds

El dolor asociado a heridas complejas se erige como una gran barrera para la resolución de estas, debido a la complejidad de abordaje y a la imposibilidad de establecer un patrón de algoritmo por diversos factores y su carácter heterogéneo, así como por la presencia de manifestaciones múltiples asociadas. Este dolor provoca al paciente un daño no solo físico sino también psicosocial, porque la escasa respuesta a los tratamientos habituales, y si bien es sensible a la medicación con opiáceos, los resultados son insufi cientes a largo plazo en un significativo número de pacientes, en quienes provoca además efectos no deseables. Se establece en el presente trabajo la administración subcutánea de dextrosa 5% a través de una técnica de infiltración perineural para el tratamiento de la infl amación neurogénica responsable del mencionado padecimiento, en las terminaciones libres de los nervios sensitivos cutáneos. Para ello se decidió realizar un estudio descriptivo multicéntrico a partir de junio del 2016 hasta mayo del 2017 en 60 pacientes que presentaban dolor crónico en ulceras de miembro inferior de diferente etiología con antecedente de medicación analgésica previa con resultado parcial (no controlado) y que tuviera evolución de su dolor entre 3 meses y 4 años.

The pain associated with complex wounds is established as a great barrier for the irresolution, due to the complexity of the approach and the impossibility of establishing an algorithm pattern due to various factors and their heterogeneous nature, as well as the presence of associated multiple manifestations. . This pain causes not only physical but psychosocial damage to the patient, because of the poor response to the usual treatments, and although it is sensitive to medication with opiates, the results are insufficient in the long-term in a significant number of patients, in whom it also causes undesirable effects. The present work establishes the subcutaneous administration of 5% dextrose through a perineural infi ltration technique for the treatment of the neurogenic inflammation responsible for the afore mentioned condition, in the free terminations of the cutaneous sensory nerves. For this, it was decided to carry out a multicenter descriptive study from June 2016 to May 2017 in 60 patients who presented chronic pain in lower limb ulcers of different etiology with a history of previous analgesic medication with partial (uncontrolled) outcome and had evolution of your pain between 3 months and 4 years.

Analysis of factors related to perineural invasion in cervical cancer and its relationship with prognosis / 中国医师杂志

Objective To investigate the relationship between perineural invasion (PNI) and the clinicopathological features of cervical cancer,and to explore its influence on the prognosis of cervical cancer patients.Methods Retrospective analysis the clinical data of 76 patients with early cervical cancer who received radical hysterectomy + pelvic lymphadenectomy ± paraaortic lymphadenectomy from November 2015 to December 2019 in Xuanwu Hospital.The clinicopathological characteristics of the postoperative pathological results of cervical cancer patients were analyzed to explore the related factors of PNI and its influence on prognosis.Results Single factor analysis suggested that the incidence of PNI was related to tumor diameter,depth of stroma invasion,lymph-vascular space invasion,lymph node metastasis and clinical stage (P ＜ 0.05).Multivariate analysis suggested that the infiltration depth of stroma invasion was the risk factor of PNI (P ＜ 0.05).K-M analysis showed that there was no significant difference in disease-free survival and overall survival between PNI positive and PNI negative patients (P ＞ 0.05).Conclusions PNI is related to the depth of interstitial infiltration.PNI has no significant effect on the short-term recurrence rate and short-term survival rate of cervical cancer patients.

Clinical diagnosis and treatment of perineural invasion of head and neck malignant tumors / 中华放射肿瘤学杂志

Perineural invasion is a unique biological behavior of tumors via nerve dissemination and metastasis, which is intimately correlated with the recurrence, metastasis and prognosis. With the deepening research, the clinical significance of perineural invasion has been widely recognized. However, due to the low incidence of head and neck neoplasms and the varying incidence of perineural invasion in different anatomical sites and pathological types, high-level evidence-based medical evidence is still lacking. Currently, the pathological mechanism of perineural invasion has not been clearly clarified. No specific treatment has been available for perineural invasion. Therefore, the treatment of perineural invasion of head and neck tumors is an enormous challenge for clinicians. In this article, the current status of clinical diagnosis and treatment of perineural invasion in head and neck malignancies was reviewed.

Clinical diagnosis and treatment of perineural invasion of head and neck malignant tumors / 中华放射肿瘤学杂志

Perineural invasion is a unique biological behavior of tumors via nerve dissemination and metastasis,which is intimately correlated with the recurrence,metastasis and prognosis.With the deepening research,the clinical significance of perineural invasion has been widely recognized.However,due to the low incidence of head and neck neoplasms and the varying incidence of perineural invasion in different anatomical sites and pathological types,high-level evidence-based medical evidence is still lacking.Currently,the pathological mechanism of perineural invasion has not been clearly clarified.No specific treatment has been available for perineural invasion.Therefore,the treatment of perineural invasion of head and neck tumors is an enormous challenge for clinicians.In this article,the current status of clinical diagnosis and treatment of perineural invasion in head and neck malignancies was reviewed.

The best route and dose of dexamethasone for brachial plexus block: A systematic review and meta-analysis / 中国组织工程研究

BACKGROUND: Dexamethasone has been widely used in brachial plexus block to enhance the block effect but the best way (perineural or intravenous) and dose are still inconclusive. OBJECTIVE: To systematically evaluate the optimal approach and dose of dexamethasone for brachial plexus block. METHODS: Studies on dexamethasone and brachial plexus block were searched in PubMed, Embase, Cochrane Library, CNKI, WanFang and VIP. Two evaluators analyzed the literatures, evaluated the quality, extracted relevant research indicators according to the screening criteria, and completed the meta-analysis. RESULTS AND CONCLUSION: A total of 16 articles were finally included in the meta-analysis (1 260 patients). As suggested by the Meta-analysis, regardless of 1-4 mg or 5-10 mg of dexamethasone, the perineural group significantly prolonged the duration of analgesia compared with the intravenous group [weighted mean difference (WMD)=201.38, 95% confidence interval (CI) (68.22, 334.54), P=0.003; WMD=302.96, 95%CI (142.41, 463.50), P=0.000 2]. There were no significant differences in the duration of motor block between the perineural and intravenous groups [WMD=121.06, 95%CI(-62.31, 304.42), P=0.20, I 2 =95%]. Compared with the intravenous group, the perineural group significantly prolonged the duration of analgesia. However, similar duration of analgesia was found in 1-4 mg and 5-10 mg of dexamethasone and the analgesia effect did not increase with the increase of dose. There were no significant differences in the duration of motor block between the perineural and intravenous groups.

Meta-analysis - perineural invasion as prognostic factor in rectal cancer / Metanálise -invasão perineural como fator prognóstico no câncer retal

ABSTRACT Objectives: The aim of this analysis was to determine prognostic value of perineural invasion in rectal cancer. Methods: Medline (PubMed, Ovid), Embase and Cochrane Library were searched for relevant reports published from January 1980 up to December 2017. All clinical trials which studied perineural invasion in rectal cancer, prospective observational studies, clinical registry data and retrospective case series which reported perineural invasion as an outcome were included. Case reports, abstracts, letters and comments were excluded. hazard ratio (HR) with 95% confidence interval (CI) was used to determine the prognostic value. Results: Nineteen studies comprising 6438 patients with rectal cancer were analysed. The results indicate that perineural invasion is a negative prognostic factor as evident from the overall survival (HR = 1.30, 95% CI 1.13-1.50, p < 0.01) and disease-free survival (HR = 2.14, 95% CI 2.06-2.22, p < 0.01). Conclusion: This study shows that presence of perineural invasion is associated with poor prognosis in rectal cancer.

RESUMO Objetivo: Este estudo buscou determinar o valor prognóstico da invasão perineural no câncer retal. Métodos: Relatos relevantes publicados entre janeiro de 1980 e dezembro de 2017 foram buscados nas bases de dados Medline (PubMed, Ovid), Embase e Cochrane Library. Todos os ensaios clínicos que avaliaram a IPN no câncer de reto, estudos observacionais prospectivos, dados de registro clínico e séries de casos retrospectivos que relataram IPN como um desfecho foram incluídos. Relatos de casos, resumos, cartas e comentários foram excluídos. A razão de risco (hazard ratio [HR]) com intervalo de confiança (IC) de 95% foi usada para determinar o valor prognóstico. Resultados: Foram analisados 19 estudos compreendendo 6.438 pacientes com câncer retal. Os resultados indicam que a invasão perineural é um fator prognóstico negativo, conforme demonstrado pela sobrevida global (HR = 1,30; IC 95%: 1,13-1,50; p < 0,01) e sobrevida livre de doença (HR = 2,14; IC 95%: 2,06-2,22, p < 0,01). Conclusão: O estudo demonstrou que a presença de invasão perineural está associada a um prognóstico ruim no câncer retal.

A study of morphological prognostic factors in colorectal cancer and survival analysis

Context: Globally, colorectal cancer (CRC) is one of the leading causes of cancer death. Many Asian countries experience an increasing incidence of CRC due to changes in diet and lifestyle. Many pathological prognostic factors other than the tumor-node-metastasis (TNM) staging reflect the biological behavior of tumor tissue and influence the treatment and survival. Aims: The aim is to evaluate: (1) Various morphological prognostic factors of colorectal cancer, (2) the correlation of the prognostic factors with survival, and (3) the prognostic factors with independent prognostic significance. Settings and Design: Descriptive study conducted in a tertiary care center in Kerala. Materials and Methods: Five hundred and eighty-seven resected specimens of CRC received from January 1, 2007 to October 31, 2012 were studied for various morphological prognostic factors. Overall survival and disease-free survival were obtained by Kaplan Meier survival analysis. Cox regression analysis was performed to identify the predictors of survival. Results: CRC incidence was higher in the age group 40–60 years and males were dominant. Rectum was the common site with bleeding per rectum as a common symptom. Predominant tumors had ulcerative gross configuration, size ?5 cm and were free of transverse, radial margin involvement. Majority of tumors were well-differentiated adenocarcinoma with invasion beyond muscularis propria, without vascular, perineural invasion, and lymph node involvement and were in Stage II. The overall and disease-free 3-year survival rates were 89.1% and 88%, respectively. Among the eight significant factors in univariate analysis, tumor histology, depth of invasion, and perineural invasion were found to have independent prognostic significance in multivariate analysis. Conclusions: In addition to the TNM staging, other morphological prognostic factors should be given importance, while considering the patients for adjuvant therapy to improve the survival rates in CRC.

Correlation analysis of perineural invasion and prognosis in cervical squamous carcinoma / 肿瘤研究与临床

Objective To investigate the relationship between perineural invasion (PNI) and clinicopathological features as well as the prognosis of cervical squamous carcinoma. Methods The clinico-pathological data of 256 patients with cervical squamous carcinoma (ⅠB1-ⅡA2) treated with extensive resection and pelvic lymphadenectomy in Shanxi Provincial Cancer Hospital from January 2010 to December 2013 were retrospectively analyzed. PNI of tumor area in the pathological sections was observed by using microscope. The relationship between PNI and clinicopathological features was analyzed. The effect of PNI on postoperative 5-year survival was also analyzed. Results There were 22 (8.6％) cases of PNI among 256 patients with cervical squamous carcinoma. PNI-positive had a relation with tumor stage, depth of invasion, lymphovascular space invasion (LVSI), and lymph node metastasis (all P < 0.05). Multivariate logistic regression showed that positive lymph node metastasis was an independent risk factor for PNI (OR = 3.89, 95％ CI 1.50-10.12, P =0.005); infiltration depth > 1/2 might be an independent risk factor for PNI (OR = 7.30, 95％ CI 0.91-58.74, P = 0.062). The 5-year total survival rate was 89.9％ for 256 patients with cervical squamous carcinoma. And the 5-year total survival rate of PNI-positive patients was lower than that of PNI-negative patients (50.3％ vs. 93.4％). Cox regression showed that PNI-positive was a risk factor for 5-year total survival (HR = 9.73, 95％CI 4.31-21.98, P < 0.01); after adjusting the relevant clinicopathological features, PNI-positive was still a risk factor of 5-year total survival (HR = 8.12, 95％ CI 2.47-26.73, P = 0.001). Conclusions The occurrence of PNI in cervical squamous carcinoma of ⅠB1 -ⅡA2 is associated with clinical stage, depth of invasion, LVSIand lymph node metastasis. PNI-positive may be a new risk factor for the prognosis of cervical squamous carcinoma.

Impact of perineural invasion on the overall survival of patients with gastric cancer / 中国肿瘤临床

Objective: To evaluate the impact of perineural invasion (PNI) on the overall survival (OS) of patients with gastric cancer. Methods: A total of 1,007 patients with gastric cancer who underwent curative resection between January 2011 and December 2012 at the Cancer Institute and Hospital of Tianjin Medical University were enrolled. All the patients were categorized into the following two groups according to the status of PNI: positive group, presence of PNI; and negative group, absence of PNI. Potential prognostic factors and clinical pathological variables correlated with the presence of PNI were analyzed. Results: One hundred and twenty (11.9%) patients had PNI. Multivariate analysis revealed that histology, depth of invasion, and lymphovascular invasion were indepen-dently associated with the presence of PNI. Univariate survival analysis revealed that age, tumor location, Borrmann type, tumor size, curability, TNM stage, type of gastrectomy, tumor deposit, lymphovascular invasion, PNI, preoperative CA19-9 levels, and CEA levels were significant prognostic factors. Gastric cancer patients with PNI had a significantly lower 5-year OS rate than those without PNI (5-year OS: 38.3% versus 66.6%, P<0.001). In the multivariate analysis, age, Borrmann typeⅣ, TNM stage, curability, tumor deposit, and PNI were independent prognostic factors for this population cohort. The strata analysis revealed that PNI merely had a significant im-pact on OS in patients at stagesⅠ,Ⅱ, andⅢa. Conclusions: PNI is an independent prognostic factor in patients with gastric cancer and can be used as a prognostic indicator for gastric cancer patients at stagesⅠ,Ⅱ, andⅢa.

Current status and controversy of nerve-sparing radical hysterectomy for cercical cancer / 中国实用妇科与产科杂志

Perineural invasion in early-stage cervical cancer,is a new risk factor for the prognosis of cervical cancer.There may be a certain potential risk in retaining nerves and this is the reason why nerve-sparing radical hysterectomy(NSRH)is an important hot topic in clinical research at present.The aim to study PNI in cervical cancer is to develop clear indications for NSRH,in order to show the advantage of this surgical technique.PNI is one of the main factors affecting NSRH indications.Therefore,it is necessary to clarify the indications for NSRH,and it is imperative.