ROLE OF PERINEURAL INVASION IN PREDICTING RECURRENCE AFTER SURGICAL RESECTION OF PANCREATIC ADENOCARCINOMA

Abstract

Background:

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with high recurrence rates even after curative-intent surgical resection. Perineural invasion (PNI) is a common histopathological feature and has been increasingly recognized as a potential prognostic marker.

Objective:

This study aimed to evaluate the role of perineural invasion in predicting recurrence following surgical resection of pancreatic adenocarcinoma.

Methods:

This retrospective observational study included 52 patients with histopathologically confirmed PDAC who underwent curative-intent surgical resection at a tertiary care center. Clinicopathological parameters, including tumor grade, lymph node status, margin status, lymphovascular invasion, and presence of PNI, were analyzed. Recurrence patterns, disease-free survival (DFS), and overall survival (OS) were assessed. Statistical analysis was performed using the Chi-square test, Kaplan–Meier survival analysis, and Cox proportional hazards regression.

Results:

Perineural invasion was present in 69.2% of cases. Recurrence was observed in 65.4% of patients and was significantly higher in the PNI-positive group (77.8%) compared to the PNI-negative group (37.5%) (p = 0.006). Early recurrence occurred more frequently in patients with PNI (50.0% vs 25.0%; p = 0.04). The median disease-free survival was significantly shorter in the PNI-positive group (10.2 months) compared to the PNI-negative group (18.6 months) (p = 0.01). On multivariate analysis, PNI emerged as an independent predictor of recurrence (HR = 3.3; 95% CI: 1.5–7.2; p = 0.003).

Conclusion:

Perineural invasion is a significant and independent predictor of recurrence in pancreatic ductal adenocarcinoma. Routine assessment of PNI can improve prognostication and guide postoperative management, including surveillance and adjuvant therapy decisions.