Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
Ann Surg Oncol. 2010 Aug;17(8):2037-44. doi: 10.1245/s10434-010-1027-y. Epub 2010 Mar 24.
The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection.
We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis.
PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12-3.13) as were classical clinicopathological features.
Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.
神经周围侵犯（PNI）在胃癌中的预后意义已在少数研究中进行了探讨，但尚未达成共识。本研究旨在确定接受根治性胃切除术的胃癌患者中 PNI 的预后价值。
我们回顾性分析了 238 例接受根治性胃切除术的患者。所有患者的手术标本石蜡切片均用苏木精和伊红染色。当癌细胞浸润到神经周围或神经束时，定义为 PNI 阳性。通过单因素和多因素分析评估 PNI 及其他预后因素。
在 238 例患者中，180 例（75.6%）检测到 PNI 阳性。pT 分期、肿瘤大小、淋巴结转移、临床分期、肿瘤分化、Bormann 分类、组织学类型、淋巴管侵犯和血管侵犯与 PNI 的存在密切相关。PNI 阳性肿瘤的大小和淋巴结转移明显大于 PNI 阴性肿瘤（P =.001 和 P <.001）。PNI 阳性患者的中位生存时间明显短于 PNI 阴性患者（28.1 与 64.9 个月，P =.001）。多因素分析表明，PNI 阳性是独立的预后因素（P =.02，风险比[HR]：2.75；95%置信区间[95%CI]：1.12-3.13），以及经典的临床病理特征。
我们的结果表明，接受根治性胃切除术的胃癌患者中 PNI 的发生率较高，PNI 阳性率随着疾病的进展和临床分期而增加。PNI 可能有助于检测接受根治性胃切除术后预后不良的胃癌患者。
