Selçukbiricik Fatih, Tural Deniz, Büyükünal Evin, Serdengeçti Süheyla
Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Istanbul, Turkey.
Asian Pac J Cancer Prev. 2012;13(7):3149-52.
The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated but not clearly clarified. The objective of our study was to investigate the role of PNI as prognostic factor in patients undergoing curative surgical resection and without distant metastasis in comparison with other clinicopathological factors.
Between 2001 and 2010, 287 cases of gastric adenocarcinoma underwent radical gastrectomy recorded in hospital based registries. PNI was assessed as positive when cancer cells were seen in the perinerium or neural fascicles intramurally. Categorical and continuous variables were summarized using descriptive statistics and compared using chi-square and Mann-Whitney U tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method.
PNI was positive in 211 of 287 cancers (73%), with a positive relation to lymph node metastases and advanced stage (p=0.0001, p=0.0001, respectively), mural invasion, and lymphatic and blood vessel invasion (p=0.0001, p=0.0001, respectively). The median survival of the PNI positive patients was significantly shorter than that of their PNI negative counterparts (24.1 versus 38.2 months, p=0.008). In the multivariate analysis, we detected PNI was an independent prognostic factor (p=0.025, HR=1.21, 95% CL 1.08-2.3) along with classical clinicopathological variables such as lymph node involvement (p=0.001), pT stage (p=0.03), and LVI (p=0.017), but not age, gender, tumour localization, stage, histologic type, and surgery procedure.
PNI positivity in gastric cancers was related mural invasion, lymph node involvement, advanced stage and lymphatic and venous blood vessels. The presence of PNI appeared as an independent prognostic factor on survival on multivariate analysis, not influenced by tumor stage, lymph node metastases and other classical factors.
先前已对胃癌中神经周围浸润（PNI）的预后意义进行了研究，但尚未明确阐明。本研究的目的是调查PNI作为预后因素在接受根治性手术切除且无远处转移的患者中的作用，并与其他临床病理因素进行比较。
2001年至2010年期间，287例胃腺癌患者在医院登记处记录接受了根治性胃切除术。当在壁内的神经束膜或神经束中看到癌细胞时，PNI被评估为阳性。分类变量和连续变量分别使用描述性统计进行汇总，并分别使用卡方检验和曼-惠特尼U检验进行比较。癌症相关生存率通过Kaplan-Meier方法估计。
287例癌症中有211例（73%）PNI呈阳性，与淋巴结转移和晚期（分别为p = 0.0001，p = 0.0001）、壁内浸润以及淋巴管和血管浸润（分别为p = 0.0001，p = 0.0001）呈正相关。PNI阳性患者的中位生存期明显短于PNI阴性患者（24.1个月对38.2个月，p = 0.008）。在多变量分析中，我们发现PNI是一个独立的预后因素（p = 0.025，HR = 1.21，95% CL 1.08 - 2.3），与经典的临床病理变量如淋巴结受累（p = 0.001）、pT分期（p = 0.03）和LVI（p = 0.017）一起，但与年龄、性别、肿瘤定位、分期、组织学类型和手术方式无关。
胃癌中的PNI阳性与壁内浸润、淋巴结受累、晚期以及淋巴管和静脉血管有关。在多变量分析中，PNI的存在似乎是生存的独立预后因素，不受肿瘤分期、淋巴结转移和其他经典因素的影响。
