Jiang Nan, Deng Jing-Yu, Liu Yong, Ke Bin, Liu Hong-Gen, Liang Han
Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, 300060, China.
Tumour Biol. 2014 Sep;35(9):9429-36. doi: 10.1007/s13277-014-2258-5. Epub 2014 Jun 28.
The aim of this study was to determine the prognostic value of perineural invasion (PNI) in patients with gastric cancer who underwent curative resection. We retrospectively analyzed 518 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. Patients with PNI had a significantly larger tumors (≥5.0 cm), lymphatic venous invasion (positive), deeper tumor invasion (T4), more number of lymph node metastases (N3), and higher tumor stage (III). Regarding survival, multivariate analysis showed that PNI emerged as an independent prognostic factor for survival (hazard ratio (HR) = 1.901, P < 0.001). We incorporated the PNI into the 7th edition tumor-node-metastasis (TNM) staging system. Comparing with the 7th edition staging system, the redefinition of TPNI stage had higher -2loglikelihood value (-2loglikelihood = 3,492.259) and lower HR and 95 % confidence interval (CI) (HR = 1.955, 95 % CI = 1.630-2.343); redefinition of NPNI and TNMIIIPNI stage both had lower -2loglikelihood value (-2loglikelihood = 3,306.608; -2loglikelihood = 2,535.151) and higher HR and 95 % CI (HR = 1.879, 95 % CI = 1.720-2.053; HR = 2.268, 95 % CI = 1.900-2.707), which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability. 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 and it should be incorporated into TNM staging.
本研究旨在确定神经周围浸润（PNI）在接受根治性切除的胃癌患者中的预后价值。我们回顾性分析了518例行根治性胃切除术的患者。所有患者手术标本的石蜡切片进行苏木精-伊红染色。当癌细胞浸润到神经束膜或神经纤维束时定义为PNI。PNI患者的肿瘤明显更大（≥5.0 cm）、存在淋巴管侵犯（阳性）、肿瘤浸润更深（T4）、淋巴结转移数目更多（N3）且肿瘤分期更高（III期）。关于生存情况，多因素分析显示PNI是生存的独立预后因素（风险比（HR）=1.901，P<0.001）。我们将PNI纳入第7版肿瘤-淋巴结-转移（TNM）分期系统。与第7版分期系统相比，重新定义的TPNI分期具有更高的-2对数似然值（-2对数似然值=3492.259）以及更低的HR和95%置信区间（CI）（HR=1.955，95%CI=1.630-2.343）；重新定义的NPNI和TNMIIIPNI分期均具有更低的-2对数似然值（-2对数似然值=3306.608；-2对数似然值=2535.151）以及更高的HR和95%CI（HR=1.879，95%CI=1.720-2.053；HR=2.268，95%CI=1.900-2.707），这代表了最佳的预后分层，同时具有更好的同质性和鉴别能力。我们的结果表明，在接受根治性胃切除术的胃癌患者中PNI的发生率较高，且PNI阳性比例随疾病进展和临床分期增加。PNI可能有助于检测胃癌根治性切除术后预后不良的患者，并且应将其纳入TNM分期。
