Hwang Jun-Eul, Hong Ji-Yun, Kim Ji Eun, Shim Hyun-Jeong, Bae Woo-Kyun, Hwang Eu-Chang, Jeong Oh, Park Young Kyu, Lee Kyung-Hwa, Lee Jae-Hyuk, Cho Sang-Hee, Chung Ik-Joo
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeonnam.
Department of Urology, Chonnam National University Hwasun Hospital, Jeonnam.
Jpn J Clin Oncol. 2015 Jun;45(6):541-6. doi: 10.1093/jjco/hyv031. Epub 2015 Mar 10.
In this study, we evaluated the prognostic significance of the concomitant existence of lymphovascular invasion and perineural invasion in patients with advanced gastric cancer.
A total of 206 consecutive patients with Stage II or III gastric cancer who underwent curative D2 gastrectomy and adjuvant chemotherapy from April 2004 to December 2011 were analyzed. Patients were classified into four groups according to the presence (+) or absence (-) of lymphovascular invasion and perineural invasion: lymphovascular invasion-/perineural invasion- (n = 33), lymphovascular invasion+/perineural invasion- (n = 31), lymphovascular invasion-/perineural invasion+ (n = 54) and lymphovascular invasion+/perineural invasion+ (n = 88).
A total of 136 patients (66.0%) received 5-fluorouracil plus cisplatin adjuvant chemotherapy and 70 patients (34.0%) received TS-1. During the median follow-up period of 35.18 months, the median disease-free survival times for lymphovascular invasion-/perineural invasion-, lymphovascular invasion+/perineural invasion- and lymphovascular invasion-/perineural invasion+ were not reached at the time of analysis; however, median disease-free survival for lymphovascular invasion+/perineural invasion+ was the worst (36.73 months, P = 0.001). The median overall survival in the four groups was also not reached at the time of analysis; however, median overall survival with lymphovascular invasion+/perineural invasion+ was the poorest (P = 0.002). In a multivariate analysis, lymphovascular invasion+/perineural invasion+ was an independent prognostic factor for both disease-free survival (hazard ratio = 1.940, 95% confidence interval 1.157-3.252, P = 0.012) and overall survival (hazard ratio = 2.973, 95% confidence interval 1.561-5.662, P = 0.001).
The concomitant existence of lymphovascular and perineural invasion has a significant prognostic impact on disease-free survival and overall survival in patients with Stage II or III gastric cancer.
在本研究中，我们评估了晚期胃癌患者中淋巴管侵犯和神经周围侵犯并存的预后意义。
分析了2004年4月至2011年12月期间连续接受根治性D2胃切除术及辅助化疗的206例II期或III期胃癌患者。根据淋巴管侵犯和神经周围侵犯的有无（+）或无（-）将患者分为四组：淋巴管侵犯-/神经周围侵犯-（n = 33）、淋巴管侵犯+/神经周围侵犯-（n = 31）、淋巴管侵犯-/神经周围侵犯+（n = 54）和淋巴管侵犯+/神经周围侵犯+（n = 88）。
共有136例患者（66.0%）接受了5-氟尿嘧啶加顺铂辅助化疗，70例患者（34.0%）接受了替吉奥。在中位随访期35.18个月时，分析时淋巴管侵犯-/神经周围侵犯-、淋巴管侵犯+/神经周围侵犯-和淋巴管侵犯-/神经周围侵犯+组的中位无病生存期未达到；然而，淋巴管侵犯+/神经周围侵犯+组的中位无病生存期最差（36.73个月，P = 0.001）。分析时四组的中位总生存期也未达到；然而，淋巴管侵犯+/神经周围侵犯+组的中位总生存期最差（P = 0.002）。在多因素分析中，淋巴管侵犯+/神经周围侵犯+是无病生存期（风险比 = 1.940，95%置信区间1.157 - 3.252，P = 0.012）和总生存期（风险比 = 2.973，95%置信区间1.561 - 5.662，P = 0.001）的独立预后因素。
淋巴管和神经周围侵犯并存对II期或III期胃癌患者的无病生存期和总生存期有显著的预后影响。
