De Franco Lorenzo, Marrelli Daniele, Voglino Costantino, Vindigni Carla, Ferrara Francesco, Di Mare Giulio, Iudici Livio, Marini Mario, Roviello Franco
Department of Medicine, Surgery and Neurosciences, Unit of Surgical Oncology, University of Siena, 53100, Siena, Italy.
Department of Medicine, Surgery and Neurosciences, Unit of Pathology, University of Siena, 53100, Siena, Italy.
Pathol Oncol Res. 2018 Apr;24(2):393-400. doi: 10.1007/s12253-017-0257-8. Epub 2017 May 30.
The purpose of this study is to investigate perineural invasion (PNI) as a prognostic factor in gastric cancer patients. 455 patients submitted to extended (D2 or more) lymphadenectomy (median number of 39 retrieved lymph nodes, range: 15-140) between 1995 and 2012 were retrospectively studied. Patients were categorized in two groups according to the PNI status, and PNI positivity was assessed in presence of cancer cells in the perinerium or the neural fascicles using hematoxylin and eosin staining. Median follow-up for surviving patients was 80.3 months. Survival analysis was performed by univariate and multivariate analysis, using a Cox proportional hazards model. 162 patients (33.9%) had positive PNI; this was strongly associated with advanced stages of disease, residual tumor, lymphovascular invasion, Lauren diffuse-mixed histotype and tumor size. Five-year cancer-related survival was 65,7% and 20,6% in PNI negative vs. positive groups, respectively (p < 0.001). The prognostic impact of PNI at univariate analysis was particularly evident in patients submitted to R0 surgery, early as well as advanced stage, advanced nodal stage and T status. At multivariate analysis, PNI did not result statistically significant in the overall series, but emerged as an independent prognostic factor in the group of patients with Lauren intestinal histotype (p = 0.005, hazard ratio: 1.99, 95% confidence interval 1.24-3.19). PNI is related to advanced stage and poor long-term survival in gastric cancer, and may serve as an adjunctive prognostic factor in the intestinal histotype.
本研究旨在探讨神经周围侵犯（PNI）作为胃癌患者的一个预后因素。对1995年至2012年间接受扩大（D2或更广泛）淋巴结清扫术（中位清扫淋巴结数为39枚，范围：15 - 140枚）的455例患者进行了回顾性研究。根据PNI状态将患者分为两组，使用苏木精和伊红染色法，在神经束膜或神经束中存在癌细胞时评估PNI阳性情况。存活患者的中位随访时间为80.3个月。采用Cox比例风险模型进行单因素和多因素生存分析。162例患者（33.9%）PNI阳性；这与疾病晚期、残留肿瘤、淋巴管侵犯、Lauren弥漫 - 混合型组织学类型和肿瘤大小密切相关。PNI阴性组和阳性组的5年癌症相关生存率分别为65.7%和20.6%（p < 0.001）。在单因素分析中，PNI的预后影响在接受R0手术的患者中尤为明显，无论早期还是晚期、晚期淋巴结分期和T分期患者均如此。在多因素分析中，PNI在整个系列中无统计学意义，但在Lauren肠型组织学类型患者组中成为独立的预后因素（p = 0.005，风险比：1.99，95%置信区间1.24 - 3.19）。PNI与胃癌的晚期阶段和不良长期生存相关，并且可能作为肠型组织学类型的辅助预后因素。
