神经旁浸润对胃癌根治术后患者预后的影响

目的：探讨神经旁浸润（PNI）对胃癌患者行根治性切除术后预后的影响。方法回顾性分析252例行胃癌根治术后的患者的临床资料。胃癌组织的石蜡标本以苏木精伊红（HE）染色，当肿瘤细胞浸润神经束膜或神经束内时判断为PNI阳性。分析PNI与其他临床病理特征之间的关系及其对患者预后的影响。结果 PNI阳性率32．1％（81／252）。PNI阳性率与T分期、N分期、TNM分期、肿瘤分化程度、血管和淋巴管侵犯及Lauren分型有关（P＜0．05），与患者的性别、年龄、肿瘤大小、肿瘤部位及Borrmann分型无关（P＞0．05）。随着肿瘤的进展，PNI阳性率增高。PNI阳性患者的5年累积生存率与平均生存时间分别为23．9％和34．5个月，明显低于PNI阴性患者的43．6％与43．8个月，差异有统计学意义（χ2＝11．765，P＝0．001）。多因素分析显示，PNI是影响患者预后的独立因素（P＝0．023，HR＝0．182，95％CI 0．042～0．793）。结论胃癌患者的PNI阳性率较高，PNI与胃癌的进展有关，是胃癌患者预后不良的标志之一。

Effects of perineural invasion on the prognosis of patients with radical resection for gastric carcino- ma

Objective To investigate the effects of perineural invasion（PNI）on the prognosis ofpatients with radical resection for gastric carcinoma.Methods A total of 252 patients with gastric carci noma who underwent radical resection were analyzed retrospectively.Paraffin sections of surgical specimensfrom all patients were stained with hematoxylin and eosin.PNI was defined as positive when carcinomacells infiltrated into the perineurium or neural fascicle.The association between PNI and other clinicopath ologic features and the effects of PNI on prognosis was studied.Results PNI was detected as positive in81 of the 252 patients（32.1%）.T stage,N stage,TNM stage,tumor differentiation,blood and lymphaticvessel invasion and Lauren type were closely associated with the PNI positivity（P 〈0.05）.On the otherhand,the relationship among PNI positivity,gender,age,tumor size,tumor site,Borrmann classification wasnot detected（P 〉0.05）.The proportion of PNI positivity increased with progression and clinical stage ofthe disease.The 5 year survival rate and mean survival of the PNI positive patients（23.9%,34.5 months）was significantly shorter than that of the PNI negative patients（43.6%,43.8 months）,respectively（χ2 =11.765,P =0.001）.Multivariate analysis indicated that the positivity of PNI was an independent prognos tic factor（P =0.023,HR =0.182,95%CI 0.042 ~0.793）.Conclusion The incidence of PNI is higherin gastric carcinoma and it corresponds to the progression of disease,which could be a new marker for thepoor prognosis.