神经浸润对胃癌患者生存预后的影响

目的:探讨神经浸润(perineural invasion,PNI)对胃癌患者生存预后的影响。方法:回顾性分析2011年1月至2012年12月天津医科大学肿瘤医院收治的1007例胃癌患者的临床病理资料,根据术后病理标本中有无PNI将所有患者分为PNI阴性组和PNI阳性组,分析PNI与临床病理因素的关系及其对胃癌患者生存预后的影响。结果:1007例胃癌患者中PNI阳性120例,阳性率为11.9%。分化程度、浸润深度和脉管癌栓是PNI的独立危险因素。单因素分析显示,年龄、肿瘤部位、Borrmann分型、肿瘤大小、根治度、TNM分期、术式、癌结节、脉管癌栓、PNI、术前CA19-9及CEA水平与胃癌患者预后相关。PNI阴性和PNI阳性患者5年生存率分别为66.6%和38.3%,差异具有统计学意义(P<0.001)。多因素分析显示年龄、BorrmannⅣ型、TNM分期、根治度、癌结节和PNI是胃癌患者的独立预后因素。分层分析显示,PNI仅对Ⅰ、Ⅱ和Ⅲa期胃癌预后影响具有统计学意义。结论:PNI是胃癌患者独立预后因素,可作为Ⅰ、Ⅱ和Ⅲa期患者预后评价指标。

Impact of perineural invasion on the overall survival of patients with gastric cancer

  Objective  To evaluate the impact of perineural invasion (PNI) on the overall survival (OS) of patients with gastric cancer.  Methods  A total of 1, 007 patients with gastric cancer who underwent curative resection between January 2011 and December 2012 at the Cancer Institute and Hospital of Tianjin Medical University were enrolled. All the patients were categorized into the following two groups according to the status of PNI: positive group, presence of PNI; and negative group, absence of PNI. Potential prognostic factors and clinical pathological variables correlated with the presence of PNI were analyzed.  Results  One hundred and twenty (11.9%) patients had PNI. Multivariate analysis revealed that histology, depth of invasion, and lymphovascular invasion were independently associated with the presence of PNI. Univariate survival analysis revealed that age, tumor location, Borrmann type, tumor size, curability, TNM stage, type of gastrectomy, tumor deposit, lymphovascular invasion, PNI, preoperative CA19-9 levels, and CEA levels were significant prognostic factors. Gastric cancer patients with PNI had a significantly lower 5-year OS rate than those without PNI (5- year OS: 38.3% versus 66.6%, P < 0.001). In the multivariate analysis, age, Borrmann type Ⅳ, TNM stage, curability, tumor deposit, and PNI were independent prognostic factors for this population cohort. The strata analysis revealed that PNI merely had a significant impact on OS in patients at stages Ⅰ, Ⅱ, and Ⅲa.  Conclusions  PNI is an independent prognostic factor in patients with gastric cancer and can be used as a prognostic indicator for gastric cancer patients at stages Ⅰ, Ⅱ, and Ⅲa.