胃癌神经旁浸润的临床特征与预后分析  

Analysis of clinical characteristics and prognosis of perineural invasion in patients with gastric carcinoma

作　　者：谢洪虎[1] 吕成余[1] 黄文斌[2] 

机构地区：[1]南京医科大学附属南京第一医院普通外科,210006 [2]南京医科大学附属南京第一医院病理科,210006

出　　处：《中华胃肠外科杂志》2010年第6期413-416,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨胃癌神经旁浸润（PNI）的临床意义.方法 对2004年1月至2008年5月期间178例行胃癌根治术后的胃癌组织石蜡标本行苏木精-伊红染色,以肿瘤细胞浸润神经束或神经束膜判定为PNI阳性.分析PNI与胃癌临床病理特征及预后的关系.结果 PNI阳性78例（43.8%）.PNI与肿瘤浸润深度（P＜0.01）、淋巴结转移（P＜0.01）和TNM分期（P＜0.01）有关,但与患者的年龄、性别、肿瘤位置和分化程度无关.单因素分析显示,胃癌患者总体生存率与PNI、胃癌浸润深度、淋巴结转移和TNM分期有关（均P＜0.01）;PNI阳性患者平均生存期（28.6个月）明显短于PNI阴性患者（44.3个月）（P＜0.01）.多因素分析显示,PNI是影响患者总体生存率的独立因素（相对危险度为2.257,95%CI为1.268～4.019,P=0.006）.结论 PNI与肿瘤的进展有关,胃癌术后检测PNI可以作为判断患者预后指标之一.Objective To investigate the association between perineural invasion （PNI） and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma.Methods A total of 178 patients with gastric carcinoma from January 2004 to May 2008 were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent gastric resection were stained with laminin. PNl-positive was defined as infiltration of carcinoma cells into the perineurium or neural fascicles. The association of PNI with clinicopathologic features and prognosis of gastric carcinoma was studied. Results PNI was positive in 78 of 178 patients （43.8%）. The proportions of T stage, lymph node metastasis and TNM stage were significantly higher in PNI-positive group than those in PNl-negative group （all P〈0.01 ）. The PNI positive rate was correlated with the depth of gastric mural invasion and clinical stage. The overall survival in PNI-positive group was significantly lower than that in PNI-negative group by univariate analysis （P〈0.01）. The mean survival of PNI-positive patients （28.6 months） was significantly shorter than that of PNI-negative patients （44.3 months,P〈0.01）, which was also influenced by pN stage, pT stage, and clinical stage（P〈0.0l ）. By multivariable Cox proportional hazards model of overall survival, the positivity of PNI appeared to be an independent prognostic factor （hazards ratio=2.257,95% CI： 1.268-4.019, P=0.006）.Conclusions PNI is associated with the degree of malignancy in gastric cancer. PNI can be a candidate of new prognostic factor.

关 键 词：胃肿瘤 神经旁浸润 预后 

分 类 号：R735.2[医药卫生—肿瘤]