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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2010

01-08-2010 | Gastrointestinal Oncology

Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection

Authors: Ahmet Bilici, MD, Mesut Seker, MD, Bala Basak Oven Ustaalioglu, MD, Umut Kefeli, MD, Emre Yildirim, MD, Dilek Yavuzer, MD, Fatih Muhammed Aydin, MD, Taflan Salepci, MD, Mustafa Oncel, MD, FASCRS(Int), Mahmut Gumus, MD

Published in: Annals of Surgical Oncology | Issue 8/2010

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Abstract

Background

The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection.

Materials and Methods

We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis.

Results

PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12–3.13) as were classical clinicopathological features.

Conclusion

Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.
Literature
1.
Desai AM, Pareek M, Nightingale PG, Fielding JW. Improving outcomes in gastric cancer over 20 years. Gastric Cancer. 2004;7:196–201.CrossRefPubMed
2.
Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.PubMed
3.
4.
Yokota T, Ishiyama S, Saito T, Teshima S, Shimotsuma M, Yamauchi H. Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol. 2003;4:423–8.CrossRefPubMed
5.
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRefPubMed
6.
Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.CrossRefPubMed
7.
Nagakawa T, Mori K, Nakano T, Kadoya M, Kobayashi H, Akiyama T, et al. Perineural invasion of carcinoma of the pancreas and biliary tract. Br J Surg. 1993;80:619–21.CrossRefPubMed
8.
Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H. Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol. 1997;65:164–70.CrossRefPubMed
9.
Ozaki H, Hiraoka T, Mizumoto R, Matsuno S, Matsumoto Y, Nakayama T, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today. 1999;29:16–22.CrossRefPubMed
10.
Seki H, Tanaka J, Sato Y, Kato Y, Umezawa A, Koyama K. Neural cell adhesion molecule (NCAM) and perineural invasion in bile duct cancer. J Surg Oncol. 1993;53:78–83.CrossRefPubMed
11.
Ueno H, Hase K, Mochizuki H. Criteria for extramural perineural invasion as a prognostic factor in rectal cancer. Br J Surg. 2001;88:994–1000.CrossRefPubMed
12.
Moreira LF, Kenmotsu M, Gochi A, Tanaka N, Orita K. Lymphovascular and neural invasion in low-lying rectal carcinoma. Cancer Detect Prev. 1999;23:123–8.CrossRefPubMed
13.
Shirouzu K, Isomoto H, Kakegawa T. Prognostic evaluation of perineural invasion in rectal cancer. Am J Surg. 1993;165:233–7.CrossRefPubMed
14.
Duraker N, Sişman S, Can G. The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today. 2003;33:95–100.CrossRefPubMed
15.
Tanaka A, Yoshikawa H, Okuno K, Koh K, Watatani M, Matsumura E, et al. The importance of neural invasion (NI) as a prognostic factor in diffuse invasive gastric cancer. Surg Today. 1997;27:692–5.CrossRefPubMed
16.
Tanaka A, Watanabe T, Okuno K, Yasutomi M. Perineural invasion as a predictor of recurrence of gastric cancer. Cancer. 1994;73:550–5.CrossRefPubMed
17.
Tianhang L, Guoen F, Jianwei B, Liye M. The effect of perineural invasion on overall survival in patients with gastric carcinoma. J Gastrointest Surg. 2008;12:1263–7.CrossRefPubMed
18.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer. 1998;1:10–24.
19.
Fleming ID, Cooper JS, Henson DE, Hunter RVP, Kennedy BJ, Murphy GP, et al. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.
20.
Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumors, pathology and genetics of tumors of the digestive system. Lyon: IARC Press; 2000:38–52.
21.
22.
Kameda K, Shimada H, Ishikawa T, Takimoto A, Momiyama N, Hasegawa S, et al. Expression of highly polysialylated neural cell adhesion molecule in pancreatic cancer neural invasive lesion. Cancer Lett. 1999;137:201–7.CrossRefPubMed
23.
Murakawa K, Tada M, Takada M, Tamoto E, Shindoh G, Teramoto K, et al. Prediction of lymph node metastasis and perineural invasion of biliary tract cancer by selected features from cDNA array data. J Surg Res. 2004;122:184–94.CrossRefPubMed
Metadata
Title
Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection
Authors
Ahmet Bilici, MD
Mesut Seker, MD
Bala Basak Oven Ustaalioglu, MD
Umut Kefeli, MD
Emre Yildirim, MD
Dilek Yavuzer, MD
Fatih Muhammed Aydin, MD
Taflan Salepci, MD
Mustafa Oncel, MD, FASCRS(Int)
Mahmut Gumus, MD
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1027-y

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