神经浸润在胃癌中的临床意义

Clinical significance of perineural invasion on the patients with gastric cancer

目的 研究神经浸润对胃癌患者预后的影响.方法 回顾性分析116例行胃癌根治性切除术患者的临床资料,对术后石蜡切片行S-100蛋白染色,观察神经浸润发生情况,分析神经浸润与临床病理及预后的关系.结果 116例胃癌患者有41例（35.3％,41/116）发生神经浸润,神经浸润的发生与浸润深度、病理类型、淋巴结转移有关（P＜0.05）,而与性别、肿瘤大小、Borrmann分型、TNM分期无关（P＞0.05）.105例患者完成随访,中位随访时间49个月,发生神经浸润患者中位生存期及5年生存率均明显少于未发生神经浸润患者[23.6个月比43.8个月、30.6％（11/36）比53.6％（37/69）],差异有统计学意义（P＜0.05）.单因素和多因素分析均提示神经浸润与患者预后相关（P＜0.05）.结论 发生神经浸润胃癌患者肿瘤细胞具有较强的侵袭能力,可作为判定胃癌患者预后的一个独立的重要指标.

Objective To investigate the effect of perineural invasion （PNI） on evaluating the prognosis of patients with gastric cancer.Methods The clinical data of 116 patients who underwent gastric resection were analyzed retrospectively,all of the paraffin sections were stained with S-100 albumen,the association between PNI with clinicopathological features and prognosis were analyzed.Results PNI was positive in 41 of all the 116 patients （35.3%,41/116）.The occurrence of PNI related with depth of invasion,histological type,lymph node metastasis （P 〈0.05）,unrelated with gender,tumor size,Borrmann classification,TNM stage （P 〉0.05）.One hundred and five patients completed follow-up,the median follow-up time was 49 months,the median life span and 5-year survival of the PNI-positive patients were significantly worse than that of PNI-negative patients [23.6 months vs.43.8 months,30.6%（ll/36） vs.53.6% （37/69）,P 〈 0.05].Univariate and multivariate analysis were prompted PNI with perineural invasion （P 〈 0.05）.Conclusions The PNI-positive tumor cell may have more power in invasiveness,and it could serve as an independent predictor of prognosis of gastric cancer.