进展期胃癌中神经旁浸润与HER-2表达及其相关性分析

Analysis of perineural invasion with HER-2 expression and its correlation in patients with advanced gastric cancer

目的检测进展期胃癌中神经旁浸润(perineural invasion,PNI)的发生及人表皮生长因子受体2(human epidermalgrowth factor receptor-2,HER-2)的表达,分析两者对进展期胃癌预后的影响以及两者之间的相关性。方法采用HE染色对100例进展期胃癌组织进行PNI阳性筛选并运用免疫组化法检测HER-2的表达,分析PNI与HER-2表达和进展期胃癌临床病理特征的关系及两者之间的相关性。结果 PNI阳性者共42例,阳性率为42%,PNI的发生与淋巴结转移、浸润深度、癌栓、TNM分期及HER-2表达等因素具有一定的相关性,差异有统计学意义(P<0.05)。单因素生存分析显示,进展期胃癌的总生存率与T分期、癌栓、N分期、TNM分期、PNI和HER-2有关(P均<0.05);PNI阳性患者生存期与PNI阴性患者相比明显降低,PNI阴性患者为45.3个月,PNI阳性患者为15.4个月(P<0.05)。HER-2阳性患者平均生存期(22.7个月)与HER-2阴性患者(43.2个月)相比亦明显降低(P<0.05)。多因素生存分析显示PNI和HER-2表达均对患者总生存率具有影响,是影响预后的独立危险因素(P均<0.05)。结论进展期胃癌术后检测PNI和HER-2对患者预后具有一定的提示作用,HER-2原癌基因蛋白可能与PNI的发生具有一定关联性或发挥一定的协同作用。

Purpose To investigate the presence of perineural invasion （PNI） and the expression of human epidermal growth factor receptor 2 （HER-2） in patients with advanced gastric cancer. To discuss the correlation between PNI and the expression of HER-2 and their prognostic significance. Methods Paraffin sections of surgical specimens from 100 patients who underwent gastric resection were selected, and then PNI were detected by HE staining and the expression of HER-2 were detected by immunohistochemical （IHC）. The correlation of perineural invasion with the clinicopathological features and HER-2 expression were performed. Results PNI was positive in 42 cases of 100 patients （ PNI positive rate was 42% ）, the occurrence of PNI has significantly related with lymph node metastases, infiltrating depth, tumor emboli, TNM stage and expression of HER- 2. The difference was statistically significant （P 〈 0. 05）. Univariate analysis showed that total survival rate of advanced gastric cancer was associated with T stage, tumor emboli, N stage, TNM stage, PNI and HER-2 expression （ P 〈 0. 05）. The overall survival of the PNI-negative patients was 45.3 months on average,much better than the PNI positive patients who was 15.4 months in average （ P 〈 0. 05 ）. The overall survival of the HER- 2-negative patients was 43.2 months on average, much better than the HER-2-positive patients who was 22. 7 months in average （P 〈 0. 05 ）. By muhivariable Cox proportional hazards model of overall survival, the positivity of PNI and HER-2 appeared to be new independent prognostic factors （ P 〈 0. 05 ）. Conclusion The detection of PNI and HER-2 expression maybe helpful for the prognosis of patients with advanced gastric cancer. In addition, HER-2 may be responsible for the presence of perineural invasion.