Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Perineural Invasion Independent Prognostic Factors in Patients with Gastric Cancer Undergoing Curative Resection

  • Selcukbiricik, Fatih (Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Istanbul) ;
  • Tural, Deniz (Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Istanbul) ;
  • Buyukunal, Evin (Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Istanbul) ;
  • Serdengecti, Suheyla (Division of Medical Oncology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Istanbul)
  • Published : 2012.07.31
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Abstract

Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated but not clearly clarified. The objective of our study was to investigate the role of PNI as prognostic factor in patients undergoing curative surgical resection and without distant metastasis in comparison with other clinicopathological factors. Methods: Between 2001 and 2010, 287 cases of gastric adenocarcinoma underwent radical gastrectomy recorded in hospital based registries. PNI was assessed as positive when cancer cells were seen in the perinerium or neural fascicles intramurally. Categorical and continuous variables were summarized using descriptive statistics and compared using chi-square and Mann-Whitney U tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. Results: PNI was positive in 211 of 287 cancers (73%), with a positive relation to lymph node metastases and advanced stage (p=0.0001, p=0.0001, respectively), mural invasion, and lymphatic and blood vessel invasion (p=0.0001, p=0.0001, respectively). The median survival of the PNI positive patients was significantly shorter than that of their PNI negative counterparts (24.1 versus 38.2 months, p=0.008). In the multivariate analysis, we detected PNI was an independent prognostic factor (p=0.025, HR=1.21, 95% CL 1.08-2.3) along with classical clinicopathological variables such as lymph node involvement (p=0.001), pT stage (p=0.03), and LVI (p=0.017), but not age, gender, tumour localization, stage, histologic type, and surgery procedure. Conclusions: PNI positivity in gastric cancers was related mural invasion, lymph node involvement, advanced stage and lymphatic and venous blood vessels. The presence of PNI appeared as an independent prognostic factor on survival on multivariate analysis, not influenced by tumor stage, lymph node metastases and other classical factors.

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References

  1. Ayala GE, Dai H, Ittmann M, et al (2004). Growth and survival mechanisms associated with perineural invasion in prostate cancer. Cancer Res, 64, 6082-90. https://doi.org/10.1158/0008-5472.CAN-04-0838
  2. Bertuccio P, Chatenoud L, Levi F, et al (2009). Recent patterns in gastric cancer: a global overview. Int J Cancer, 125, 666-73. https://doi.org/10.1002/ijc.24290
  3. Bilici A, Seker M, Ustaalioglu BB, et al (2010). Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection. Ann Surg Oncol, 17, 2037-44. https://doi.org/10.1245/s10434-010-1027-y
  4. Carter RL, Foster CS, Dinsdale EA, et al (1983). Perineural spread by squamous carcinomas of the head and neck: a morphological study using antiaxonal and antimyelin monoclonal antibodies. J Clin Pathol, 36, 269-75. https://doi.org/10.1136/jcp.36.3.269
  5. Devesa SS, Blot WJ, Fraumeni JF Jr (1998). Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer, 83, 2049-53. https://doi.org/10.1002/(SICI)1097-0142(19981115)83:10<2049::AID-CNCR1>3.0.CO;2-2
  6. Duraker N, Sisman S, Can G (2003). The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today, 33, 95-100. https://doi.org/10.1007/s005950300020
  7. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  8. Jemal A, Siegel R, Ward E, et al (2009). Cancer statistics, 2009. CA Cancer J Clin, 59, 225-49. https://doi.org/10.3322/caac.20006
  9. Knudsen JB, Nilsson T, Sprechler M, et al (1983). N. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum, 26, 613-7. https://doi.org/10.1007/BF02552975
  10. Kurtz KA, Hoffman HT, Zimmerman MB, et al (2005). Perineural and vascular invasion in oral cavity squamous carcinoma: increased incidence on re-review of slides and by using immunohistochemical enhancement. Arch Pathol Lab Med, 129, 354-9.
  11. Lauren P (1965). The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand, 64, 31.
  12. Macdonald JS, Smalley SR, Benedetti J, et al (2001). Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 345, 725-30. https://doi.org/10.1056/NEJMoa010187
  13. Maru N, Ohori M, Kattan MW, et al (2001). Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens. Hum Pathol, 32, 828-33. https://doi.org/10.1053/hupa.2001.26456
  14. Nagakawa T, Mori K, Nakano T, et al (1993). Perineural invasion of carcinoma of the pancreas and biliary tract. Br J Surg, 80, 619-21. https://doi.org/10.1002/bjs.1800800526
  15. Ozaki H, Hiraoka T, Mizumoto R, et al (1999). The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today, 29, 16-22. https://doi.org/10.1007/BF02482964
  16. Parkin DM, Pisani P, Ferlay J (1993). Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer, 54, 594-606. https://doi.org/10.1002/ijc.2910540413
  17. Parkin DM, Bray FI, Devesa SS (2001). Cancer burden in the year 2000. The global picture. Eur J Cancer, 37, 4-66.
  18. Parkin DM (2004). International variation. Oncogene, 23, 6329-40. https://doi.org/10.1038/sj.onc.1207726
  19. Seki H, Tanaka J-I, Sato Y, et al (1993). Neural cell adhesion molecule (NCAM) and perineural invasion in bile duct cancer. J Surg Oncol, 53, 78-83.
  20. Soo KC, Carter RL, O'Brien CJ, et al (1986). Prognostic implications of perineural spread in squamous carcinomas of the head and neck. Laryngoscope, 96, 1145-8.
  21. Starzynska T (2007). Dig Dis. Molecular Epidemiol of Gastric Cancer, 25, 222-4. https://doi.org/10.1159/000103889
  22. Takahashi T, Ishikura H, Motohara T, et al (1997). Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol, 65, 164-70. https://doi.org/10.1002/(SICI)1096-9098(199707)65:3<164::AID-JSO4>3.0.CO;2-4
  23. Tianhang L, Guoen F, Jianwei B, et al (2008). The effect of perineural invasion on overall survival in patients with gastric carcinoma. J Gastrointest Surg, 12, 1263-7. https://doi.org/10.1007/s11605-008-0529-4
  24. Tanaka A, Yoshikawa H, Okuno K, et al (1997). The importance of neural invasion (NI) as a prognostic factor in diffuse invasive gastric cancer. Surg Today, 27, 692-5. https://doi.org/10.1007/BF02384978
  25. Tanaka A, Watanabe T, Okuno K, et al (1994). Perineural invasion as a predictor of recurrence of gastric cancer. Cancer, 73, 550-5. https://doi.org/10.1002/1097-0142(19940201)73:3<550::AID-CNCR2820730309>3.0.CO;2-0
  26. Ueno H, Hase K, Mochizuki H (2001). Criteria for extramural perineural invasion as a prognostic factor in rectal cancer. Br J Surg, 88, 994-1000. https://doi.org/10.1046/j.0007-1323.2001.01810.x
  27. Wittekind C, Meyer H-J (2010): TNM Classification of Malignant Tumours (ed 7). Weinheim, Germany, Wiley.
  28. Yokota T, Ishiyama S, Saito T, et al (2003). Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol, 4, 423-8. https://doi.org/10.1016/S1470-2045(03)01140-9

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