CAJ | 학술논문

目的：探讨神经旁浸润（PNI）对胃癌患者行根治性切除术后预后的影响。方法回顾性分析252例行胃癌根治术后的患者的临床资料。胃癌组织的石蜡标本以苏木精伊红（HE）染色，当肿瘤细胞浸润神经束膜或神经束内时判断为PNI阳性。分析PNI与其他临床病理特征之间的关系及其对患者预后的影响。结果 PNI阳性率32．1％（81／252）。PNI阳性率与T分期、N分期、TNM分期、肿瘤分化程度、血管和淋巴管侵犯及Lauren分型有关（P＜0．05），与患者的性别、年龄、肿瘤大小、肿瘤部位及Borrmann分型无关（P＞0．05）。随着肿瘤的进展，PNI阳性率增高。PNI阳性患者的5年累积生存率与平均生存时间分别为23．9％和34．5个月，明显低于PNI阴性患者的43．6％与43．8个月，差异有统计学意义（χ2＝11．765，P＝0．001）。多因素分析显示，PNI是影响患者预后的独立因素（P＝0．023，HR＝0．182，95％CI 0．042～0．793）。结论胃癌患者的PNI阳性率较高，PNI与胃癌的进展有关，是胃癌患者预后不良的标志之一。
목적：탐토신경방침윤（PNI）대위암환자행근치성절제술후예후적영향。방법회고성분석252례행위암근치술후적환자적림상자료。위암조직적석사표본이소목정이홍（HE）염색，당종류세포침윤신경속막혹신경속내시판단위PNI양성。분석PNI여기타림상병리특정지간적관계급기대환자예후적영향。결과 PNI양성솔32．1％（81／252）。PNI양성솔여T분기、N분기、TNM분기、종류분화정도、혈관화림파관침범급Lauren분형유관（P＜0．05），여환자적성별、년령、종류대소、종류부위급Borrmann분형무관（P＞0．05）。수착종류적진전，PNI양성솔증고。PNI양성환자적5년루적생존솔여평균생존시간분별위23．9％화34．5개월，명현저우PNI음성환자적43．6％여43．8개월，차이유통계학의의（χ2＝11．765，P＝0．001）。다인소분석현시，PNI시영향환자예후적독립인소（P＝0．023，HR＝0．182，95％CI 0．042～0．793）。결론위암환자적PNI양성솔교고，PNI여위암적진전유관，시위암환자예후불량적표지지일。
Objective To investigate the effects of perineural invasion(PNI)on the prognosis ofpatients with radical resection for gastric carcinoma.Methods A total of 252 patients with gastric carcinoma who underwent radical resection were analyzed retrospectively.Paraffin sections of surgical specimensfrom all patients were stained with hematoxylin and eosin.PNI was defined as positive when carcinomacells infiltrated into the perineurium or neural fascicle.The association between PNI and other clinicopathologic features and the effects of PNI on prognosis was studied.Results PNI was detected as positive in81 of the 252 patients(32.1%).T stage,N stage,TNM stage,tumor differentiation,blood and lymphaticvessel invasion and Lauren type were closely associated with the PNI positivity(P <0.05).On the otherhand,the relationship among PNI positivity,gender,age,tumor size,tumor site,Borrmann classification wasnot detected(P >0.05).The proportion of PNI positivity increased with progression and clinical stage ofthe disease.The 5year survival rate and mean survival of the PNIpositive patients(23.9%,34.5 months)was significantly shorter than that of the PNInegative patients(43.6%,43.8 months),respectively(χ2 =11.765,P =0.001).Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor(P =0.023,HR =0.182,95%CI 0.042 ~0.793).Conclusion The incidence of PNI is higherin gastric carcinoma and it corresponds to the progression of disease,which could be a new marker for thepoor prognosis.