J Pathol Transl Med.  2018 Mar;52(2):79-84. 10.4132/jptm.2017.11.01.

Extramural Perineural Invasion in pT3 and pT4 Gastric Carcinomas

• España-Ferrufino A
• Lino-Silva LS
• Salcedo-Hernández RA

• KMID: 2408507
• DOI: http://doi.org/10.4132/jptm.2017.11.01

Abstract

BACKGROUND
Perineural invasion (PNI) is widely studied in malignant tumors, and its prognostic significance is well demonstrated. Most studies have focused on evaluating the mural PNI (mPNI); however, extramural PNI (ePNI) may influence the prognosis in gastric cancer. We evaluated the prognostic value of ePNI compared with mPNI in gastric cancer in this observational comparative cross-sectional study.
METHODS
Seventy-three pT3 and pT4 gastric carcinomas with PNI were evaluated. Forty-eight (65.7%) were in the mPNI group and the remaining in the ePNI group.
RESULTS
Clinicopathologic characteristics between the two groups were similar, except for the outcomes. The 5-year disease-specific survival (DSS) rate was 64% for the mPNI group and 50% for the ePNI group (p=.039), a difference that did not remain significant in multivariate analysis. The only independent adverse prognostic factor in multivariate analysis was the presence of lymph node metastasis (hazard ratio, 1.757; 95% confidence interval, 1.082 to 2.854; p=.023).
CONCLUSIONS
We demonstrated the prognostic effect of ePNI for DSS in surgically resected pT3-pT4 gastric cancer patients. ePNI could be considered in the staging and prognostic systems of gastric cancer to stratify patients with a high risk of recurrence.

Keyword

Stomach neoplasms; Perineural invasion; Survival; Prognostic factor; Neoplasms

MeSH Terms

Cross-Sectional Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Recurrence
Stomach Neoplasms

Figure

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  Fig. 1. Histologic microphotography showing perineural space invasion. Note that neoplastic glands invade perineurium and encases at least 33% of the circumference of the nerve.

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  Fig. 2. Five-year disease-specific survival of 73 patients with gastric carcinoma divided by perineural invasion.

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