Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

Abstract

The availability of different treatment options for radically resectable gastric cancer reopened the question of treatment selection and correct definition of high-risk categories. Lymphatic, blood vessel and perineural invasion (LBVI/PNI) seem to possess the necessary potential to provide useful information for the clinical management of this disease. Seven hundred and thirty-four patients with advanced gastric cancer who underwent curative gastrectomy were analysed according to the presence of LBVI/PNI. Patients were divided into two groups: group A for patients with LBVI/PNI (189 patients 26%) and group B for patients without LBVI/PNI (545 patients, 74%). The disease-free survival (DFS) for patients in group A was 32.1 months, whereas it was not reached for patients in group B (P ¼ 0.0001); the median overall survival was 45.5 months for patients in group A, whereas it was not reached for patients in group B (P ¼ 0.0001). At multivariate analysis, the presence of LBVI/PNI appeared an independent prognostic factor for DFS and OS. Our results were confirmed in subgroup analysis, separately considering stage I and early gastric cancer patients with and without LBVI/PNI. Taken together, our findings suggest the importance of LBVI/PNI in gastric cancer as it may provide additional information for identifying patients at high risk, who may be candidates for further medical treatment after or before surgery.

Perineural Invasion After Preoperative Chemotherapy Predicts Poor Survival in Patients With Locally Advanced Gastric Cancer

“…Our findings are in concordance with the results of other investigators who have shown that in resected gastric and esophageal cancer, lymphovascular, or PNI is associated with poor survival. 30,31,32 In particular, Scartozzi et al 32 reported that in resected early stage, gastric cancer, lymphovascular or PNI predicts for OS and disease-free survival. In our study, we demonstrate the added benefit of PNI in discriminating survival in patients with advanced stage gastric cancer after preoperative chemotherapy.…”

Superior Prognostic Importance of Perineural Invasion vs. Lymph Node Involvement After Curative Resection of Duodenal Adenocarcinoma

“…27,28 Why carcinomas exhibit a predilection for perineural invasion and others do not remains unknown. Perineural invasion is emerging as an important feature in many malignancies, including oropharyngeal, 12 prostate, 13 colorectal, 14 biliary, 15 gastric, 16 lung, 17 breast, 18 and ampullary cancers. 11 The highest rate of perineural invasion is documented in pancreatic cancer, head and neck squamous cell carcinomas, and prostate cancer, while lower rates are documented in gastrointestinal cancers.…”

“…[11][12][13][14][15][16][17][18] While perineural invasion has been evaluated as a prognostic factor in patients with periampullary malignancies including pancreatic adenocarcinoma, distal cholangiocarcinoma, and ampulla of Vater carcinoma, 8,11,19 we know of no studies which have addressed the significance of perineural invasion in a large series of patients with duodenal adenocarcinoma.…”

Incorporation of perineural invasion of gastric carcinoma into the 7th edition tumor–node–metastasis staging system

“…However, PNI is found to be related to a more aggressive tumor phenotype and poor prognosis in several malignancies, most notably head and neck and prostate cancers [2,3]. The prognostic importance of PNI in gastric cancer (GC) had been evaluated in a few studies, but they had not reached consensus [4,5]. Recently, Bilici et al [6] indicated that the incidence of PNI in GC was higher, and it was related to the progression of patients with GC.…”