Prognostic Significance of Lymphatic, Venous and Perineural Invasion After Neoadjuvant Chemotherapy in Patients with Gastric Adenocarcinoma.
Adenocarcinoma
/ drug therapy
Adult
Aged
Aged, 80 and over
Female
Gastrectomy
Humans
Lymph Node Excision
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Staging
Peripheral Nerves
/ pathology
Prognosis
Retrospective Studies
Stomach Neoplasms
/ drug therapy
Survival Rate
Young Adult
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
22
01
2020
pubmed:
29
3
2020
medline:
7
4
2021
entrez:
29
3
2020
Statut:
ppublish
Résumé
The significance of perineural (PNI), lymphatic (LI) and venous invasion (VI) in gastric cancer patients who have received neoadjuvant chemotherapy is unclear. The aim of this study is to determine the incidence and prognostic significance of LI, VI and PNI in these patients. Consecutive patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy were reviewed. Presence of LI, VI and PNI was recorded and correlated with clinical outcomes. A total of 243 patients underwent gastrectomy after neoadjuvant therapy for gastric adenocarcinoma. LI was identified in 129 (53%), VI in 107 (44%) and PNI in 116 (48%) of patients. Presence of LI (HR, 2.95, CI 1.91-4.56), VI (HR, 2.66, CI 1.78-3.98) and PNI (HR, 3.85, CI 2.49-5.95) was associated with poorer survival (all p < 0.001). Multivariable analysis revealed that ypT stage (HR, 1.35, CI 1.05-1.74), ypN stage (HR, 1.53, CI 1.28-1.83) and PNI (HR, 2.11, CI 1.31-3.42) were independent predictors of survival. LI, VI and PNI are associated with poorer survival, with PNI having prognostic significance independent of lymph node status. These factors may be useful for further prognostication, in particular when multiple factors are present, and appear especially useful for prognostic stratification in patients with no nodal involvement.
Sections du résumé
BACKGROUND
BACKGROUND
The significance of perineural (PNI), lymphatic (LI) and venous invasion (VI) in gastric cancer patients who have received neoadjuvant chemotherapy is unclear. The aim of this study is to determine the incidence and prognostic significance of LI, VI and PNI in these patients.
PATIENTS AND METHODS
METHODS
Consecutive patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy were reviewed. Presence of LI, VI and PNI was recorded and correlated with clinical outcomes.
RESULTS
RESULTS
A total of 243 patients underwent gastrectomy after neoadjuvant therapy for gastric adenocarcinoma. LI was identified in 129 (53%), VI in 107 (44%) and PNI in 116 (48%) of patients. Presence of LI (HR, 2.95, CI 1.91-4.56), VI (HR, 2.66, CI 1.78-3.98) and PNI (HR, 3.85, CI 2.49-5.95) was associated with poorer survival (all p < 0.001). Multivariable analysis revealed that ypT stage (HR, 1.35, CI 1.05-1.74), ypN stage (HR, 1.53, CI 1.28-1.83) and PNI (HR, 2.11, CI 1.31-3.42) were independent predictors of survival.
CONCLUSIONS
CONCLUSIONS
LI, VI and PNI are associated with poorer survival, with PNI having prognostic significance independent of lymph node status. These factors may be useful for further prognostication, in particular when multiple factors are present, and appear especially useful for prognostic stratification in patients with no nodal involvement.
Identifiants
pubmed: 32219726
doi: 10.1245/s10434-020-08389-7
pii: 10.1245/s10434-020-08389-7
pmc: PMC7410853
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3296-3304Références
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.
doi: 10.1002/ijc.29210
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.
doi: 10.1056/NEJMoa055531
Li Z, Rice TW. Diagnosis and staging of cancer of the esophagus and esophagogastric junction. Surg Clin N Am. 2012;92:1105–1126.
doi: 10.1016/j.suc.2012.07.010
TNM Classification of Malignant Tumours, 7th Edition. Sobin, LH. Wiley-Blackwell Available from: http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1444332414.html . 2009. Accessed May 31, 2015.
Lagarde SM, Phillips AW, Navidi M, et al. The presence of lymphovascular and perineural infiltration after neoadjuvant therapy and oesophagectomy identifies patients at high risk for recurrence. Br J Cancer. 2015;113:1427–33.
doi: 10.1038/bjc.2015.354
Du C-Y, Chen J-G, Zhou Y, et al. Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer. World J Gastroenterol. 2012;18:3610–6.
doi: 10.3748/wjg.v18.i27.3610
Li P, Ling Y-H, Zhu C-M, et al. Vascular invasion as an independent predictor of poor prognosis in nonmetastatic gastric cancer after curative resection. Int J Clin Exp Pathol. 2015;8:3910–8.
pubmed: 26097575
pmcid: 4466962
Deng J, You Q, Gao Y, et al. Prognostic value of perineural invasion in gastric cancer: a systematic review and meta-analysis. PLoS ONE. 2014;9:e88907.
doi: 10.1371/journal.pone.0088907
Ajani J, In H, Sano T. Stomach. In: Amin M, Edge S, Greene F, et al., eds. AJCC Cancer Staging Manual. New York: Springer; 2016:203–220.
Navidi M, Madhavan A, Griffin SM, et al. Trainee performance in radical gastrectomy and its effect on outcomes. BJS Open. 2020;4:86–90.
doi: 10.1002/bjs5.50219
Mapstone N. Dataset for the histopahtological reporting of oesophageal carcinoma (2nd edition). 2007.
Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73:2680–6.
doi: 10.1002/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C
Jiang L, Yang K, Guan Q, et al. Survival benefit of neoadjuvant chemotherapy for resectable cancer of the gastric and gastroesophageal junction. J Clin Gastroenterol. 2015;49:387–394.
doi: 10.1097/MCG.0000000000000212
Scartozzi M, Galizia E, Verdecchia L, et al. Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients. Br J Cancer. 2006;95:445–9.
doi: 10.1038/sj.bjc.6603286
Kunisaki C, Makino H, Kimura J, et al. Impact of lymphovascular invasion in patients with stage I gastric cancer. Surgery. 2010;147:204–211.
doi: 10.1016/j.surg.2009.08.012
Lee J-H, Kim MG, Jung M-S, et al. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg. 2015;39:732–9.
doi: 10.1007/s00268-014-2846-y
Royston D, Jackson DG. Mechanisms of lymphatic metastasis in human colorectal adenocarcinoma. J Pathol. 2009;217:608–19.
doi: 10.1002/path.2517
Guntupalli SR, Zighelboim I, Kizer NT, et al. Lymphovascular space invasion is an independent risk factor for nodal disease and poor outcomes in endometrioid endometrial cancer. Gynecol Oncol. 2012;124:31–5.
doi: 10.1016/j.ygyno.2011.09.017
Cornwell LB, McMasters KM, Chagpar AB. The impact of lymphovascular invasion on lymph node status in patients with breast cancer. Am Surg. 2011;77:874–7.
pubmed: 21944350
Ozaki H, Hiraoka T, Mizumoto R, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today. 1999;29:16–22.
doi: 10.1007/BF02482964
Li P, He H-Q, Zhu C-M, et al. The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China. BMC Cancer. 2015;15:370.
doi: 10.1186/s12885-015-1370-2
Araki I, Hosoda K, Yamashita K, et al. Prognostic impact of venous invasion in stage IB node-negative gastric cancer. Gastric Cancer. 2015;18:297–305.
doi: 10.1007/s10120-014-0362-2
Duraker N, Sişman S, Can G. The significance of perineural invasion as a prognostic factor in patients with gastric carcinoma. Surg Today. 2003;33:95–100.
doi: 10.1007/s005950300020
Jhawer M, Coit D, Brennan M, et al. Perineural invasion after preoperative chemotherapy predicts poor survival in patients with locally advanced gastric cancer: gene expression analysis with pathologic validation. Am J Clin Oncol. 2009;32:356–62.
doi: 10.1097/COC.0b013e31818c08e8
Zhu Y, Sun Y, Hu S, et al. Comparison of five tumor regression grading systems for gastric adenocarcinoma after neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in China. BMC Gastroenterol. 2017;17:41.
doi: 10.1186/s12876-017-0598-5
Geramizadeh B, Owen DA. Handling and pathology reporting of gastrointestinal endoscopic mucosal resection. Middle East J Dig Dis. 2017;9:5–11.
doi: 10.15171/mejdd.2016.45
Eguchi T, Nakanishi Y, Shimoda T, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006;19:475–80.
doi: 10.1038/modpathol.3800557