title: 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=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=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.
authors.affiliation: The Departments of Clinica di Oncologia Medica, Azienda Ospedaliera Ospedali Riuniti, Università Politecnica delle Marche, Via Conca, 60020 Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Scartozzi
authors.forename: E
authors.initials: E
authors.lastname: Galizia
authors.forename: L
authors.initials: L
authors.lastname: Verdecchia
authors.forename: R
authors.initials: R
authors.lastname: Berardi
authors.forename: F
authors.initials: F
authors.lastname: Graziano
authors.forename: V
authors.initials: V
authors.lastname: Catalano
authors.forename: P
authors.initials: P
authors.lastname: Giordani
authors.forename: D
authors.initials: D
authors.lastname: Mari
authors.forename: R R
authors.initials: RR
authors.lastname: Silva
authors.forename: C
authors.initials: C
authors.lastname: Marmorale
authors.forename: C
authors.initials: C
authors.lastname: Zingaretti
authors.forename: S
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010524:Peripheral Nervous System Neoplasms / Q000556:secondary*; D011379:Prognosis; D013270:Stomach / Q000098:blood supply / Q000294:innervation; D013274:Stomach Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000556:secondary*