| Purpose:Perineural invasion(PNI)is associated with the prognosis of various malignancies,including head and neck cancer,pancreatic cancer,breast cancer,prostate cancer,biliary tract cancer,colorectal cancer,and gastric cancer,but the relationship with the prognosis of gastric stump cancer has not been clearly established.This study intends to investigate the effect of neural invasion(PNI)on the survival prognosis of patients with gastric stump cancer.Method:Based on the inclusion and exclusion criteria,139 cases of gastric stump cancer who underwent surgical treatment(including radical and palliative surgery)in the Department of General Surgery(Gastrointestinal Surgery Ward)of the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 were selected for this study and retrospectively studied.The clinical,postoperative pathological and follow-up data of these 139 cases of gastric stump cancer were collected,grouped according to the presence or absence of neurological invasion,compared between the clinicopathological characteristics of the two groups using the chi-square test,performed one-way survival analysis using the log-rank test and multi-factor prognostic analysis using the COX proportional risk model,and the Kaplan-Meier method was used to plot the survival curves of each clinical factor.Statistical significance was considered at P <0.05.Result:The median postoperative survival of 139 patients with gastric stump cancer was45.0(95% CI: 22.378-67.622)months,with a 5-year survival rate of 46.9%;the5-year survival rate after surgery was 30.0% for patients with positive neural invasion(PNI)and 68.9% for patients with negative PNI,with statistically significant differences(P <0.001).The PNI positivity rate was 59.0%,and PNI positivity was associated with TNM stage,degree of tumor differentiation,tumor size and presence of vascular invasion(VI)(all P <0.05).Univariate analysis showed that overall survival was associated with TNM stage,tumor differentiation,tumor size,PNI,vascular invasion,and surgical approach(P <0.05).Multifactorial analysis showed that PNI and TNM stage were independent influencing factors on the prognosis of patients with gastric stump cancer(P <0.05).Subgroup analysis showed that PNI had a significant effect on overall survival in patients with TNM stage Ⅰ-Ⅱ,open and laparoscopic residual gastric cancer after surgery(all P <0.001).In contrast,in patients with postoperative TNM stage III-IV gastric stump cancer,the effect of nerve invasion on overall survival was not statistically significant(P >0.05).Conclusion:Our results showed that among 139 patients with gastric stump cancer in our study center,the positive rate of PNI was high,the overall survival of PNI-positive patients was significantly shorter than that of negative patients,and PNI status and TNM stage were independent risk factors affecting the prognosis of gastric stump cancer.Further analysis revealed that PNI mainly affected the overall survival of patients with TNM stage Ⅰ-Ⅱ gastric stump cancer after surgery.Therefore,a more individualized and comprehensive treatment plan should be considered for patients with PNI-positive gastric stump cancer,especially for patients with stage Ⅰ-Ⅱ. |
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