| Objective:To analyze the effect of lymphovascular and perineural invasion on the efficacy and prognosis of neoadjuvant chemotherapy for gastric cancer.Methods:The clinicopathological data of 719 patients with gastric cancer who underwent radical gastrectomy at Qingdao University Affiliated Yantai Yuhuangding Hospital from January2011 to January 2015 were retrospectively analyzed to explore the relationship of lymphovascular and perineural invasion with other clinicopathological factors,as well as the effect on the efficacy and prognosis of neoadjuvant chemotherapy for gastric cancer.Results:1.Among the 719 patients with gastric cancer,230 were positive for lymphovascular invasion,and 124 were positive for perineural invasion.The positive rate was 32.0% and17.2%,respectively.There was no significant difference between the neoadjuvant chemotherapy group and the surgical group in patients’ gender,age,tumor location,Lauren type,differentiation degree,lymphovascular invasion,perineural invasion,tumor nodules and surgical methods(P>0.05).There was significant difference in tumor gross type,tumor size,infiltration mode,T staging and N staging between the two groups,which were more advanced in the neoadjuvant chemotherapy group compared to the surgical group,and the difference was statistically significant(P<0.05).2.Unvariate cox analysis showed that tumor location,gross type,tumor size,Lauren type,differentiation degree,infiltration mode,lymphovascular invasion,perineural invasion,tumor nodules,T staging,N staging and surgical methods had significant effects on the 5-year overall survival rate and 5-year recurrence-free survival rate of gastric cancer(P<0.05).Multifactorial survival analysis showed that tumor size,Lauren type,lymphovascular invasion,perineural invasion,T staging and N staging were independent factors affecting the 5-year overall survival rate and 5-year recurrence-free survival rate of gastric cancer after operation(P<0.01).The 5-year overall survival rate and recurrence-free survival rate of gastric cancer in patients with lymphovascular or perineural invasion were worse than those without invasion,and the difference was statistically significant(P<0.01).3.Binary logistic regression analysis found differentiation degree(OR: 1.74;95%CI:1.05～2.88;P=0.03),perineural invasion(OR: 2.49;95%CI: 1.61～3.85;P< 0.01),T staging(OR: 1.56;95%CI: 1.28～1.89;P<0.01)and N staging(OR: 1.53;95%CI: 1.29～1.82;P<0.01)were independent risk factors for the occurrence of lymphovascular invasion in patients with gastric cancer.4.Binary logistic regression analysis found lymphovascular invasion(OR: 2.56;95%CI: 1.65～3.95;P<0.01),T staging(OR: 1.78;95%CI: 1.36～2.32;P<0.01)and N staging(OR: 1.35;95%CI: 1.10～1.65;P<0.01)were independent risk factors for the occurrence of perineural invasion in patients with gastric cancer.5.A total number of 98 patients with gastric cancer receiving neoadjuvant chemotherapy and preoperative evaluation of chemotherapy efficacy.Among the 98 patients,37 had partial response(PR)(37.8%),59 had stable disease(SD)(60.2%),and 2had progressive disease(PD)(2.0%).Overall,the objective response rate(ORR)was 37.8%,and the disease control rate(DCR)was 98%.The 5-year overall survival rate and 5-year recurrence-free survival rate in patients with the neoadjuvant chemotherapy was 45.9% and37.7%,respectively.The 5-year overall survival rate and recurrence-free survival rate were higher in patients with PR than those with SD or PD(78.4% VS 26.2%;62.1% VS 22.9%),and the difference was statistically significant(P<0.01).Binary logistic regression analysis found tumor size(OR: 0.12;95%CI: 0.03～0.53;P<0.01),lymphovascular invasion(OR:0.11;95%CI: 0.02～0.61;P=0.012),perineural invasion(OR: 0.04;95%CI: 0.003～0.47;P<0.01),ypT staging(OR: 0.13;95%CI: 0.03～0.50;P<0.01)and yp N staging(OR: 0.15;95%CI: 0.05～0.43;P<0.01)were independent risk factors for the objective response rate in patients receiving neoadjuvant chemotherapy.6.Multivariate cox analysis showed that tumor size,lymphovascular invasion,perineural invasion,ypT staging and yp N staging were independent factors affecting the 5-year overall survival rate and 5-year recurrence-free survival rate of patients receiving neoadjuvant chemotherapy(P<0.05).The 5-year overall survival rate and recurrence-free survival rate in patients with lymphovascular or perineural invasion were worse than those without invasion,and the difference was statistically significant(P<0.01).Conclusion:1.The tumor size,Lauren type,lymphovascular invasion,perineural invasion,T staging and N staging were independent factors affecting the prognosis of gastric cancer after operation.2.The differentiation degree,perineural invasion,T staging and N staging were independent risk factors for the occurrence of lymphovascular invasion in patients with gastric cancer.And the lymphovascular invasion,T staging and N staging were independent risk factors for the occurrence of perineural invasion in patients with gastric cancer.3.The tumor size,lymphovascular invasion,perineural invasion,ypT staging and yp N staging were independent risk factors for the objective response rate in patients receiving neoadjuvant chemotherapy.4.The tumor size,lymphovascular invasion,perineural invasion,ypT staging and yp N staging were independent factors affecting the 5-year overall survival rate and 5-year recurrence-free survival rate of patients receiving neoadjuvant chemotherapy. |
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