| Research Abstract |
Perineural invasion(PNI) was sutdied histochemically in 283 cases of gastric cancer resected from 1982 to 1989 with pm or deeper invasion. PNI was studied in relation to the histopathological findings, the type of meatastasis, the type of recurrence and outcome. Immunohistochemical staining of Laminin was most useful for judgment of PNI as it stained the perineurium and nerve fiber in comparison with the other staining methods of HE, S-100 and silver-impregnation. PNI-positive cases were most frequently invasive type in gross appearance with the primary lesion occupying entire stomach, circular type in horizontal location, and stage III ・ IV and ssgamma・se in depth of invasion. Of the peritoneal dissemination cases 72.4% were PNI-positive. Among the 216 curative resection cases, recurrence occurred in 103 cases, and was highly frequent in the cases with ssgamma or deeper invasion. These recurrent cases were closely associated with ly, n and PNI. Peritoneal recurrence was found in 63.1% (65 cases) of the 103 recurrent cases. Peritoneal recurrence was most closely associated with PNI in the cases with pm and ss invasion. The 5-year survival rate of 71.3% for PNI-negative cases was significantly higher than the 23.7% for PNI-positive cases. Furthermore, the survival rate in PNI-positive cases was evidently low in the cases with pm and ss invasion. The results of multivariate analysis with a Cox regression model in the relationship between histopathological findings and outcome, revealed that the presence of PNI had the largest influence on the outcome, and was indicated to be useful as a prognostic factor in advanced gastric cancer.
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