Prognostic Value Of Perineural Invasion Lymphovascular Invasion Combined With Tumor Stroma Ratio In Gastric Cancer

Object To analyze the correlation between postoperative pathological features of patients with gastric cancer and other clinicopathologic data,such as peri-nerve infiltration,lymphatic vascular infiltration,and tumor interstitial ratio,and to explore their relationship with prognosis,so as to provide a new basis for prognosis judgment and clinical diagnosis and treatment strategy of gastric cancer.Methods A retrospective analysis of 745 patients with gastric adenocarcinoma who underwent radical gastrectomy between December 2012 and December 2019(SGH cohort)showed that PNI,LVI and TSR were independent prognostic factors except pTNM stage among pathological factors according to multivariate COX regression analysis.Independent predictors of lymph node metastasis were calculated using logistic regression.PNI(+),LVI(+)and high TSR gastric cancer were defined as high-risk group(triple positive gastric cancer),LVI positive,PNI positive and any two items satisfying high TSR were double positive group,LVI positive and PNI positive,only one item satisfying high TSR was single positive group,LVI negative,PNI negative and low TSR were triple negative group.The correlation of clinicopathologic features,preoperative serum tumor markers and peripheral blood indicators in different groups was compared.Survival analysis was performed using the product limit method(Kaplan-Meier)and Log-rank test(log-rank).Univariate and multivariate Cox regression models were used to determine independent risk factors influencing prognosis.The linear propensity score model was used to match 276 PSM patients at a ratio of 1:1 and the caliper value was set to 0.01.A nomogram of triple postive,CEA,and LMR combined to predict the long-term prognosis was drawn,and the ROC Curve was drawn to calculate the Area Under the Curve(AUC),and the calibration curve was drawn to compare the prediction efficacy.Results According to the results of multivariate COX analysis,PNI,LVI and TSR were independent prognostic and pathological factors except TNM stage,and their occurrence was correlated.In the SGH cohort,PNI was correlated with survival status,pathological stage,T stage,N stage,pathological grade,tumor size,pathological nature,primary location,P53 and Ca199(P<0.05).LVI was correlated with survival status,pathological stage,T stage,N stage,pathological grade,tumor size,pathological nature,primary location,P53,Ca199,Ca724,NLR,PLR,LMR,and SII(P<0.05).TSR was correlated with survival status,pathological stage,T stage,N stage,tumor size,primary location,CEA and Ca199(P<0.05).Compared with the non-triple postive group,OS showed differences in tumor nature,tumor size,pTNM stage,primary site and pathological grade,among which signet ring cell carcinoma,large tumor(≥5cm),stage Ⅲ,proximal stomach,poorly differentiated and classified as triple postive group had the worst prognosis,with 5-year overall survival rates of 15.5%,12.4%and 12.6%,respectively.10.9%,14.9%.Combined with the results of COX analysis and Kaplain-Meier analysis,we incorporated pTNM,triple postive,CEA,and LMR into the nomogram for the prediction of gastric cancer OS,and verified the results.The results showed that the new nomogram had a good predictive effect on postoperative gastric cancer survival.Conclusions Triple postive gastric cancer with PNI(+),LVI(+)and high TSR is a poor prognostic type of GC,which can supplement the prognostic prediction of tumor-node-metastasis(TNM)pathological staging system,predict the postoperative development of GC patients and guide the treatment.