The Guidance Of Iodine Stain Within Gastroscopy To Radiotherapy And Significance E-cadherin,MMP-2,PCNA Expression In Tumor And Precursor

Objective: To investigate the length difference amongesophageal radiography,chest computed tomography(CT),gastroscopy and combined with iodine stain in detecting thelesion of the esophageal cancer,try to find guidance toradiotherapy. Explore the activity of E-cadherin﹑MMP-2﹑PCNA expression in carcinoma and precursor,try to find theircorrelation and expression difference in carcinoma andprecursor, investigate the role of E-cadherin﹑MMP-2﹑PCNAin invasion and metastasis.Methods: Each esophageal cancer patient undergogastroscopy combined with iodine stain before receiveddefinitive radiotherapy. Lesion diagnosed as squamous cellcarcinoma and not stained area diagnosed as dysplasia,suchpatient were selected.The specimens were store in -80℃refrigeratory.From november 2003 to july 2004, 47 patients ofesophageal squamous cell carcinoma(ESCC) were collected.Among them, male 29, female 18, median age 60(37~82y),Radiography showed local lesion length less than 5.0 ㎝are 21cases, more than 5.0 ㎝are 26 cases. CT showed lesion invadedepth less than 2.0 ㎝are 33 cases,more than 2.0cm are 14cases. CT showed lesion diameter less than 2.0,2.1～3.0,3.1～4.0,4.1～5.0,5.1～6.0,more than 6.0 ㎝are7,18,14,4,3,1 cases respectively.After iodine stain 32 casesappeared no stain areas. The cases of T1,T2,T3,T4 are 6,32,8,1 respectively. The cases of stageⅠ,Ⅱ,Ⅲand Ⅳwere 5,19, 15, and 8 respectively .Radiotherapy was given with6MV-X ray. 42 patients accepted conventional radiotherapy(CRT), 2Gy per fractions, 5 fractions per week, and other 5patients accepted later hyperfractionated radiotherapy(LHART), single doses was 1.5Gy, 2 fractions per day, interval6 hours, 5 days per week, total doses is 50~70Gy, median dosesis 60 Gy. E-cadherin,MMP-2 and PCNA protein was measuredin carcinoma and precursor by western blot.Results:(1)The mean length of gastroscopy,iodine stain,radiography,CT detected is 5.596±2.747cm,8.971±3.117cm﹑5.502±2.610cm ﹑6.617±3.271cm respectively. There issignificant difference between the length of CT andradiography,gastroscopy,P<0.001. The length of CT is 1.1cmlonger than radiography and gastroscopy. There is nosignificant difference between the length of gastroscopy andradiography,P>0.05. Iodine stain detected length is significantlonger than radiography,CT and gastroscopy, P<0.001.Therewere 28 cases appeared no stain area above the lesion afteriodine stain,the mean of the distance to lesion is2.45±1.86cm,median is 2cm,range 1～10cm. There were 30cases appeared no stain area below the lesion after iodinestain,the mean of the distance to lesion is 3.76±2.85cm,medianis 2.4cm,range 1～12cm. (2)The lesion length of CT measuredcorrelates with the invasion depth which measured by CTtoo,r=0.406,P=0.005.(3)MMP-2 expression higher in tumorthan in precursor,P=0.022.E-cadherin expression lower intumor than in precursor,P=0.014.PCNA has a trend to increasedexpression in tumor,but no significant difference betweentumor and precursor.(4) E-cadherin,MMP-2 expression intumor has significant correlation, r=0.606;MMP-2 andPro-MMP-2 has significant correlation too. r=0.714.PCNA hasno correlation with neither of MMP-2 or E-cadherin,P>0.05.(5)E-cadherin ,MMP-2 ,PCNA expression in tumor has norelationship with sex,age,node metastasis and stage,butE-cadherin,MMP-2 expression in tumor correlation with depthof lesion invasion, P value is 0.04,0.004 respectively.(6) Theevaluation in clincial response after radiotherapy of esophagealcarcinoma: CR, 63.8% (30/47),The 1-year survival rate andmedian were 61.39% and 11.4 months respectively. One-waysurvival analysis showed that age,length of radiography andCT,clinical response,stage correlated with prognosis ofradiotherapy,however E-cadherin ,MMP-2 ,PCNA did notcorrelate with prognosis.Cox multivariate analysis showed thatstage,clinical response were probably independent prognosticfactors of ESCC.Conclusion:(1)iodine stain combined with gastroscopycan find precursor,so it has value in confining the radiotherapy...