Clinicopathologic Features And Lymphatic Vessel For Esophageal Adenocarcinoma In Northeast Sichuan

Esophageal adenocarcinoma(EAC)is a highly malignant tumor,mainly caused by Barrett’s esophagus transformed by chronic gastroesophageal reflux disease.Since the 1970 s,the incidence of EAC in western countries has increased by more than 350%,and it has exceeded the esophageal squamous cell carcinoma(ESCC).In China,the histopathologic types of esophageal cancer(EC)gave the priority to squamous cell carcinoma,accounting for more than 90%.As lifestyle changed,the incidence rate of EAC has increased,which has attracted the extensive attention of scholars.Invaded and lymph node metastasis of EAC in the early stage is not only important biological characters,but also can influence postoperative survival period.The lymphatic system plays an important role in the lymph node metastasis and proliferate,which influence the treatment and long-term survival.In the past,the lack of lymphatic specific molecular markers makes the study of tumor lymph node metastasis is lagging behind.Recently,more and more lymphatic specific markers were found in succession,and D2-40 was used the most.It is considered to be a high selectivity of lymphatic endothelial cells specific markers.It is extremely valuable in a variety of malignant tumor infiltration study of lymphatic vessels.So it is an ideal lymphatic endothelial marker.More research about the tumor lymphatic density on the lymph node metastasis,prognosis of clinical parameters,but the results are not identical.The relationship between the lymphatic vessel density(LVD)and lymph node metastasis in early stage or poor prognosis of EAC had explored as a new direction of treatment.This research was divided into the following two parts.PartⅠClinicopathologic Features and Outcome for Esophageal AdenocarcinomaObjective:An analysis was performed on clinicopathologic features for patients with EAC from west China,so as to determine the clinicopathologic features and the independent prognostic factors.Materials and Methods : A total of 20 cases of EAC with esophagectomy was analyzed retrospectively and compared with 24 cases of the same period resected ESCC from January 2004 to January 2011 in the affiated hospital of north sichuan medical college.Results:1 The average length of tumor for EAC was less than that in ESCC(4.2±1.76 cm vs.5.4±1.97 cm,p< 0.05).The survival time was shorter than ESCC(20.2±15.0 month vs.33.7±24.2 month,p<0.05)。In addition,among the gender,age,tumor location,symptoms,duration,the postoperative complications,pathological form,T stage,N stage,G stage,TNM stage and lymph node metastasis or not there were no statistical significance difference between the two(p>0.05).2 The lymph node metastasis was associated with tumor length in EAC,on which tumor length be equal or greater than 5cm were more likely to happen lymph node metastasis than that of less than 5cm,the difference between the two had statistical significance(p<0.05).In addition,among other clinicopathological parameters the differences had no statistical significance(p>0.05).3 The tumor length,T stage,N stage,G stage,TNM clinical stage,and lymph node metastasis in EAC influenced the survival time by Univariate Analysis(p<0.05).In addition,among other clinicopathological parameters the differences had no statistical significance(p>0.05).4 There was no clinicopathological parameters influenced the prognosis of EAC by using the Cox model analysis,there was no significant difference(p>0.05).The TNM stage and histologic types were the independent factors,which could influence the prognosis of 44 patients with EC,the difference had statistical significance(p<0.05).Conclusion:1 All clinicopathological parameters compared,only tumor length and survival time had statistical significance between EAC and ESCC.That was the tumor length and survival time of EAC was shorter than ESCC,the difference had statistical significance.No statistical difference significance in other clinicopathological parameters.2 Patients of EAC with lymph node metastasis or not only associated with the tumor length,but other clinicopathological parameters had nothing to do.3 The tumor length,T stage,N stage,G stage,TNM clinical stage,and lymph node metastasis in EAC had influenced the prognosis.No statistical difference significance in other clinicopathological parameters.4 No factors which effected the prognosis of patients in EAC was selected to Cox model,small number of cases were related.The TNM stage and histologic types were the independent factors,which can influence the prognosis of 44 patients with EC the difference had statistical significance.PartⅡ Lymphatic Vessel Density and Their Clinical Significance in Esophageal AdenocarcinomaObjective:To study the lymphatic vessel density and whether there were proliferation lymphatics in EAC.Explore the differences on LVD among EAC,ESCC and normal esophageal organization.Analysis their clinical significance.Materials and Methods:D2-40 was used to immunostain lymphatic vessel density in EAC.Antibodies of D2-40 and Ki-67 were used together by double immunohistochemistry to detect proliferation of lymphatic vessel.Comparative analysised the differences of LVD to ESCC and the normal esophageal organization and the clinical significance of EAC.Results:1.D2-40 could identify the lymphatics,antibodies of D2-40 and Ki-67 were used together by double immunohistochemistry could detect the lymphatics and proliferation cells.2 The LVD marked by D2-40 in EAC,ESCC and the normal esophageal organization was 3.3±1.70/0.17 ㎜2,4.6±1.17/0.17 ㎜2,3.8±1.20/0.17 ㎜2,respectively.The LVD of EAC was less than ESCC,there was significant difference between LVD in EAC and ESCC(P<0.05).No significant difference between LVD in EAC and normal esophageal organization(P>0.05).3 Symptom and disease course were associated with LVD,the difference had statistical significance(p<0.05).No statistical difference significance in other clinicopathological parameters.Conclusion1 D2-40 was a strong specificity molecules to lymphatics that can distinguished well from capillaries,and it could be used in the study of tumor lymphatics.2 Antibodies of D2-40 and Ki-67 were used together by double immunohistochemistry could detect the proliferated lymphatics,which reflected its proliferation objectively.3 The LVD of EAC was less than ESCC,there was significant difference between LVD in EAC and ESCC,but no significant difference between LVD in EAC and the normal esophageal organization.4 Symptom and disease course were associated with LVD.No statistical difference significance in other clinicopathological parameters.