Investigation Of The Relationship Between CD44v6,Lymphatic Vessel Density And Gastric Precancerous Lesions,Early Gastric Carcinoma And Lymph Node Metastasis

Objective In this study,the expression of CD44v6 and lymphatic vessel density(LVD)were compared in the gastric precancerous lesions and early gastric cancer.The relationship between CD44v6,LVD and the clinicopathological factors and lymph node metastasis of early gastric cancer were also analyzed.The purpose of this study was to investigate the diagnostic value of CD44v6 and LVD in the gastric precancerous lesions and early gastric cancer,and its predictive value in lymph node metastasis.Methods A total of 286 cases of paraffin specimens were selected from January 2011 to December 2012,including 50 cases of chronic gastritis(gastritis group),65 cases of low grade intraepithelial neoplasia(LGIN group),60 cases of high grade intraepithelial neoplasia(HGIN group)and 111 cases of early gastric cancer(EGC group).Immunohistochemical method was used to detect the expression of CD44v6,while lymph nodes were labeled with D2-40 and LVD was measured.The CD44v6 positive expression and LVD were compared in each group.To analyze the relationship between CD44v6,LVD and the clinicopathological factors and lymph node metastasis of early gastric cancer.To analyze the independent risk factors of lymph node metastasis in early gastric cancer,and to evaluate the value of LVD in predicting lymph node metastasis in early gastric cancer by ROC curve.Results 1)The positive expression of CD44v6 in low grade intraepithelial neoplasia group(29.2%,19/65)was significantly higher than in gastritis group(4%,2/50),while high grade intraepithelial neoplasia group(48.3%,29/60)and early gastric cancer group(55.8%,62/111)were significantly higher than in low grade intraepithelial neoplasia group(P<0.05).However,the early gastric cancer group was slightly higher than in high grade intraepithelial neoplasia group,the difference was not statistically significant(P=0.347).2)LVD increased gradually from gastritis group(2.66±1.189),low grade intraepithelial neoplasia group(4.17±1.464),high grade intraepithelial neoplasia group(6.37±1.974)to early gastric cancer group(12.52±4.622),and the difference were statistically significant(P <0.01).3)The positive expression of CD44v6 and LVD were correlated with lymph node metastasis and lymphatic invasion in early gastric cancer group(P<0.05),but not related with sex,age,depth of invasion,pathological type,location and size of tumor.4)There was a positive correlation between the expression of CD44v6 and LVD in the early gastric cancer group(r=0.302,P<0.01).5)Univariate analysis showed that tumor size,depth of invasion,pathological type,CD44v6,LVD,and lymphatic invasion were correlated with lymph node metastasis in early gastric cancer group.Binary logistic regression analysis revealed that tumor size >2cm,invasion into the submucosa,undifferentiation,increased of LVD,lymphatic invasion were independent risk factors for lymph node metastasis(P<0.05).6)LVD is the specific prediction indicator for lymph node metastasis in early gastric cancer.ROC curve analysis showed that the area under the curve of predicting the lymph node metastasis was 0.835(95% CI: 0.758-0.912),when the cutoff value of LVD was 14,the sensitivity was 63.4%,while specificity was 90%.Conclusions 1)The positive expression of CD44v6 in precancerous lesions and early gastric cancer is of certain value in early diagnosis.2)LVD detection combined with tumor size,depth of invasion,pathological type and lymphatic invasion can predict lymph node metastasis in early gastric cancer.The positive expression of CD44v6 has a certain clinical reference value for predicting lymph node metastasis in early gastric cancer.