Significant Prognostic Factors By Univariate And Multivariate Analysis In Elder Patients With Gastric Carcinoma

Gastric carcinoma is one of the major causes of death from malignant diseases in china. An increasing number of elderly patients are presenting with this diseases as the size of the geriatric population in china increases. Unfortunately, at the time of dignosis, the majority of patients are in advanced stages and a fatal outcome will expected. The purpose of this study was to determine the factors affecting the prognosis of elderly patients suffering from gastric carcinoma. 92 cases patients charts were retrospectively viviewed. Univariate and multivariate analysis were performed to evaluate the impact of thrombocytosis, Lymph node micrometastasis and the expression of VEGF, PD-ECGF, COX-2, MMP-7 and their influence on clinicopathlogical characteristics and the prognosis in elderly patients with gastric carcinoma. The results are ?Thrombocytosis was found in 26 patients (28. 26%) . There was a positive correlation between the size, depth, lymph node metastasis, vessel invasion and TNM stage of gastric carcinoma. Kaplan-meier analysis revealed that patients with thrombocytlsis had shorter survival compared with thosewithout thrombocytosis(P<0. 01). 〦xpress of VEGFand PD-ECGF were significantly higher in gastric carcinoma than in chronic atrophic gastrtis. VEGF and PD-ECGF levels in advanced carcinoma were higher compared with early carcinoma (P<0. 01) . A significant correlation was found between VEGF and PD-ECGF, The expression of VEGF PD-ECGF were related to the tumor size, depth, lymph node metastasis, vessel invasion and TNM stage. The survival rate in the patients with VEGF or PD-ECGF expression was much lower than the rate in those patients without expression of VEGF and PD-ECGF. The prognosis of patients with both VEGF and PD-ECGF expression was extremely poor. 〦xpress of COX-2 and MMP-7 were significantly higher in gastric carcinoma than that normal tissues near the gastric carcinoma. COX-2 and MMP-7 levels in advanced carcinoma were higher compared with early carcinoma(P<0. 01) . A signifiant correlation was found between COX-2 and MMP-7. The expression of COX-2 and MMP-7 were related to the tumor size, Lymph node metastasis, vessel invasion and TNM stage. The survival rate in the patients with COX-2 or MMP-7 expression was much lower than the rate in those patients without expression of COX-2 and MMP-7. The prognosis of patients with both COX-2 and MMP-7 expression was extremely poor. (4)LNM were observed in 37. 3% ofpNO gastric carcinoma. There was a close relation between the LNM and histologic type, depth of tumour and TNM stage (P<0.01).LNM correlated with poor prognosis, (5) On multivariate analysis, Independent prognostic factors were lymph node metastasis, TNM stage, thrombocytosis, and expression of VEGF, MMP-7. We show that:?Gastric carcinoma can be divided into Low-malignancy cases and high-malignancy cases prior to surgery on the basis of the expression of VEGF PD-ECGF and thrombrcytos is. Therefore, we recommened a more extensive operative range dissection for high-malignanacy. (2)pNO gastric carcinoma can be divided into Low-malignancy cases and high malignany cases group on the basis of the basis of the LNM and overexpression of COX-2 MMP-7, Therefore we recommened a useful adjuvant treatment for high-maliganacy cases in order to reduce the recurrence. (3)5-Fluorouracil (5-Fu) may be effective anti-tumour chemotherapeutic agents with less toxicity in patients with PD-ECGF positive tumours. ㏕hrombocytosis, TNM stage, Lymph node metastasis and expression of VEGF, MMP-7 are independent prognostic factor in gastric carcinoma and enhance the possibility of invasion and metastasis and implicate a poor poognosis.