Prognostic Value Of Clinicopathologic And Adjuvant Chemotherapy Features And Angiogenesis-related Moleculars' Expressions In Stage Ⅰ-Ⅲ Postoperative Gastric Canccr

【Objective】To summarized clinicopathologic characters and features oftreatments and survival in stage I-III postoperative gastric cancer patients, to evaluatethe prognostic efficacy of the7thedition tumor-node-metastasis (TNM) classificationcompared with the6thedition, to explore the clinical and prognostic significant ofangiogenesis-related molecules' expressions, to explore the clinical and molecularpredictors of therapeutic effect, recurrence risk and death risk, to provide evidencesfor establishing individual postoperative adjuvant chemotherapy model, clarifyingmechanism of recurrence and metastasis and exploring new molecular target in gastriccancer patients.【Methods】 The cases who received radical surgery in our hospital from Jan.2003to Dec.2008and were diagnosed with stage I-III gastric cancer were analyzedretrospectively. Those who were lost of follow up were deleted. The relationships ofclinicopathological feature, postoperative treatment characteristics and prognosis ofthese patients were analyzed. Paraffin-embedded specimens of the cases that hadenough samples were collected to make into tissue microarray and to detectexpression of VEGF, HIF1|á, pERK1/2and TGF|1by IHC method. The relationshipsof these markers' expression, clinicopathological features, treatment and prognosiswere analyzed by SPSS19.0software.【Results】827cases were collected. The median follow-up time was58.2months. Until the destination of study (Aug1,2011), of the827patients,507patients(61.3%) had experienced tumor recurrence and metastasis, and457patients (55.3%) had died. The median DFS was26.6months and the median overall survival (MST)was39.7months. The5-year DFS rate and overall survival rate were37.9%and43.8%. Total gastrectomy or not, surgical margin, tumor diameter, cancer embolus,adjuvant chemotherapy or not, new and old edition TNM staging were all independentrisk factors in predicting DFS and OS. In562patients who all received adjuvantchemotherapy, the DFS and OS of group with4～6-cycle chemotherapy or group withmore than7-cycles chemotherapy was significant longer than those of group with1～3-cycle chemotherapy respectively. There was no difference between DFS and OS ofevery chemotherapy regimen. In343cases whose paraffin-embedded specimens wereenough and available, there were significant correlations between expressions ofHIF1|á, pERK1/2and TGF|1with expression of VEGF. The DFS and OS in negativeof VEGF group were significant longer than positive group (DFS:45.9vs.13.4months, P<0.001and OS:64.0vs.21.7months, P<0.001). And the DFS and OS innegative of HIF1|ágroup were significant longer than positive group (DFS:29.5vs.14.7months, P=0.003and OS:39.9vs.22.8months, P=0.001), while the DFS and OSin negative group of pERK1/2were significant longer than positive group (DFS:26.0vs.14.8months, P=0.059and OS:38.4vs.22.8months, P=0.021). And in237patients who all received adjuvant chemotherapy with positive expression ofpERK1/2, the regimen with OXA had prolonged the median DFS compared with anyother regimens (26.1month vs.7.4months,P=0.028). There was no significantdifference in DFS and OS between positive group of TGF|1and negative group(P>0.05). Of patients with VEGF, HIF1|áand TGF|1co-expression, the DFS and OSwere significant shorter than those of patients with two markers or less co-expression(P<0.001). The COX proportional regression analysis showed that expressions ofVEGF and HIF1|áwere independent risk factors in predicting DFS and OS, andpERK1/2expression was an independent risk factor in predicting OS, besidesadjuvant chemotherapy or not and new edition TNM staging.【Conclusion】 Adjuvant chemotherapy was approved to contribute to DFS andOS for postoperative patients with gastric cancer. Total gastrectomy or not, surgical margin, tumor diameter, cancer embolus, adjuvant chemotherapy or not, new and oldedition TNM staging were all independent risk factors in predicting DFS and OS inwhole patients with gastric cancer. In343cases whose paraffin-embedded specimenswere enough and available, the expressions of VEGF and HIF1|áwere independentrisk factors in predicting DFS and OS, and pERK1/2expression was an independentrisk factor in predicting OS.