| Part1Expression and significance of candidate stem cell markers in gastric cancer and its distant metastasisObject:To investigate the roles of candidate stem cell markers in distant metastasis of human gastric caner, and their correlation with clinic-pathological parameters, prognosis of patients with gastric cancer.Methods:Immunohistochemistry was used to examine the expression of candidate stem cell markers Bmi-1, Mel-18, EZH2, CBX7, Oct4, Sox2, Gli1, CD44, CD133and their potential downstream tagets p-AKT, p-ERK in samples of gastric cancer primary lesion and distant metastasis. All statistical analyses were performed using the SPSS version16.0software package. The proteins expression difference in gastric primary site and ovarian metastatic lesion were analyzed by χ2-test. McNemar-test was used to compare the protein expression in the matched primary and metastatic case. The χ2-test was also employed to analyze the relationships between the protein expression and clinicopathological factors. Survival curves were estimated using the Kaplan-Meier method, and the differences in survival distributions were evaluated by the log-rank test. The Cox proportional hazards model was used to identify which factors may have a significant influence on survival. The relationship between different factors expression was investigated by Spearman analysis. Differences with a p value of less than0.05were considered to be statistically significant and a value less than0.01were considered to be significant markedly.Results:The positive rate of Bmi-1, Oct4, Sox2, Gli1, CD44, CD133, p-AKT, p-ERK was significant higher in distant metastasis than in primary lesion of gastric cancer, while the Mel-18reveals the opposite result. The expression EZH2and CBX7showed no significant difference between distant metastasis and primary lesion. The expression of Bmi-1, EZH2, Oct4, CD44were related to lymph node metastasis, and the expression of Sox2was related to the T stage of gastric cancer. The expression of EZH2, Oct4, CD44, CD133correlated with later TNM stage. The expression of Oct4, CD133correlated with differentiation. By using Kaplan-Meier method analysis, the samples with negative expressed of EZH2, Oct4, Sox2, Gli1, CD44, p-ERK or positive expressed of Mel-18acquired better survival of gastric cancer. By using the Cox proportional hazards model, we found out that TNM stage and CD44expression were independent prognostic factors.Conclusion:Candidate stem cell markers (Bmi-1, Mel-18, Oct4, Sox2, Gli1, CD44, CD133) and p-AKT, p-ERK were related to the distant metastasis of gastric cancer. The factors of TNM stage and CD44expression were possibly the independent prognostic factors of gastric cancer. Part2Risking factors of metastasectomy for ovary metastasis from gastric cancerObjective:To determine the risking factors related to the survival of patients who underwent resection of ovarian metastasis from stomach origin and investigate who would benefit from the resection of ovarian metastasis.Methods:A total of133patients who had undergone resection of ovarian metastasis were retrospectively analyzed. Clinical characteristics including age, synchronous or metachronous ovarian metastasis, gastrectomy, extra-ovarian metastasis, ascites, ovarian involvement (bilateral of unilateral), abdomen-pelvic metastasis, residual disease post resection, treatment before ovarian metastasectomy were indentified. Survival curves were estimated using the Kaplan-Meier method, and the differences in survival distributions were evaluated by the log-rank test. The Cox proportional hazards model was used to identify which factors may have a significant influence on survival. A subgroup analysis was also used. Differences with a p value of less than0.05were considered to be statistically significant. All statistical analyses were performed using the SPSS version16.0software package.Results:133patients were enrolled in this retrospective study and the median survival time of the patients was16months (95%CI:13.332-18.668months). Multivariate analysis demonstrated that ascites (P=0.008) and gastrectomy (P=0.048) were independent prognostic factors related to survival of patients who underwent resection of ovarian metastasis. Subgroup analysis showed that ascites (P=0.003) was still the independent prognostic factor. Younger patients (≤50years) had the better survival than the elder ones (>50years)(P=0.042). Patients with synchronous metastasis had better prognosis when they recived both gastrectomy and ovarian metastasis surgery.Conclusions:The patients who did not present ascites, had received gastrectomy before and with low age may benefit from the resection of ovarian metastasis. The ovarian metastasectomy should be decided with cautions when the patients could not receive gastrectomy, present ascites or with advanced age. |
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