1.The Clinicopathological Characteristics Of Patients With Different Pathological Types Of The Stomach 2.The Role Of Toll Like Receptor 9 In Gastric Cancer Induced By Helicobacter Pylori

BACKGROUND AND AIM: At present,the biologic behavior of early papillary(PAC)and tubular gastric cancer,early signet-ring cell carcinoma(SRC)and non-signet-ring cell carcinoma(NSRC)remains controversial.Now,the decision to perform endoscopic resection for treating either papillary early gastric cancer(EGC)or tubular EGC is made according to identical criteria.However,there is controversy in the literature whether the risk of lymph node metastasis(LNM)and submucosal invasion for these disease modalities is equal,and this prompts investigation to clarify this issue.METHODS: We reviewed the clinicopathologic features,including age,sex,location,size,depth,lymphovascular invasion(LVI),LNM,between these groups in our hospital,who had undergone surgical resection between 2009 and 2014.The Pub Med and Web of Science databases were searched for relevant studies published up to January 2017.The quality of the included studies was assessed using the NewcastleOttawa Scale(NOS).Data were extracted,and the pooled odds ratios(ORs)and 95%confidence intervals(95% CIs)were calculated using a random-effects or a fixedeffects model,according to heterogeneity.Heterogeneity between studies was assessed by the Q-test and the I2-test.Publication bias was tested using Begg's testand Egger's test.In addition,a sensitivity analysis was also conducted.RESULTS: Thirteen studies were included in this analysis.Papillary EGC had a significantly higher LNM risk(OR = 1.97,95% CI = 1.38–2.82)and submucosal invasion risk(OR = 1.44;95% CI = 1.08–1.93),compared to tubular EGC.Submucosal PAC had a significantly higher LNM risk compared to submucosal tubular adenocarcinoma.Stratified by geographic location,a significantly increased risk of LNM(OR = 2.28;95% CI = 1.57–3.30)and submucosal invasion(OR = 1.52;95% CI= 1.13–2.04)associated with papillary EGC was found in Asian studies.In addition,papillary EGC exhibited significantly more frequent elevated/flat growth patterns(OR= 7.54,95% CI = 4.76–11.96).There was no statistically significant heterogeneity between studies.There was no evidence of publication bias in the overall meta-analysis for risk of LNM(Begg's test: P = 0.28;Egger's test: P = 0.69)or submucosal invasion(Begg's test: P = 0.45,Egger's test: P = 0.81).With regard to the macroscopic aspect,there was also no evidence of publication bias(Begg's test: P = 1.0;Egger's test: P =0.52).A total of 1008 patients with early gastric cancer met the inclusion criteria,including 163 signet ring cell and 845 non-signet ring cell carcinoma.The clinicopathological characteristics suggest that gastric cancer patients with signet ring cell adenocarcinoma were younger(P < 0.001),had a greater female/male ratio(P <0.001)compared with non signet ring cell adenocarcinoma.The risk of lymphovascular invasion was lower in pure signet-ring cell carcinoma,when compared with non signet ring cell carcinoma(P = 0.04),however,there was no difference in lymph node metastasis between the two groups(P =0.48).Patients with Mixed SRC had a higher frequency of lymphovascular invasion,and lymph node metastasis.CONCLUSIONS: Our study identifies an increased risk for submucosal invasion and LNM in papillary EGC compared to tubular EGC,indicating that papillary EGC requires more careful clinical management compared to tubular EGC.For signet ring cell carcinoma,Mixed type tumors may not be considered for endoscopic resection.Background: Helicobacter pylori(H.pylori)infection is a well-known risk factor for gastric cancer.Toll-like receptor 9(TLR9)plays an important role in many cancers and is important for immunity to H.pylori infection.Thus,this study aimed to evaluate the influence of H.pylori on TLR9 and explore their roles in gastric cancer.Methods: TLR9 expression in MKN45 cells was detected using q RT-PCR and western blot assays.Then,TLR9 was knocked down through RNA interference(RNAi)technology in MKN45 cells.CCK-8 assay was performed to investigate cell proliferation,and the Transwell system was established to test the migrative and invasive abilities of MKN45 cells.Results: H.pylori infection or H.pylori DNA level was positively correlated with TLR9 upregulation in MKN45 cells.In vitro,H.pylori DNA significantly accelerated cell proliferation,and promoted the migration and invasion in MKN45 cells.In contrast,the knockdown of TLR9 significantly suppressed cell proliferation,and inhibited the migration and invasion in MKN45 cells.Conclusions: The present results suggest that the H.pylori DNA/TLR9 signaling pathway plays an important role in gastric cancer,which might be a potent therapeutic target.