Expression Of Cyclooxygenase-2, Vascular Endothelial Growth Factor And Proliferating Cell Nuclear Antigen And Prognostic Significance In Human Gastric Carcinoma

Objective To investigate the expression of COX-2, VEGF and PCNA in chronic atrophic gastritis, gastric mucosal atypical hyperplasia, early and middle stage of gastric carcinoma, to identify the relationship between expression of COX-2, VEGF and MVD, PCNA labeling index(LI) and prognostic significance of COX-2, VEGF and PCNA. Methods 281 patients with early and middle stage of gastric carcinoma who underwent surgical resection between 1990 and 1999 at Fist Affiliated Hospital, Anhui Medical University, were followed up. Expression of COX-2, VEGF and PCNA was examined by ABC immunohistochemistry in 232 archival paraffinembedded tissue specimens and control groups. The relationship of COX-2, VEGF, MVD and PCNA with clinicopathologic factors and prognosis was analysed by SPSS VI0.0 for Windows software. Results The detection rate between 1990 and 1999 of early gastric carcinoma in our study fluctuated between 1.1% and 6.6%. Average detection rate was 4.3%( 110/2533). The follow-up rates of early gastric carcinoma and middle stage of gastric carcinoma were 88.2%(97/110) and 84.8%(145/171), respectively. 5-year survival rates of early and middle stage of gastric carcinoma were 93.4% and 59.0%, respectively. Survival time was highly correlated with lymph node metastasis, vascular invasion, depth of invasion and treatment with chemotherapy(P<0.05-0.01). Expression of COX-2 and PCNA was significantly higher in mucosal atypical hyperplasia than that in chronic atrophic gastritis (P<0.01). Compared with paired noncancerous specimens, COX-2 and PCNA levels in carcinoma tissue were significantly higher (P<0.05-0.01).Expression of VEGF and MVD value in carcinoma tissue was significantly higher than those in noncahcerous specimens and correlated with depth of invasion (P<0.01). The MVD value and PCNA LI were much higher in COX-2(+) group and VEGF(+) group than that in COX-2(-) group and VEGF(-) group (PO.01). Expression of COX-2, VEGF, the MVD value and PCNA LI were highly correlated with lymph node metastasis and vascular invasion(P<0.01). The 5-year survival rate in the patients with COX-2, VEGF expression and PCNA LI 2^55.64% was much lower than the rate in those patients with PCNA LI<55.64% or without COX-2, VEGF expression (P<0.05). Multivariate analysis indicated that VEGF expression, lymph node metastasis, COX-2 expression, depth of invasion and vascular invasion were all independent prognostic factors of gastric carcinoma. Conclusion Our detection rate of early gastric carcinoma (4.3%) is still lower than other reports. Overexpression of COX-2, VEGF and PCNA in patients with gastric carcinoma can enhance the possibility of invasion and metastasis, implicating a poor prognosis. They may serve as the fairly good prognostic factors to indicate biologic behavior and prognosis in gastric carcinoma.