| Objective: Adenocarcinoma of esophagogastric junction(AEGJ) is an adenocarcinoma which occurs and encroaches the boundary area between oesophagus and stomach. So far, operation was the main treatment method.However, postoperative tumor recurrence and lymphatic metastasis were the significant causes of increasing the rate of AEGJ death after the operation and the 5 years’ survival rate was only 30%, which without significant improvement in the last 10 years. Lymphatic metastasis and bad prognosis were the main biological characteristics of AEGJ in the early time, but the mechanism was not clear. Previous studies showed that the SPG 20 gene methylation was highly expressed in colorectal cancer, which resulted in the low expression of Spartin protein which expressed by the gene of SPG 20, but the Spartin protein express a high lever in normal mucosal tissue, so, Spartin protein could be the molecular marker of adenocarcinoma and one of the carcinogenic mechanism. In the present study, we aimed at investigating the expression level of Spartin protein, exploring the relationship with occurrence and development of AEGJ, providing new research direction for AEGJ pathogenesis.Method:60 cases of patients with AEGJ were chosen from fourth hospital of Hebei Medical University from the date of Oct 2013 to Feb 2014 were selected. 40 cases of male, 20 cases of female, age range from 46 to 72,average age is 54.5±6.9. All The samples were proved adenocarcinoma by HE staining. Removal fresh cancer tissue and normal gastric mucosal tissue within0.5 hour after operation. And then fixed by formalin, embed by paraffin, and then can be tested the expression of Spartin protein in cancer tissue and normal gastric mucosal tissue by the method of immunohistochemistry. Test data were processed by SPSS 16.0 statistical software, comparing the twogroups by the method of t test, measurement data expressed as averrage ±standard deviation, count data expressed as χ2 test to show the relationship of all indexes. P<0.05 shows that difference was statistically significant.Results:1 During the 60 cases of AEGJ tissue, 23 cases showed positive in Spartin protein expression, accounting for 38.33%; during the 60 cases of AEG with normal gastric mucosa, 50 cases showed positive in Spartin protein expression, accounting for 83.33%, the rate of normal gastric mucosa tissues group was higher than the rate of AEGJ tissues group in Spartin protein expression, with significant difference between two groups(P<0.01);2 The level of Spartin protein significantly decreased with the increased of clinical stage, increased of differentiation degree and lymphatic metastasis.It showed significant difference between differentiated clinical stage(χ2=9.212, P=0.018) and showed significant difference with differentiation degree(χ2=12.564,P=0.011). The methylation level of SPG20 gene of patients with lymphatic metastasis were lower(χ2=9.414,P<0.005). No correlation between the Spartin protein and gender, age, tumor size, tissue;3 All 60 cases of AEGJ take part in the postoperative follow-up more than 16 months, To observe the postoperative anastomotic recurrence,mediastinal, abdominal lymphatic metastasis and distant metastasis, we found that 46 cases did not recurrence and metastasis,14 cases showed recurrence and metastasis which include 1 case of anastomotic recurrence, 5cases of abdominal lymph metastasis, 9 cases of distant metastasis( 1 case of mediastinal lymph nodes and liver multiple metastases);4 Observe the 60 cases who were postoperatived follow-up for 16 months,we found that, among 23 cases whose Spartin protein showed positive, 4cases showed recurrence and metastasis, the rate of progression-free survival is 82.61%; among 37 cases patients whose Spartin protein was negative, 10 cases showed recurrence and metastasis, the rate of progression-free survival is 72.93%;5 Using COX multi factors analysis pathological factors of tumor size,differentiated degree, depth of invasion, lymphctic metastasis, clinical stage and expression of Spartin protein, etc. It indicated that differentiated degree,clinical stage, depth of invasion and Spartin protein expression of AEGJ patients can be used as independent predictors factors. With the increasing of depth of invasion, the risk of relapse and metastasis increased(Risk degree=4.561, P=0.032), with the lower differentiation degree, the risk of relapse and metastasis increased(Risk degree=5.620, P=0.017), wiht higher clinical stage, the risk of relapse and metastasis increased(Risk degree=5.254,P=0.021), lymphatic metastasis(Risk degree=3.998,P=0.045),with lower Spartin protein expression, the risk of relapse and metastasis increased(Risk degree= 2.998, P=0.025).Conclusion:1 There was significant difference between low expression of Spartin protein in cancer tissue and normal tissue, indicating that the down-regulated expression of Spartin protein play a important role in process of AEGJ and was correlated with the occurrence and development of AEGJ;2 The expression level of Spartin protein of AEGJ was correlated with clinical stage, differentiatiron degree, and lymphatic metastasis;3 The patients with abnormal expression of Spartin protein has obvious risk of postoperative recurrence and metastasis, indicating that Spartin protein expression may be the prognostic factor of AEGJ. |
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