| Research background: Gastric cancer is one of the most common gastrointestinal tumors, which has a serious threat to life and health of patients, and which is strong invasive, high malignant degree and poor prognosis results. It is gastric cancer high-risk areas in China whose incidence is much higher than the world average. There are about 46.8% [1] of the new patients with gastric cancer in Chinese. With the deepening of the basic research related to gastric cancer, detection technology matures, and the corresponding comprehensive treatment, the level of diagnosis and treatment to gastric cancer has been a certain degree of improvement at present. The therapeutic effect of gastric cancer depends on the detection rate of early gastric cancer fundamentally. The cure rate can be more than 90%, when operation is in time. But it is often less than 40% in the advanced gastric carcinoma. Due to large lag of early gastric cancer screening, most of patients are already advanced when they are diagnosed as gastric cancer in china. The main factors influencing the prognosis of gastric cancer is cancer cells spreading and lymphatic metastasis is the main mode for gastric cancer metastasis, but the detection rate of peritoneal metastasis in advanced gastric cancer is also increasing with the improvement of testing technology. The incidence of gastric cancer patients with peritoneal metastasis is higher at preoperative or postoperative, and according to research shows that in the cases of postoperative recurrence of gastric cancer. There are about half of patients with peritoneal metastasis[2]. Peritoneal metastasis often produce the serious complications such as malignant ascites, intestinal obstruction, cachexia, which are threat factors to the life. The occurrence of peritoneal metastasis is the end-stage of the gastric cancer, the curative effect and prognosis of patients is still poor generally, after active treatment. Saita[3] found that, the five-year survival rate of 64 patients with peritoneal metastasis is still 0, when after a positive antitumor therapy in their study and the five-year survival rate of 90 patients whose result is positive in the patients Intraperitoneal free cancer cells inspection is only 15.3%. At the same time, according to the retrospective study of 7395 cases patients with gastric cancer, the Japanese scholar[4] also found that: There are 5 cases of gastric cancer patients with peritoneal metastasis whose five-year survival rate is only 7.1%. Thus, peritoneal metastasis are the important and risk factors affecting the prognosis of gastric cancer and need to be pay attention to.The peritoneal metastasis of gastric cancer are complex migration behavior of tumor cells, and research hotspot in recent years. A series of research reports: A variety of molecules involved in the process of the peritoneal metastasis of gastric cancer, but at the moment the happen mechanism has not been fully elucidated. Meanwhile, epithelial-mesenchymal transition(EMT) system received great attention in peritoneal metastasis of gastric cancer, and according to the research. In the process of EMT, E-cadherin expression decrease in tumor cells. E-cadherin is a kind of adhesion molecules between cells, transmembrane glycoprotein encoded by the CDH1 gene. Research found that after the E-cadherin expression decrease or missing, intercellular adhesion can be affected. Then, the invasion and metastasis potential of tumor cells will increase, leading to a wide variety of tumor's development. It is reported in literature, E-cadherin is abnormal expression in many kinds of epithelial tumors(Such as breast cancer, colorectal cancer, renal cell carcinoma, esophageal cancer, cervical cancer, etc). E-cadherin abnormal expression is associated with the occurrence, metastasis and prognosis of those tumors. According to the research in a variety of digestive tract tumors, E-cadherin may play an important role in peritoneal metastasis of tumor, but there is no clear conclusion In gastric cancer with peritoneal metastasis. Thus, our study will discusses the function of E-cadherin in the gastric cancer with peritoneal metastasis, in order to improve the understanding of it.Objective: Preliminary discussion on the correlations of E-cad expression with gastric cancer with peritoneal metastasis and reveal its clinical significance, further study on the role of E-cadherin the in gastric cancer with peritoneal metastasis.Methods: We select 47 clinical cases of gastric cancer randomly and they are further confirmed with peritoneal metastasis, all of these patients are operated in the Lu Zhou Medical School Affiliated Hospital gastrointestinal surgery from July 2010 to August 2015. All of the primary tumors are completely excised. Their medical records are intact, and they were never treated by chemotherapy or radiotherapy and so on. Meanwhile, we select 43 clinical cases of gastric cancer randomly as the negative group, all of these patients are excised completely. And we did not found the basis of peritoneal metastasis during the operation or postoperative pathologic examination. All of the 90 specimens conducted regular fixed with formalin, using S-P immunohistochemical method for qualitative after paraffin embedding.In the final, analyze the relationship between E-cadherin expression in gastric cancer with peritoneal metastasis and the clinical pathological features.Result: 1. There is no significant difference(P>0.05) between incidence of peritoneal metastasis of gastric cancer and Patients' age, sex and tumor size, etc. But there is obvious significant difference(P<0.05)between incidence of peritoneal metastasis of gastric cancer and tissue differentiation type and degree of infiltration. 2. E-cadherin negative expression rate is 91.49%(43/47) in the primary tissue of gastric cancer with peritoneal metastasis, and it is 53.49%(23/43) in the primary tissue of gastric cancer without peritoneal metastasis. The negative expression have statistically significant difference(P<0.05). 3. There is no significant difference(P>0.05) between E-cadherin negative expression rate of gastric cancer with peritoneal metastasis and age, sex and tumor size, etc. But there is obvious significant difference(P<0.05) between E-cadherin negative expression rate of gastric cancer with peritoneal metastasis and tissue differentiation type, degree of infiltration.And E-cadherin expression decrease obviously in the Low differentiated adenocarcinoma, signet ring cell carcinoma and mucous adenocarcinoma. The deeper of the tumor infiltration depth the higher of the E-cadherin negative expression rate. 4. The risk factors of gastric cancer with peritoneal metastasis Including: Infiltration depth, histological type, lymph node metastasis and E-cadherin expression.Conclusion: 1. It is obviously related between gastric cancer with peritoneal metastasis and tumor tissue differentiation degree and the types. And the poorly differentiated adenocarcinoma, mucous adenocarcinoma and signet ring cell carcinoma may have a greater potential of peritoneal metastasis. At the same time, gastric cancer peritoneal metastasis is closely related to the progress of gastric cancer, especially the tumor involving the serous. It prompts peritoneal metastasis are the biological behavior of gastric cancer. 2. Meanwhile, E-cadherin expression decreased significantly in the poorly differentiated adenocarcinoma, mucous adenocarcinoma and signet ring cell carcinoma. It prompts the types of tumors have more CDH1 gene mutation or missing and those cancer cells are more likely to be lost that it's easy for local invasion and peritoneal planting. E-cadherin can be used as one of the prediction index of gastric cancer with peritoneal metastasis, and can be used as candidate index of the gastric cancer molecular targeted therapy. |
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