| BackgroundAs a common malignant tumor of the digestive system,gastric cancer ranks fifth and third in the world in terms of morbidity and mortality.China is a country with a high incidence of gastric cancer and a heavy burden of disease.About 679,000 new cases of gastric cancer are estimated every year.Because 90% of the cases of gastric cancer are locally advanced or advanced at the time of discovery,the mortality rate of gastric cancer is the second highest among malignant tumors in China.About 498,000 cases of death caused by gastric cancer each year.Gastric cancer is still the focus of cancer diagnosis and treatment in China.Based on preoperative clinical data,risk stratification of gastric cancer patients,screening of patients with high risk of recurrence and metastasis to receive neoadjuvant chemotherapy,and stratified management of postoperative patients according to the risk of recurrence,has become the research focus of individualized diagnosis and treatment of gastric cancer.However,there are relatively few comprehensi-ve studies and literature reports on the preoperative risk analysis of advanced gastric cancer at home and abroad,and the data available for preoperative risk stratification in patients with advanced gastric cancer is limited.Gastric cancer is a group of highly heterogeneous and invasive diseases.The development of gastric cancer is also a complex pathological and physiological process involving multiple genes.Exploring the invasion and metastasis mechanism of gastric cancer at the molecular level is a hot topic in the field of gastric cancer research.Finding tumor markers that can effectively predict postoperative recurrence and prognosis of gastric cancer is necessary for the development of individualized diagnosis and treatment of gastric cancer and improvement of postoperative survival.A number of studies have shown that FN1 plays an important role in the development of tumors,and its high expression often means poor clinical outcomes in cancer patients.However,in the aspect of gastric cancer,the relationship between the expression of FN1 and prognosis has not been reported.Part I: Predictive value of CT signs for postoperativesurvival of advanced gastric cancer Objective:Based on preoperative imaging data of patients with advanced gastric cancer,try to stratify risk of gastric cancer patients,screen for high-risk image signs of recurrence,and analyze the value of CT in evaluating the prognosis of patients with gastric cancer.Materials and Methods:From June 2011 to June 2012,106 patients with advanced gastric adenocarcinoma(pT2-4)confirmed by pathology were retrospectively collected.All patients underwent surgical radical surgery within one to two weeks after CT examination.CT signs were recorded including: size of the lesion,invasion of the serosa,lymph node metastasis status,ct-EMVI status,longitudinal extent of the lesion,and enhanced CT values at various stages of the lesion.All patients were followed up for more than 5 years.Chi-square test or independent sample t test were used to compare the differences of clinical radiological factors among different DFS and OS groups.Then single factor and multivariate logistic regression analysis were used to screen independent CT signs of recurrence after operation,and ROC curve was used to evaluate the diagnostic efficacy.Survival analysis was performed using Kaplan-Meier method and multivariate Cox regression analysis to screen CT signs affecting DFS and OS after gastric cancer operation.Results:1.CT signs such as the size of the lesion,serosa invasion,lymph node metastasis,ct-EMVI status,the longitudinal range of the lesion and the degree of enhancement of the lesion were significantly different between the recurrence group and the non-recurrence group,the death group and the survival group(P<0.05).The recurrence rate and mortality of gastric cancer patients with serosa invasion,lesion size>5cm,positive ct-EMVI,cN2-3 lymph node metastasis,non-localized lesions and high degree of enhancement were higher.2.There was no significant difference in sex and age between groups with recurrence and death outcomes(P>0.05).The average thickness of the lesions in the recurrence group was(18.01±5.65)mm,while that in the non-recurrence group was(16.83±5.36)mm.There was no significant difference between the two groups(t=0.929,P=0.355).The average thickness of the lesions in the dead group was(18.81±5.33)mm,and that in the surviving group was(14.91±4.72)mm.There was a significant difference between the two groups(t=3.987,P < 0.05).Gastric cancer patients with thicker lesions had a higher mortality rate after operation.3.Univariate logistic regression analysis showed that all CT signs were significantly correlated with postoperative recurrence(P<0.05),while multivariate logistic regression analysis showed that only two CT signs,serosal invasion and lesion size>5 cm,were significantly correlated with postoperative recurrence of gastric cancer(P<0.05).The sensitivity and specificity of combined serosal invasion and lesion size for predicting recurrence were 84.0% and 69.1% respectively,and the area under ROC curve was 0.820.4.Univariate survival analysis showed that all CT signs(depth of invasion,size of lesion,ct-EMVI status,lymph node metastasis,lesion extent,Borrmann classification,enhancement degree)had statistical significance for OS and DFS in patients with gastric cancer after operation(P<0.05).The overall survival time and disease-free survival time of patients with serosa invasion,lesion size > 5cm,positive ct-EMVI,cN2-3 lymph node metastasis,non-localized lesions and high degree of enhancement were shorter.5.Cox regression analysis showed that serosal invasion,ct-EMVI status,CT lymph node metastasis and enhancement were related to DFS,but only serosal invasion,ct-EMVI status and enhancement degree were related to OS.Conclusion:1.CT signs such as serosal invasion and lesion size are independent predictors of recurrence of gastric cancer after operation.2.Serosal invasion,ct-EMVI status,lymph node metastasis and enhancement degree are risk factors for disease-free survival after gastric cancer surgery.Serosal invasion,ct-EMVI status and enhancement degree are independent risk factors for overall survival after gastric cancer surgery.3.CT can stratify the risk of advanced gastric cancer patients before operation,and provide imaging basis for making individualized treatment plan and judging clinical prognosis.Part II: Correlation between CT signs and expression of F protein in advanced gastric cancerObjective: To explore the relationship between FN1 protein expression and clinical prognosis in gastric cancer,and to study the correlation between CT signs and FN1 protein expression in gastric cancer,so as to provide a more comprehensive basis for the prognosis of gastric cancer and the formulation of individualized diagnosis and treatment program.Materials and Methods: A retrospective collection of 99 cases of patients with advanced gastric adenocarcinoma(pT2-4)confirmed by pathology from June 2011 to June 2012 and FN1 immunohistochemistry was performed.Gastric cancer resection specimens were obtained in all cases.According to the results of immunohistochemistry,all cases were divided into FN1 positive group and FN1 negative group.Kaplan-Meier survival curve was used to analyze the relationship between FN1 protein expression and disease-free survival time and overall survival time after gastric cancer surgery.The correlation between CT signs(lesion thickness,serosal invasion,size,lymph node metastasis,ct-EMVI status,enhanced CT value)and FN1 protein expression was analyzed by Chi-square test or independent sample t test.Results:1.Kaplan-Meier survival analysis showed that the expression of FN1 protein in gastric cancer tissues was related to DFS and OS after operation,and the difference was significant(P<0.05).2.CT features such as lesion thickness,degree of invasion,lesion size,and lymph node metastasis were all related to the positive expression of FN1,and the statistics were significantly different(P<0.05).The ct-EMVI status,the intensified CT value and the degree of enhancement were not related to the expression of FN1,and there was no significant difference(P>0.05).Conclusion:1.Those with positive FN1 protein expression in gastric cancer tissues have poor DFS and OS after operation.2.The thickness of the lesion,the degree of invasion,the size of the lesion,and the state of lymph node metastasis were positively correlated with the positive expression of FN1 protein.3.CT as a routine preoperative examination method for gastric cancer,CT signs and FN1 protein expression have a certain correlation,suggesting that CT can evaluate the molecular biological behavior of gastric cancer,and contribute to the comprehensive evaluation of postoperative recurrence and prognosis of gastric cancer. |
PDF Full Text Request