| BackgroundGastric cardia adenocarcinoma is the integration of a adenocarcinoma of gastroesophageal junction,is one of the most common malignant tumors,and its incidence is on the rise in the world.Its clinical manifestations are hidden and its anatomical sites are special,and its early diagnosis is difficult and its prognosis is poor.Vascular endothelial growth factor(VEGF)is one of the important factors affecting tumor angiogenesis,which can promote cell growth,invasion,metastasis and increase cell permeability.As one of the important tumor suppressor factors,P53 can induce DNA damage repair,block cell cycle,inhibit angiogenesis,lead to cell apoptosis and other functions,which can inhibit the malignant transformation of cells.When P53 is mutated,it loses its tumor suppressor effect,which can lead to the loss of regulation of damaged cells,and eventually lead to tissue canceration.Relevant studies have shown that there is a certain association between VEGF and P53,and the two have been studied in lung cancer,gastric cancer,cervical cancer and other malignant tumors.However,the correlation between its expression in gastric cardiac adenocarcinoma and prognosis has rarely been reported.ObjectiveTo analyze the relationship between clinicopathological factors and postoperative prognosis of patients with gastric cardiac adenocarcinoma.To explore the relationship between VEGF,P53 and clinicopathological features and prognosis,so as to find out the possible factors related to postoperative prognosis of gastric cardiac adenocarcinoma,and lay a foundation for predicting the survival time of patients with gastric cardiac adenocarcinoma and selecting new treatment regimens to prolong the survival time of patients.MethodsA total of 471 patients with gastric cardiac adenocarcinoma undergoing surgical treatment in Puyang People’s Hospital from January 2010 to October 2019 were collected.After consulting medical records,patients with complete clinicopathological data were followed up by telephone,and those patients with complete follow-up data were finally enrolled.Kaplan-Meier method was used to conduct univariate analysis for 14characteristic clinicopathological factors(gender,age,tumor site,gross type,longest diameter of tumor,degree of differentiation,degree of invasion,lymph node metastasis,tumor thrombus,nerve invasion,surgical margin,postoperative adjuvant chemotherapy,smoking history,family history),and the factors related to postoperative prognosis of patients with gastric cardiac adenocarcinoma were screened out.Then prognostic factors were included in Cox proportional risk model for multivariate analysis,and the independent influencing factors for postoperative prognosis were finally obtained.Looking for 255 cases of patients with postoperative tumor tissue paraffin samples,using immunohistochemical method to detect the expression of VEGF and P53 in tumor tissues.The brownish yellow cytoplasm of VEGF was considered as positive,no staining or less than 25%positive cells were considered as negative,and≥25%positive cells were considered as positive.P53 is positive if the nucleus is brownish yellow,no staining or less than 5%positive cells were considered as negative,and≥5%positive cells were considered as positive.Chi-square test was used to analyze the relationship between the expression of VEGF and P53 and clinicopathological characteristics,Kaplan-Meier method was used to analyze the relationship between the expression of VEGF and P53 and prognosis,and Spearman correlation analysis was used to analyze the correlation between VEGF positive expression and P53 positive expression.P<0.05 was considered statistically significant.Results1.General data and follow-up results:a total of 471 patients were collected in the past 10 years,among whom 358 patients with complete clinicoppathological data were found by consulting medical records,followed by telephone follow-up,and 255 patients with complete follow-up data were finally enrolled.Among them,there were 218 males and37 females,ranging from 40 to 85 years old,with an average age of 65±8 years old.There were 18 cases with high differentiation,91 cases with moderate differentiation and 146cases with low differentiation.36 cases survived for less than 1 year,213 cases survived for1 year or more,121 cases survived for 3 years or more,and 62 cases survived for 5 years or more.The mean survival time of 255 patients was 59.7 months,and the median survival time was 54.0 months.Overall 1-,3-,and 5-year survival rates were 85.0%,62.7%,and44.7%,respectively.2.Single factor analysis showed:patients with gastric cardiac adenocarcinoma with large tumor diameter,low differentiation degree,deep invasion degree,late stage of lymph node metastasis,tumor embolism,poor surgical margin,and no postoperative adjuvant chemotherapy had poor prognosis after surgery(all P<0.05),and age was not related to the prognosis of patients with cardiac adenocarcinoma.3.Cox proportional hazards model of multi-factor analysis showed:infiltration degree(P=0.000,OR=2.304,95%CI=1.531～3.466),lymph node metastasis(N2:P=0.015,OR=2.019,95%CI=1.149～3.549;N3:P=0.000,OR=3.779,95%CI=2.257-6.327)and postoperative adjuvant chemotherapy(P=0.000,OR=2.289,95%CI=1.534-3.414)were independent influencing factors for postoperative prognosis of patients with cardiac adenocarcinoma.4.VEGF expression results:(1)In 255 cases of gastric cardiac adenocarcinoma,185 cases(72.5%)showed positive expression of VEGF.(2)The high expression of VEGF was correlated with the longest tumor diameter,degree of invasion and lymph node metastasis(P<0.05),but not with gender,age,tumor location,gross type,degree of differentiation,presence of tumor thromb,presence of peripheral nerve invasion,surgical margin status,postoperative adjuvant therapy,smoking history,and family history.(3)The survival time of patients with positive expression of VEGF was significantly lower than that of patients with negative expression(P<0.05).5.P53 expression results:(1)In 255 cases of gastric cardiac adenocarcinoma,160 cases(62.7%)showed positive expression of P53.(2)The high expression of P53 was correlated with gross tumor type,longest tumor diameter,depth of invasion and lymph node metastasis(P<0.05),but not with gender,age,tumor location,degree of differentiation,presence of tumor thromb,presence of peripheral nerve invasion,surgical margin status,postoperative adjuvant therapy,smoking history,and family history.(3)The survival time of patients with positive expression of P53 was significantly lower than that of patients with negative expression(P<0.05).6.There was a significant positive correlation between the expression of VEGF and P53 in gastric cardiac adenocarcinoma(r=0.144,P<0.05).7.255 patients were divided into 4 groups(VEGF~+P53~+group,VEGF~—P53~—group,VEGF~+P53~—group,VEGF~—P53~+group),and survival analysis showed that there was statistically significant difference in survival time between the 4 groups.The survival time of the VEGF~—P53~—group was significantly higher than that of the other three groups,and the survival time of the VEGF~+P53~+group was lower than that of the VEGF~+P53~—group and the VEGF~—P53+group.Conclusion1.Among the clinicopathological factors,the longest tumor diameter,degree of differentiation,degree of invasion,lymph node metastasis,presence of tumor thromb,surgical margin status,and presence of postoperative adjuvant chemotherapy were related to postoperative prognosis,among which the degree of invasion,lymph node metastasis,and postoperative adjuvant chemotherapy were independent prognostic factors.2.Postoperative adjuvant chemotherapy can significantly prolong the survival time of patients.3.Age did not affect the postoperative survival time of patients with gastric cardiac adenocarcinoma.4.The high expression of VEGF was related to the longest tumor diameter,degree of invasion and lymph node metastasis.The survival time of patients with positive VEGF expression was significantly lower than those with negative VEGF expression.5.The high expression of P53 was correlated with the gross tumor type,the longest tumor diameter,the depth of invasion and lymph node metastasis.The survival time of patients with positive expression of P53 was significantly lower than that of patients with negative expression of P53.6.The expression of VEGF was significantly positively correlated with the expression of P53,and the combined detection was significant for predicting the prognosis. |
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