| PurposeTo retrospectively analyze the differences in clinicopathological features and related protein expression between Mucinous gastric carcinoma(MGC)and non-mucinous gastric carcinoma(NMGC),and to explore the biological characteristics and prognosis of MGC.The prognostic factors affecting MGC were analyzed to provide help for the diagnosis,treatment and prognostic risk assessment of MGC.MethodsIn this study,the clinical data of surgically resected MGC and NMGC patients registered in the SEER database from 2009 to 2010 were downloaded to analyze the clinicopathological characteristics and prognosis of the two patients.At the same time,the relevant data of surgically resected MGC and NMGC patients admitted to a third-grade A hospital in Shaanxi Province from 2011 to 2015 were collected to analyze the clinicopathological characteristics and prognosis of the two patients.Multivariate Cox regression was used to analyze the prognostic factors of MGC patients.In addition,the expressions of MUC2 protein,p53 protein and HER-2 protein in postoperative immunohistochemistry of MGC and NMGC patients who underwent surgical treatment in a third-grade A hospital in Shaanxi Province from 2015 to 2017 were collected to analyze whether the expressions of MUC2 protein,p53 protein and HER-2 protein were different in MGC and NMGC,and whether they were associated with prognosis.Results1.Among the patients registered in SEER database,137 cases were MGC,accounting for 11.5%;NMGC in 1059 cases(88.5%).Among the MGC patients,89 were males and 48 were females.Among the NMGC patients,there were 701 males and 358 females.Among the MGC patients,40 were ≥60 years old and 97 were <60 years old.Among the NMGC patients,297 cases were ≥60 years old and 762 cases were <60 years old.The results showed that there was no significant difference in gender and age composition between MGC and NMGC patients(P>0.05).2.The clinicopathological characteristics of the patients in the SEER database: at the time of diagnosis,the stage of MGC patients was relatively late,with 55 cases of T3+T4in MGC patients(40.1%)vs 329 cases of T3+T4 in NMGC patients(31.1%),P<0.05;In terms of lymph node metastasis,MGC patients were significantly higher than NMGC patients(62.0% vs 52.0%,P<0.05).In postoperative TNM staging,MGC patients in stage Ⅲ +Ⅳ were significantly higher than those in NMGC patients(61.3% vs 52.0%,P<0.05).At the time of diagnosis,MGC patients had a higher rate of abdominal metastasis than NMGC patients(23.4% vs 10.0%,P<0.05).In terms of surgery,96 cases(70.0%)of MGC patients underwent radical surgical resection.837 NMGC patients underwent radical surgical resection,accounting for 79.0%,and there was a significant statistical difference between the two(P<0.05).Borrmann typing of patients not registered in the SEER database is not possible for comparison.3.The 5-year survival rate for patients in the SEER database was 27.5% for MGC patients;The 5-year survival rate of patients with NMGC was 49.5%.The difference between them was statistically significant(P<0.05).However,in the same TNM stage,the 5-year survival rates of stage Ⅲ +Ⅳ MGC and NMGC patients were 25.0% and28.5%,respectively,and there was no statistically significant difference between the two(P>0.05).Univariate analysis of 5-year OS(Overall Survival(OS))of MGC patients showed that the depth of invasion,lymph node metastasis,abdominal metastasis,TNM stage and surgical method were the factors affecting the 5-year OS of MGC patients,while gender and age were not.The results of multivariate analysis showed that the independent prognostic factors affecting 5-year OS in MGC patients were whether radical surgery was performed(HR=57.141,95%CI: 16.316-200.120,P<0.001)and whether abdominal metastasis was performed(HR=0.299,95%CI: 0.130-0.690,P=0.005).4.In the data of patients In a third-class hospital In Shaanxi Province,41 cases(6.7%)were MGC,Among the MGC patients,there were 28 males and 13 females.Among the MGC patients,568 cases(93.3%)were NMGC.There were 453 males and 115 females Among the MGC patients,13 were ≥60 years old and 28 were <60 years.Among the NMGC patients,204 cases were ≥60 years old and 364 cases were<60 years old;60years old.The results showed that there was no significant difference in gender and age composition between MGC and NMGC patients(P>0.05).5.The clinicopathological characteristics of patients in a third-class A hospital in Shaanxi Province were as follows: in Borrmann type Ⅲ+Ⅳ,there were 35 cases of MGC(14.6%)vs 314 cases of NMGC(44.7%),P<0.05;At the time of diagnosis,the stage of MGC patients was relatively late,34 cases(82.9%)of MGC patients were T3+T4 vs.318cases(58.0%)of NMGC patients were T3+T4,P<0.05;In terms of lymph node metastasis,MGC patients were significantly higher than NMGC patients(71.0% vs 50.9%,P <0.05).In the postoperative TNM staging,MGC patients in stage Ⅲ +Ⅳ were significantly higher than NMGC patients(87.8% vs 62.5%,P<0.05).At the time of diagnosis,MGC patients had a higher rate of abdominal metastasis than NMGC patients(22.0% vs.9.2%,P<0.05).In terms of surgery,radical surgical resection was performed in 28 MGC patients,accounting for 68.3%.NMGC patients underwent radical surgical resection in 460cases(81%),and there was a significant statistical difference between them(P<0.05).6.The 5-year survival rate of patients in a third-class A hospital in Shaanxi Province:the 5-year survival rate of MGC patients was 24.4%;The 5-year survival rate of patients with NMGC was 45.4%.The difference between them was statistically significant(P <0.05).However,in the same TNM stage,the 5-year survival rates of stage Ⅲ+Ⅳ MGC and NMGC patients were 20.5% and 21.5%,respectively,and there was no statistically significant difference between the two(P > 0.05).Univariate analysis of 5-year OS of MGC patients showed that Borrmann type,depth of invasion,lymph node metastasis,abdominal metastasis,TNM stage and surgical method were factors affecting 5-year OS of MGC patients,while gender and age were not factors affecting 5-year OS of MGC patients.Multivariate analysis showed that the independent prognostic factor affecting5-year OS in MGC patients was whether radical surgery was performed(HR=49.503,95%CI: 5.430-451.331,P =0.001).7.The expression of MUC2 protein and HER-2 protein in gastric cancer was not related to the gender,age,invasion depth,TNM stage and lymph node metastasis of the patients,but was closely related to pathological classification.The positive rates of MUC2 protein in MGC and NMGC were 70.0% and 23.3%,respectively,and the difference was statistically significant(P<0.05).The positive rate of HER-2 protein in MGC and NMGC was 0% and 20%,respectively,and there was a statistical difference between the two(P <0.05).The 3-year survival rates of MGC patients with positive and negative expression of MUC2 protein were 33.3% and 77.8%,respectively,and the difference was statistically significant(P<0.05).The expression of p53 protein in gastric cancer is not related to the gender and age of the patients,but is closely related to the depth of invasion,TNM stage and lymph node metastasis.The expression of p53 protein in MGC was higher than that in NMGC(60% and 50%,respectively),but there was no statistically significant difference between the two(P > 0.05).The 3-year survival rates of MGC patients with positive and negative P53 protein expression were 22.2% and 83.3%,respectively,and there was a statistically significant difference between them(P<0.05).Conclusion1.Compared with NMGC patients,the overall prognosis was worse in MGC patients.However,at the same TNM stage,there was no significant difference in prognosis between the two groups.Therefore,the reason for the worse prognosis of MGC patients compared with NMGC patients may be that serosal infiltration,lymph node metastasis and abdominal metastasis had occurred at the time of diagnosis,the staging was late,and the radical resection rate was low.2.Multivariate analysis showed that radical surgery and abdominal metastasis were independent prognostic factors for MGC patients in the SEER database.3.Multivariate analysis showed that radical surgery was an independent prognostic factor for MGC patients in a third-class A hospital in Shaanxi Province.4.The expression of MUC2 protein in MGC was significantly higher than that in NMGC,and the prognosis of patients with positive MUC2 protein in MGC was worse,suggesting that MUC2 protein may be a potential prognostic molecular marker of MGC.5.The expression of p53 protein was significantly correlated with the depth of tumor invasion,TNM stage,presence of lymph node metastasis and prognosis,and the prognosis of patients with positive p53 protein in MGC was worse,suggesting that it may be a potential prognostic molecular marker of MGC.6.The negative expression of HER-2 protein in MGC suggests that HER-2 may not be involved in the carcinogenesis of MGC. |
