Analysis Of Clinicopathological Features And Prognosis Of Tissue Necrosis In Patients With Esophageal Squamous Cell Carcinoma

1 Background and objectiveEsophageal cancer is a serious threat to human health.Globally,esophageal cancer has a very high morbidity rate and a very high mortality rate.The situation of esophageal cancer in China is even more unoptimistic.The number of esophageal cancer patients in the world is increasing at a rate of about 570,000 per year,and the growth rate of esophageal cancer patients in China is more than 280,000 per year.More than 95%of Chinese esophageal cancer is esophageal squamous cell carcinoma.The prognosis of esophageal cancer is extremely poor.For all patients with esophageal cancer,only 15%can live more than five years.However,for patients with early esophageal cancer,the probability of living for more than 5 years is more than 90%.Unfortunately,early esophageal cancer has no obvious symptoms.When dysphagia and other symptoms occur,it is often too late.Among the patients diagnosed with esophageal cancer for the first time,more than 95%are in the middle and late stages.The study of the occurrence,development,molecular changes and pathological characteristics of esophageal cancer is of great significance for the prevention,early detection and individualized treatment of esophageal cancer patients.In the process of observing the postoperative pathological sections of patients with esophageal cancer,we found that tumor tissue necrosis is not rare.For patients who underwent preoperative radiotherapy and chemotherapy,the number of tumor parenchymal cells decreased significantly and degenerative changes occurred,and interstitial fibrosis,fibromyxoid or vitreous degeneration also occurred;However,necrosis also exists in the postoperative pathological tissues of many patients without preoperative radiotherapy and chemotherapy,and the ways of necrosis are obviously different.In some tumor tissues,cancer cells are dense,very vigorous,and there are still large areas of necrosis..The boundary between necrotic tissue and normal tumor tissue is clear and separated from each other;In some tissues,many keratinizations can be seen at the level of single cells,but keratinizing beads do not form and begin to necrosis.At present,the research on esophageal cancer tissue necrosis is very rare.The pathological characteristics,occurrence law and molecular changes of tumor tissue necrosis need to be studied.The occurrence,development and prognosis of tumor is a very complex process.Many studies have shown that a variety of genes and proteins have changed in the development of esophageal cancer.Dock10 gene is a member of the human dock gene family.It belongs to dock-d subtype and is an atypical Rho family guanylate exchange factor.Dock10 has the function of guanylate regulator of Cdc42 and Racl,and can activate inactive Cdc42 to active state.When Cdc42 is activated,the deformation,extension and migration ability of cells will change,so that the invasion ability of cells will also change.Based on large sample data,this study explored the characteristics of esophageal squamous cell carcinoma tissue necrosis and its relationship with prognosis,And further analyze the clinical significance of DOCK10 protein in patients with ESCC,hoping to provide a basis for the clinically individualized treatment plan for patients with esophageal squamous cell carcinoma.2 Materials and methods2.1 Object of studyA total of 2,312 patients(1994-2020)with esophageal squamous cell carcinoma were enrolled.All the data came from the State Key Laboratory of Esophageal Cancer Prevention and Treatment jointly established by the Ministry of the First Affiliated Hospital of Zhengzhou University.The included patients underwent radical surgery and were diagnosed as esophageal squamous cell carcinoma by postoperative pathology;At the same time,there were no other malignant tumors;Basic information and clinical diagnosis and treatment information are complete.2.2 Research methods①The clinical diagnosis of 2312 patients with ESCC were analyzed retrospectively,including gender,age,smoking history,drinking history,family history,address,details of postoperative pathological diagnosis,tumor length,depth of invasion,degree of differentiation,lymph node metastasis and distant metastasis.The relationship between tumor tissue necrosis and other clinical features was analyzed,and the survival of patients was analyzed.② Immunohistochemical staining was performed on 2312 postoperative pathological sections.Finally,the expression of DOCK 10 protein in 2054 patients with ESCC was obtained,and the relationship between the DOCK10 protein and the clinicopathological and prognosis with ESCC was analyzed.2.3 Statistical methodsThe statistical analysis software is SPSS25.0.Chi-square test was used to analyze the distribution characteristics of DOCK10 protein expression and ESCC tumor tissue necrosis;K-M was used for univariate survival analysis,and Log-rank test,Cox proportional hazard regression model was used to analyze esophageal squamous cell carcinoma Factors affecting the prognosis of patients.Inspection level:α=0.05.3 Results3.1 The clinicopathological characteristics and survival effects of tissue necrosis with esophageal squamous cell carcinomaThe 2,312 patients with ESCC tissue necrosis included in this study were all diagnosed with ESCC.Among them,there were 1,532(66.3%)males with average age at 61.14±8.49 years;780(33.7%)females with average age at 62.29±8.00 years.Age,tumor length,degree of differentiation,and depth of invasion have no differences in the distribution of esophageal squamous cell carcinoma tissue necrosis,but gender,smoking history,drinking history,family history,high/low incidence area,N staging,and pathological staging are in the esophagus The distribution of squamous cell carcinoma tissue necrosis was significantly different(P<0.001).Comparison of the distribution of tissue necrosis of esophageal squamous cell carcinoma found that gender,age at diagnosis,high/low incidence area,smoking history,drinking history,family history,lymph node metastasis,tumor length,differentiation degree,depth of invasion,and pathological staging were not related to tumor tissue necrosis Difference in distribution3.2 The relationship between DOCK10 protein expression and tissue necrosis of ESCC and its influence on survivalAmong the 2,054 patients with ESCC included in this study,1,354 males,with average age of 60.73 years;700 females with average age of 61.90 years.393 cases were positive with DOCK10 protein expression,and positive expression rate was 19.1%.There are significant differences in the distribution of DOCK10 protein expression in high/low incidence areas and tumor long diameters.There was no statistical difference in the distribution of DOCK 10 protein expression in factors such as gender,smoking history,drinking history,family history,N stage,early/mid-late stage,tumor necrosis,age,depth of invasion,etc..DOCK10 protein expression,tumor tissue necrosis,high/low incidence area,T stage,and N stage are independent factors influencing the prognosis patients with ESCC.DOCK10 protein expression is negative,high incidence area,increased depth of invasion,positive lymph node metastasis,tumor tissue necrosis It is a risk factor for the prognosis of patients with esophageal squamous cell carcinoma.4 Conclusions1.High-risk areas,increased depth of invasion,positive lymph node metastasis,positive tumor tissue necrosis,and negative DOCK10 protein expression are risk factors affecting the prognosis of patients with esophageal squamous cell carcinoma.2.Among patients with esophageal squamous cell carcinoma tissue necrosis,patients with keratotic necrosis have better survival than those with tumor necrosis.