ObjectiveTo investigate the expressions of contactin-1 (CNTN-1), vascular endothelial growth factor-C (VEGF-C), and its receptor VEGFR-3 (Flt-4) in primary gastric cancer and to explore the relevance among them and their correlation with clinicopathologic features of gastric cancer. MethodsThe VEGF-C, VEGFR-3, and CNTN-1 protein expressions of tumor tissues and normal gastric mucosa tissues in 68 patients with primary gastric cancer were analyzed by immunohistochemistry. The Flt-4-positive vessel density (FVD) and lymphatic vessel density (LVD) were also analyzed by VEGFR-3positive and D2-40-positive staining, respectively. ResultsThe positivity rate of VEGF-C, VEGFR-3, and CNTN-1 protein expression in the primary tumor was 57.4% (39/68), 60.3% (41/68), and 55.9% (38/68), respectively, which was significantly higher than that in the normal gastric mucosa tissues 〔20.6% (14/68), 23.5% (16/68), and 16.2% (11/68)〕， P=0.000. The expressions of VEGF-C, VEGFR-3, and CNTN-1 protein were significantly correlated with TNM stage, lymphatic vessel invasion, and lymph node metastasis (Plt;0.05). The expression of CNTN-1 protein was significantly correlated with VEGF-C (r=0.372, P=0.002) and VEGFR-3 protein expression (r=0.308, P=0.011). In tumor tissues of sixtyeight patients the FVD was (10.41±9.38)/HP, which was significantly lower than LVD 〔(18.19±7.44)/HP〕, P=0.000. Elevated FVD and LVD was significantly found in patients with tumor characterized by later TNM stage, severer lymphatic vessel invasion, and severer lymph node metastasis (Plt;0.05). The FVD of tumor was significantly correlated with VEGF-C (P=0.029) and CNTN-1 protein expression (P=0.003). The LVD of tumor was not significantly correlated with CNTN-1 (P=0.727), VEGF-C (P=0.173), and VEGFR-3 protein expression (P=0.924). The patients with positive expression of VEGF-C, VEGFR-3, and CNTN-1 protein showed poorer prognosis (Plt;0.05). ConclusionsElevated expression of CNTN-1 protein is observed in primary gastric cancer and correlated with VEGF-C and VEGFR-3 protein expression, indicating that combined detection has great value in prediction of invasive potential and prognosis. VEGF-C-mediated CNTN-1 overexpression may promote lymphatic invasion via lymphangiogenesis pathway in patients with gastric cancer.
Objective To investigate the related factors affecting the metastases to left gastric artery lymph nodes in patients of esophageal cancer, and evaluate the clinical significance of resection of left gastric artery. Methods One hundred and eighty-six patients with esophageal cancer undergone esophagectomy and esophagogastrostomy were involved in these case-control study. The left gastric artery, lymph nodes and fat tissue around it were removed in these patients. Patients were divided into 2 groups according to the occurrence of metastases to para left gastric artery lymph nodes. Chi-square test, rank sum test, t-test and the logistic regression were adopted to analyze the correlations between these related factors and the metastases to para left gastric artery lymph nodes. Results Thirty-three patients had para left gastric artery lymph nodes metastases （17. 74%）. Related factors that affect the metastases to para left gastric artery lymph nodes were showed by monovariate analysis as follows： TNM staging of tumor, the metastases to paraesophageal nodes, paracardial nodes and subcarinal nodes （P〈0.001, P=0.025, 0.047,0.038）. Multivariate analysis showed that location of tumor was the only independent factor that influences the metastases of para left gastric artery lymph nodes（P= 0. 002）. Skip metastasis was a distinct feature of esophageal cancer, with a frequency of 78.79%（26/33）. Conclusions This study suggests that the major correlative factor of para left gastric artery lymph node metastasis is location of tumor. Resection of left gastric artery as a routine procedure in radical operation of esophageal cancer should be considered.
Objective To evaluate the potential of specific mRNA marker keratin 19(K19) to detect micrometastasis by reverse transcriptase polymerase chain reaction (RT-PCR) .Methods One hundred and ninty four regional lymph nodes harvested from 6 cases of benign diseases, 4 cases of breast carcinoma, 5 cases of gastric carcinoma and 12 cases of colorectal carcinoma patients were examined by conventional pathology and amplifying tissue specific K19 mRNA by RT-PCR separately, then the two methods were compared with each other. Results None of the 34 lymph nodes which were pathological metastasis-negative from benign diseases expressed K19 mRNA by RT-PCR, all of the 28 regional lymph nodes which were pathological metastasis-positive from malignant cases showed trains of K19 mRNA by RT-PCR. Of the 132 lymph nodes which were pathological metastasis-negative from malignant cases, 11 lymph nodes were detected with micrometastasis by genetic diagnosis.Conclusion Genetic diagnosis of lymph node micrometastasis is more sensitive than conventional pathology and has diagnostic value and merits further study.
ObjectiveTo investigate the expressions of CD133 and CD44 protein in primary lesions of gastric cancer and its clinical significance. MethodsThe expressions of CD44 and CD133 protein in gastric cancer tissues of 100 patients with gastric cancer were detected by immunohistocheimcal stainings.The relation between the expressions of CD44 and CD133 protein and the clinicopathologic characters were analyzed. ResultsBoth CD44 and CD133 protein were expressed on the cell membranes.No correlation were found between CD44/CD133 and the clinicopathologic parameters include gender and age (P > 0.05), but the positive expression rate of CD44/CD133 with diameter>5 cm was significantly higher than that tumor with diameter≤5 cm (CD44 P=0.150;CD133 P=0.056), and correlated with the tissue differentiation (CD44 P=0.008;CD133 P=0.007), vascular invasion (CD44 P=0.043;CD133 P=0.023), lymphatic vessel invasion (CD44 P=0.020;CD133 P=0.044), lymph nodes metastasis (CD44 P=0.002;CD133 P=0.004), inva-sion depth of tumor (CD44 P=0.006;CD133 P=0.021), and pTNM stage (CD44 P=0.034;CD133 P=0.001).No correlation were found between the co-expression of CD44 and CD133 protein and the clinicopathologic parameters include gender, age, tissue differentiation, and vascular invasion (P > 0.05), but the positive co-expression rate of CD44 and CD133 with diameter>5 cm was significantly higher than that tumor with diameter≤5 cm (P=0.010), and correlated with lymphatic vessel invasion (P=0.003), lymph nodes metastasis (P=0.045), invasion depth of tumor (P=0.041), and pTNM stage (P=0.049).The Spearman rank correlation analysis showed that there was positive correlation between the expressions of CD44 and CD133 protein (r=0.207, P=0.039).Univariate analysis showed that lymph nodes metastasis (P < 0.001), pTNM stages (P=0.013), CD44 protein expression (P=0.005), CD133 protein expression (P=0.002), and co-expression of CD44 and CD133 protein (P < 0.001) were significantly correlated with 3-year survival rate of pati-ents with gastric cancer respectively.Logistic regression analysis revealed that lymph node metastasis (P=0.038) was independent risk factor for co-expression of CD44 and CD133 protein.Multivariate analysis with the Cox regression models showed that co-expression of CD44 and CD133 protein (P=0.003) and lymph node metastasis (P=0.006) were significantly associated with poor prognosis. ConclusionsCD44 and CD133 protein may be considered as robust cancer stem cell markers in gastric cancer.The co-expression of CD44 and CD133 protein is the independent prognosis factor for gastric cancer and strongly associated with poor prognosis when they are expressed more high.
Objective To investigate the correlation among lymph node metastasis and clinical features, postoperative survival rate in rectal cancer. Methods Seventy-nine patients who had accepted total mesorectal excision (TME) were collected, and the correlation among their clinical features (including gender, age, tumor size, gross type, depth of infiltration, histology type, differentiated degree and the level of blood serum CEA), lymph node metastasis, and postoperative survival rate were analyzed. Results There was significant correlation between six factors (namely the tumor size, gross type, depth of infiltration, histology type, differentiated degree and the level of blood serum CEA) and lymph node metastasis in single factor analysis. However， multivariate analysis showed that only gross type of tumor and depth of tumor infiltration were related to lymph node metastasis. The postoperative survival time of 43 non-metastasis cases was remarkably longer than that of 33 cases with lymph node metastasis (χ2=18.806， P=0.000), and it was longer in 22 cases with ＜4 lymph nodes metastasis than that of 11 cases with ≥4 lymph nodes metastasis (χ2=4.659， P=0.031). Conclusion In rectal cancer patients the clinical features can reflect the condition of lymph node metastasis in a certain extent, and it can help doctors to evaluate the lymph node metastasis and prognosis.
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1—3N0 gastric cancer. Methods One hundred and twenty patients with stage pT1—3N0 gastric tumors were included, and 2 106 lymph nodes were harvested and examined in all the specimens. There were 9－28 lymph nodes with average 18 lymph nodes from each patient. All the lymph nodes were negative by HE staining. The CK20 expression of lymph nodes was tested by immunohistochemistry. The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed. Results The positive expression rate of CK20 was 9.07% (191/2 106) in lymph nodes and 26.67% (32/120) in patients with pT1—3N0 gastric cancer by immunohistochemistry. Eleven cases were with micriometastasis, 21 cases were isolated tumor cells (ITC). The average postoperative follow-up was 66.35 (range 24—121) months. Five-year disease free survival rates were 87.4%, 78.3%, and 40.9% for the lymph node negative, ITC, and micrometastasis groups, respectively. Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group (P=0.000) and ITC group (P=0.046). However, there was no significant difference between the lymph node negative group and ITC group （P=0.253）. Multivariate analysis identified tumor diameter (P=0.011), depth of tumor invasion (P=0.043), and lymphatic vessel invasion (P=0.002) were related with CK20 positive expression. There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates. Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi), the restage rate was 9.17%. While the lymph node negative (88 patients) and ITC (21 patients) were recorded pN0(i-) and pN0(i+), respectively, and were not recommended restage (stage pN0). Conclusion Patients with stage pT1—3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate, for whom adjuvant therapies may be justified and effective.
Objective To provide a current language for clinical and pathological discription of gastric cancer. Methods The literature in recent years on the distribution of lymph nodes and staging of gastric cancer were reviewed. Results The lymph nodes of gastric cancer are distributed near the blood vessel and organs of gastric milieu. To ensure radical gastrectomy rational and scientific, the anatomic structure of gastric milieu should be familiarized. Conclusion The excellent outcome of surgery will be achieved by the effective dissection and removel of lymph nodes in gastric cancer.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
Objective To investigate the expression of claudin-1 in breast tumor tissues and the relationship of development and progress of breast neoplasm．Methods The expressions of claudin-1 in 89 cases of breast cancer and 37 benign breast diseases were tested by tissue chip technology and immunohistochemistry．The relationships of claudin-1 expression to the lymph node metastasis，TNM staging，maximum diameter of the tumor，and histology grade were statistically analyzed．Results The expression of claudin-1 in the breast cancer was significantly lower than that in the benign breast disease（χ2=19.20，P=0.000 2）．The claudin-1 expression in the patients with lymph node metastasis was significantly lower than that without lymph node metastasis （χ2=3.85，P=0.049 7）．The claudin-1 expression in the stageⅢ of TNM staging was weaker than that in the stage Ⅰ（χ2=5.29，P=0.021 4） and stage Ⅱ （χ2=7.46，P=0.006 3），respectively. There was no significant difference of the claudin-1 expression in the different maximum diameters of tumor （χ2=1.58，P=0.453 8） or histology grades （χ2=1.02，P=0.600 5），respectively．Conclusions The expression of claudin-1 might be correlated with the occurrence，development，and metastasis in breast tumor．It may be one of the potential indicator for lymph node metastasis and prognosis assessment in breast cancer．
Objective To detect the expression of cytokeratin 20 (CK20) mRNA (micrometastasis) in regional lymph nodes and the serum activities of CD4+ cells, CD8+ cells and NK cells, serum levels of IL-2, IL-12 and sIL-2R in peripheral blood of patients with colorectal cancer; and to investigate the relationship between them. Methods Total 281 lymph nodes of 21 patients with colorectal cancer were collected. The positive expression of CK20 mRNA in lymph nodes was detect by reverse transcription-polymerase chain reaction (RT-PCR) and the metastasis in lymph nodes was detected by conventional pathological examination; the serum activities of CD4+ cells, CD8+ cells and NK cells were detected by flow cytometry and serum levels of IL-2, IL-12 and sIL-2R were detected by ELISA method in peripheral blood of patients with colorectal cancer. Results Among the positive metastasis in the 281 lymph nodes of the 21 patients, there were 16 (5.7%， 16/281) lymph nodes in 2 patients detected by pathological examination and 140 (49.8%， 140/281) lymph nodes in 10 patients by RT-PCR. There was a significant difference between the two measures in the aspects of the detection rate and the positive cases of lymph node metastasis in the 21 patients. Before operation, the serum activities of CD4+ cells, CD4+/CD8+ and NK cells, levels of IL-2 and IL-12 in 11 patients whose CK20 mRNA in regional lymph nodes were negative expression were higher than those in the other 8 patients whose lymph nodes metastasis were negative by conventional pathological examination but CK20 mRNA were positive expression （P＜0.05）; and the serum activity of CD8+ cells and level of sIL-2R in the former ones were lower than those in the latter ones （P＜0.05）. The serum activities of CD4+（r＝－0.769） cells, CD4+/CD8+（r=－0.755） and NK cells （r=－0.532）, the levels of IL-2 （r＝－0.834） and IL-12 （r＝－0.819） were negative correlated with the expression of CK20 mRNA （P＜0.05, P＜0.01）; and the activity of CD8+ cells （r=0.562） and level of sIL-2R （r=0.751） were positive correlated with the expression of CK20 mRNA （P＜0.05）. Conclusion The micrometastasis in lymph nodes is correlated significantly with the lower immune function of patients with colorectal cancer.