| Gastric cancer is one of the common clinical malignant tumors. Nearly half of the patients who have radical resection will relapse and metastasis,recurrence and metastasis are the most important causes of poor prognosis and death.The liver is one of the most common distant metastasis organ of gastric cancer patients.Early detection and early treatment to such patients are expected to delay the survival time of the patients,relieve pain and improve the quality of life. Liver metastases of gastric cancer is a multi-step,multi-factor involved complex process,which includes the cancer cells coming out from the original tumor, extracellular matrix damage, vascular invasion, transferring organ revascularization and further proliferation, etc.In this process, ontogeny such as adhesion molecule, angiogenesis factor, extracellular matrix metalloproteinase is unusual.The present study think that CEA, AFP,C-met,MMP11,COX-2, VEGF, E-cad and MVD play an crucial role in the invasion and metastasis of gastric cancer.How to select the most closely linked factors from so many influencing factors about liver metastasis from gastric cancer as an effective indicator to predict gastric cancer liver metastases has the very important clinical significance, and is also a problem that the clinicians are eager to understand.Our study will analyze the clinical data of patients with gastric cancer and detect the liver metastases of gastric cancer related biological molecules.With a view to clarify the link between the various factors and liver metastases of gastric cancer, we can find a more accurate projection method about liver metastases of gastric cancer. Therefore, the designs of our experimental study are as follows: (1)Through a review of the case study, discuss the link between liver metastases of gastric cancer and the factors associated with clinical pathological.(2)Detect the expression of CEA, AFP, C-met, MMP2, COX-2, VEGF, E-cad and MVD in gastric carcinoma, and use statistical methods to select the most closely factor associated with liver metastases of gastric cancer.(3)Associate detect the expression of relevant factor of gastric carcinoma in the experiment, do a series of diagnostic tests, evaluate the diagnostic tests,and find a better diagnosis model of liver metastases of gastric cancer. Chapter1Analysis of potential risk factors about liver metastases of gastric cancerObjective:Liver metastases of gastric cancer is one of the most common way to transfer, but there is a lack of effective prediction and assessment indicators.The aim of this study was to discuss the relationship between the liver metastases of postoperative gastric cancer and its clinical pathology factors to evaluate the risk of liver metastases for gastric cancer and find the potential risk factors.Methods:From5,2002-5,2012, a total of792patients who had undergone a prospective follow-up protocol were studied. Among of them, there were47cases with liver metastases of postoperative gastric cancer,745cases with no liver metastasis.The association between clinicopathologic variables and hepatic recurrence was investigated using standard univariate methods and multivariate logistic regression analysis.Results:①The frequency of hepatic metastasis of gastric carcinoma is5.9%(47out of792).②In many clinical pathology factors, the result of single factor analysis of variance to clinical pathology data showed that gastric cancer hepatic metastasis correlated with Borrmann’s classification(X2=11.2, P=0.019), depth of infiltration (X2=4,P=0.042), peritoneal invasion (X2=7.7,P=0.028), canals haemalis infiltration (X2=20.4,P=0.000), and lymph node metastases(X2=13.9,P-0.000).③By logistic multivariate regression analysis, independent risk factors for liver recurrence included depth of infiltration (OR=3.657, P=0.022), canalis haemalis infiltration (OR=8.975,P=0.000) and lymph node metastasis(OR=6.752,P=0.000).Conclusion:①Borrmann’s classification, depth of infiltration, peritoneal invasion, canalis haemalis infiltration and lymph node transfusion are risk factors for liver metastases from gastric cancer.②Depth of infiltration, canalis haemalis infiltration and lymph node involvement may be useful for an early diagnosis of hepatic recurrence with gastric cancer during follow up. Chapter2Multivariate analysis of immunohistochemical Indicators of liver metastases with gastric cancerObjective:To detect a number of immunohistochemistry indicators of gastric cancer and explore the relationship between the various indicators and liver metastases of gastric cancer.Methods:The expression of CEA, MVD, C-met, MMP, COX-2, VEGF, E-cad and AFP was detected in80cases of gastric cancer by the immunohistochemistry (SP method).The relationship between the indicators and liver metastases of gastric cancer was analyzed using X2test, respectively. Logiatic regression multivariate analysis was performed.Results:①There was a significant difference expression of the five immuno histochemistry indicators including CEA, MMP, VEGF, E-cad and AFP in the liver metastasis group and the group without hepatic metastases (P<0.05); while, the expression of MVD, C-met and COX-2in the two groups had no significant difference (P>0.05).②Logiatic regression multivariate analysis showed that only three indicators such as CEA, VEGF, E-cad entered model equations, and had significantly correlation to liver metastasis with gastric cancer71.8%(r2=0.718).Conclusion:①CEA,MVD,MMP,VEGF and E-cad are related to liver metastases of gastric cancer.CEA, VEGF, E-cad can be combined used for predicting the liver metastases of gastric cancer effectively.②MVD,C-met,MMP,COX-2and AFP are not suitable as a prediction of liver metastases of gastric cancer. Chapter3Significance of associate detection of mRNA expression of CEA, VEGF and E-cad in the liver metastases of gastric cancerObjective:To increase the rate of surgical resection, early forecasting and diagnosis in liver metastases gastric cancer is especially necessary.On the basis of the above study, further discuss the relationship between the mRNA expression of CEA, VEGF and E-cad and postoperative gastric cancer liver metastases, as well as to evaluate the role in forecasting gastric caner liver metastases and the feasibility of clinical application.Methods:The mRNA expression of CEA, VEGF and E-cad were detected in280cases of patients with gastric cancer tumor samples by the method of RT-PCR,CEA/VEGF/E-cad was selected for index in forecasting the gastric cancer liver metastases,using single-index method,parallel testing and Test Series were used to evaluate the diagnostic test.Results:①280patients with gastric cancer who have routine surgery,in accordance with the diagnostic standard after three years, there were39cases of liver metastases(13.9%).②The mRNA expression of CEA were positive in230cases, VEGF,208cases,and E-cad,192cases.③As the single indicator to forecast liver metastases of gastric cancer, the sensitivity of CEA was100%and specificity was20.7%.The sensitivity of VEGF was92.1%and specificity was28.6%.The sensitivity of of E-cad was87.1%and specificity was37.4%.④Combined the above three indicators as paralleled parameters, the sensitivity to forecast liver metastases of gastric cancer was100%and specificity was9.13%.If the indicators were used for series test in the diagnosis, the sensitivity was89.7%and specificity was88.3%.Conclusion:①AS single indicator for forecasting liver metastases of gastric cancer postoperatively, the sensitivity and specificity of CEA, VEGF and E-cad was100%and20.7%,92.1%and28.6%,87.1%and37.4%respectively.②Combined the three indexes of in parallel experiments, the sensitivity and specificity were100%and9.13%.③In series test combined the three indexes, the sensitivity and specificity were much higher (89.7%and88.3%). |
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