Study Of Splenectomy And Biomarkers On The Survival Of Patients Underwent Radical Surgery For Adenocarcinoma Of The Esophagus And Esophagogastric Junction

Aims: In adenocarcinoma of the esophagus and esophagogastric junction, the spleen is usually removed when the tumor is resected. This allows thorough lymph node dissection in the splenic hilus. However, the effect of splenectomy on patient survival is controversial. To study the influence of splenectomy and biomarkers on patients, survival, this study gives insight into the effect of splenectomy in radical surgery for adenocarcinoma of the esophagus and esophagogastric junction, at the same time, we study the effect of biomarkers expression on tumor tissue。Methods: We reviewed the records of 348 patients who underwent radical resection for adenocarcinoma of the esophagus and esophagogastric junction. Of these 348 patients, 105 underwent splenectomy and 243 had splenic preservation. The clinicopathologic features of 105 patients underwent gastrectomy combined with resection of the spleen(splenectomy group) and 243 patients underwent gastrectomy(spleen-preservation group) were compared. We used immunohistochemical method to detect 348 cases of tumor tissues and normal tissue adjacent to carcinoma of VEGF MMP-9, E-cadherin expression.Results:1. The 5-year survival of splenectomy group was 20.8% as compared with 30.5% for spleen-preservation group.2. With respect to patients with splenectomy and splenic preservation, multivariate analysis showed that lymph node metastasis and serosal invasion were significant factors affecting surviva(P<0.01), but splenectomy was not an independent prognostic factor(P=0.206).3. Positive rate of VEGF、MMP-9 and E-cadherin were 57.31%、60.25% and 21.23%, respectively. Rate of each protein expression in normal tissue adjacent to carcinoma rate were11.41%、13.24% and 51.74%. There was different significance between tumor tissue and normal tissue adjacent to carcinoma.4. VEGF、MMP-9 and E-cadherin were associated with lymph node metastasis and serosal invasion(P<0.05).5. If the expression of VEGF and MMP-9 were higher, the five-years survival rate of patients was lower(P=0.012, 0.015). Conversely, if the expression of E-cadherin was higher, the five-years survival rate was higher(P=0.006)6. VEGF was positively related with MMP-9(r = 1.357, P < 0.05), and negatively correlated with E-cadherin(r = 3.241, P < 0.05), MMP-9 was negatively correlated with E-cadherin(r = 2.563, P < 2.563).Conclusions:1. Splenectomy was not suitable for all types of cardia cancer patients, it was more suitable for patients that was serosal invasion and positive lymph node metastasis. Serosal invasion and lymph node metastasis were important prognostic factors in patients with cardia cancer, and splenectomy is not independent prognostic factor in patients with cardia cancer.2. The expression of VEGF, MMP-7 and E-cadherin plays an impormant role in the biological behavior of gastric cancers. They could be the objective factor to predict the prognosis of gastric cardia cancers.