The Correlation Analysis Of Risk Factor In Hepatic Metastasis Of Gastric Carcinoma

Objective: China has a high incidence of gastrointestinal cancer. Despite of thedecreasing incidence of gastric cancer all over the world, we still have the highestincidence in China. Hepatic metastasis is the main factor that leads to unfavorableprognosis, as well as the late mortality of gastric cancer. Moreover, as early diagnosis isdifficult, most of patients are in their late phase when being diagnosed. How to forecastin the early stage and diagnose the possibility of metastases become crucial points toimprove life quality and prolong survival time for the gastric cancer patients. Theprogram is conducted to make a correlation analysis between hepatic metastasis andother clinicopathological feature for the purpose of early prediction and detection ofhepatic metastasis in gastric cancer.Methods: Clinicopathological information and following-up data of232patientswith gastric cancer, admitted between2006and2008in oncology department of the1stAffiliate Hospital of Dalian Medical University, are retrospectively analysed for thecorrelation with hepatic metastasis. Candidate risk factors for hepatic metastasisinclude: gender, age, primary tumor location, general type, primary tumor size,infiltration depth, vascular invasion, lymph node metastasis, histological type,histological grade, serum CEA value, tumor TNM stage (AJCC2010, the seventhedition).All the objectives are from36to79years old among which there are168malepatients and64female patients. The tumor-location of these objectives is four parts:cardia and fundus, gastric body, antrum and pylorus, full stomach, and there are33,83,113and3cases respectively. For the general type, there are220cases of infiltratingulcer type and12cases of protruded type. The size of tumor is from0.5cm and11.0cm.The tumor TNM stage and the histological type are based on the AJCC(2010, theseventh edition) and WHO(2000) recommend criteria for clinical as well as pathologicalclassification. The histological type is165cases of adenocarcinoma and67cases of others (including gastric signet ring cell carcinoma, mucous cell carcinoma and themixed pathological type). Histological grade is divided into64cases of highly andmoderately differentiated and101cases of low and non-differentiated, those who aremixed-differentiated are considered as low level classification. The results of serumCEA are from patients`first visit inspection results, above normal ones is defined asmore than3.4ng/ml,74cases and below normal ones is less than3.4ng/ml,158cases.Statistical analysis are carried out by SPSS software(version17.0for window), thecorrelation analysis between hepatic metastasis and the clinicopathological factors areexamined by χ~2test in univariable analysis; survival analysis are conducted byKaplan-Meier curves; Cox proportional hazards methods are employed to calculaterelative risk accounting for covariates, p<0.05is considered statistically significance.Results: For the single factor analysis, there are close relationships betweenhepatic metastases and following clinicopathological features: tumor size (χ~2=47.458,P=0.017), histological type (χ~2=4.158, P=0.042), infiltration depth (χ~2=27.672,P=0.000), lymph node metastasis (χ~2=31.881，P=0.000), vascular invasion (χ~2=24.757,P=0.000),tumor TNM stage (χ~2=40.884，P=0.000), and serum CEA value (χ~2=21.819,P=0.000). However, no relationships are showed between hepatic metastasis and factorssuch as age (χ~2=43.618, P=0.135), gender (χ~2=0.539, P=0.595), primary tumor location(χ~2=1.459, P=0.676), general type (χ~2=0.067, P=0.795) and histological grade(χ~2=2.537, P=0.111); multiple factor analysis demonstrate that vascular invasion, lymphnode metastasis, tumor TNM stage and serum CEA value are the independent riskfactors for hepatic metastasis; survival analysis by Kaplan-Meier curve shows that thePFS of patients with CEA above normal value is significantly shorter than that withnormal level（χ~2=9.998, P=0.002）.Conclusion: There are close relationships between hepatic metastasis and tumorsize, histological type, lymph node metastasis, infiltration depth, vascular invasion,tumor TNM stage, among which lymph node metastasis, vascular invasion, tumor TNMstage and serum CEA value are the independent risk factors of hepatic metastasis forgastric cancers. Serum CEA value is an advert factor for the survival of the gastriccarcinoma.