Clinicopathological Features And Prognosis Of Patients With Esophageal Squamous Cell Carcinoma In Northwest Hubei Province

Background:Esophageal cancer(EC)is considered to be one of the most common malignant tumors in the worl,the third in incidence and sixth in mortality among digestive system tumors.Among them,esophageal squamous cell carcinoma(ESCC)is the most common pathological type.ESCC has the highest incidence in my country,with a fatality rate of more than 90%.It has a strong invasiveness.It is usually advanced and has a poor prognosis with an extremely low five-year survival rate.Esophageal cancer has obvious regional characteristics,among which the incidence of esophageal cancer in the northwest of Hubei Province ranks high;There are few studies on the situation.Objective:This article will summarize and analyze the clinical data of 203 ESCC patients who have been treated in three tertiary hospitals in northwest Hubei,with the purpose of exploring the incidence of ESCC in northwest Hubei,clarifying the clinicopathological characteristics of ESCC in northwest Hubei,and by immunohistochemistry Methods The expression levels of MMP-9 and CD44 in ESCC tissues were detected,and their differences in ESCC tissues and adjacent tissues were compared,so that they could be used as biological detection indicators for patients with esophageal cancer and provide reference for clinical diagnosis,treatment and prognosis.Methods:①A retrospective analysis of the total number of patients diagnosed in Shiyan People’s Hospital(73 cases),Sinopagic Dongfeng General Hospital(49 cases)and Taihe Hospital of Shiyan city(81 cases)from 2013-1-1 to 2017-12-30 General and clinicopathological information of 203 ESCC patients.It included the patient’s gender,age at diagnosis,tumor differentiation,long diameter,tumor location,TNM stage,gross type,lymph node metastasis,and postoperative atypical hyperplasia at the surgical margin,etc.Relationship between ESCC living states.②The clinical data required in this study were obtained from the medical records of inpatients provided by the attending hospitals,and the squamous cell carcinoma was diagnosed by pathologic microscopy.③Immunohistochemistry was used to detect the expression of MMP-9 CD44 protein in 60 cases of ESCC pathological tissue specimens,and the correlation between MMP-9、CD44 protein and clinicopathological features was compared to analyze the impact of MMP-9、CD44 protein on the survival status of ESCC patients.④Statistical data were analyzed by SPSS 25.0 software,chi-square test was used for comparison of enumeration data,and Spearman was used to analyze the correlation of two protein expressions.In survival analysis,univariate Log-rank test was used to establish a multivariate regression model.The inspection level is α=0.05.Results:1.Among the 203 ESCC patients included in this study,131 were male and 72 were female(64.5%vs.35.5%);133(65.5%)were≥60 years old,and 70(34.5%)were<60 years old),85 cases(41.9%)were moderately differentiated,77 cases(37.9%)were well differentiated,128 cases(63.0%)had tumor diameters>3 cm,75 cases(37.0%)had tumor diameters≤3cm.;158 cases(77.8%),45 cases(22.2%)in the cervical segment and upper thoracic segment;151 cases(74.4%)and 34 cases(16.7%)of ulcerative,medullary,constrictive and fungal esophageal cancers,respectively,7 cases(3.5%),11 cases(5.4%);the positive rate of lymph node metastasis was 31.0%,124 cases(61.1%)had clean resection margins,and 79 cases(38.9%)had unclean resection margins.2.ESCC patients in northwestern Hubei,male,diagnosed age≥60 years old,cervical esophagus and upper thoracic segment,poorly differentiated,tumor diameter>3 cm,stage Ⅲ+Ⅳ,and lymph node metastasis have a shorter survival time(P<0.001).3.Gender,age at diagnosis,predilection site,degree of differentiation,tumor diameter,TNM stage,and lymphatic metastasis were independent prognostic factors for ESCC patients in northwestern Hubei(P<0.05).4.MMP-9 and CD44 proteins were expressed in cytoplasm in ESCC and normal esophageal squamous epithelium.5.The expression of MMP-9 protein in ESCC tissue was higher than that in peritumoral tissue,and the difference was statistically significant(P<0.05).6.The expression of CD44 protein in ESCC tissue was higher than that in peritumoral tissue,and the difference was statistically significant(P<0.05).7.The positive rate in esophageal cancer tissue of natients with high expression of MMP-9 and CD44 was significantly higher than that of patients with low expression and no expression,and the difference was statistically significant(P<0.05).8.There was a positive correlation between MMP-9 and CD44 protein expression in ESCC patients(rs=0.613,P=0.003).9.The MMP-9 and CD44 negative survival time of ESCC patients was better than that of positive patients.The expression of MMP-9 and CD44 protein was the influencing factor of their prognosis,and the difference was statistically significant(P<0.05).Conclusions:①The incidence and detection rate of ESCC are high in the northwest of Hubei province.They are more common in middle-aged and elderly men,and they usually occur in the middle and lower esophagus,mainly in the middle and low grades.The long diameter of the tumor is more than 3cm.The majority of patients are ulcerative,the general type is ulcerative,the postoperative lymphatic metastasis rate is high,the postoperative margin is clean and common,and the prognosis is poor.②Gender,age,degree of differentiation,tumor diameter,TNM stage,predilection site and lymph node metastasis were independent prognostic factors of ESCC patients in northwestern Hubei.③The high expression of MMP-9 in ESCC is related to tumor differentiation,stage and lymphatic metastasis;the high expression of CD44 in ESCC is related to tumor stage and lymphatic metastasis.ESCC patients with high expression of MMP-9 and CD44 proteins have poor prognosis.