The Precautionary Effect Of Precancerous Leisions And Expressions Of Multigene On Gastric Carcinogenensis

BACKGROUND Periodical and regular follow-up by gastroscopy is the best modality for ealier diangnosis of GC. As there are no enough patients with GC who were diagnosed after screening and long-period follow-up, and the conclusions came from kinds of researches on GC are different. So we don't know well about the natural progress of GC, and there is long time to go we can treat GC better.OBHECT To elucidated the precautionary effects of gastroscopic image and gastric mucosal lesions on GC diagnosis, and to understand the progressive rule of GC, and last to estimate a carcinogenesis mould of expressions of p53, smad4, VEGF-C and PD-ECGF.METHODS The data of 156 patients who suffered from GC are reviewed by self-control and case-control, and the patients include 73 diagnosed by open access gastroscopy and 83 patients diagnosed by follow-up gastroscopy. We also measured the expression of Ki-67, P53, Smad4, PD-ECGF, VEGF-C, and CD34 by immunohistochemical staining. The estimated Weibull regression model was used to identify carcinogenesis factors for GC.RESULTS The rate of EGC that diagnosed in follow-up population during the follow-up period was higher than the outpatient population (75.90% VS. 36.99%, p<0.01), and the patients with asymptomatic EGC in follow-up group were higher than the outpatient group too. The stage when the GC was diagnosed wasn't correlated with total follow-up time and total gastroscopy times, but was correlated with the mean gastroscopy time and the last interval gastroscopy time and the last interval biopsy time. Especially, the last biopsy time was the most important factor that canimprove the diagnostic stage of GC. The degree of differentiation of GC was correlated with the soakage of carcinoma, the progressive trend is more soakage lower differentiation (ρ_s= 0.6152, p=0.0000). Perimeter~2/ area can be used as a parameter to measure the lesion of stomach. The perimeter /area was different in normal and precancerous lesion and carcinoma; it is 20.37, 29.33, 41.76 respectively. What perimeter~2/area is 24.35 can been used a criteria to distinguish the character of lesion. The important gastric mucosal lesions and pathology of carcinogenesis were polyp, serrated erosion, heavy intestinal metaplasia, dysplasia. The carcinogeneis mould was estimated by Logestic regression, that is: Logit P' = 2.6201 IM+ 0.8086 dyspalsia + 1.4317 polyp - 0.7879. The outcomes of EGC therapy by gastroscopic measure are same with surgery. There are obvious different expression of Ki-67 and CD34 and their regulators between precancerous lesion and carcinoma. PI and MVD increased from 51.19% to 75.64% and 130 to 166, respecticely; expression of p53 and PD-ECGF and ECGF-C increased from 58.33% to 79.49%, 33.33% to 79.49% and 51.19% to 75.64%, respectively; and expression of Smad4 decreased form 97.02% to 60.51%. The proportion of 5-year and 10-year gastric carcinoma diagnosed in high PI population was 47.58% and 68.11% respectively, and in the high MVD population the rate was 30.77% and 50.68% also. 5-year and 10-year incidence of gastric carcinoma in positive P53 population was 40.77% and 62.97%, and in VEGF-C and PD-ECGF positive population the rate was 51.56%, 74.00% and 67.35%, 82.42%, respectively. In abnormal Smad4 population the rate was 60.29% and 72.49%. Multivariate analysis demonstrated that p53, Smad4, VEGF-C and PD-ECGF were the independent carcinogensis factor of gastric carcinoma. The carcinogenic regression mould estimated by Weibull regression mould was that: λ (t)=exp(4.1651-0.5178 PD-ECGF-0.4815 PS3 -0.6981 VEGF-C+0.8816 Smad4) CONCLUSIONS Gastroscope is a best stool for screening and follow-up...