| Background: Gastric cancer is one of the most common tumors in the whole world.There were significant differences in the biological behavior and prognosis of gastric cancer with different clinicopathologic features.The TNM staging system is of certain significance to measure the condition and judge the prognosis.However,the value of Lauren classification in evaluating the prognosis of patients after radical gastrectomy is not clear.This study was to investigate the clinical value of Lauren classification in prognosis evaluation with retrospectively analyzing survival of patients with gastric cancer after radical surgery in terms of Lauren type and the other clinical pathological characteristics.Although precision medicine continues to expand in clinical practice,the prognosis of patients with diffuse-type gastric cancer remains relatively poor in the absence of prognostic biomarkers.Previous studies have reported that miRNA were closely in many biological processes including cell differentiation,cell growth,cell apoptosis and metastasis in gastric cancer.The dysregulation of miRNAs has been reported in different kind of gastric cancer.This also makes the abnormal expression of miRNA in the prognosis of GC with different Lauren classification.Part One: Clinicopathological characteristics and prognosis of Lauren classification in patients with of gastric cancerMethods: From January 2005 to December 2011,1144 patients who came from the first affiliated hospital of Nanjing Medical University and underwent radical surgical treatment with identified pathologically as gastric cancer were recruited into this retrospective study.All complete clinical and following-up data was available.A total of 13 clinicopathologic parameters were analyzed including Lauren classification gender,age,tumor location,tumor diameter,macroscopic appearance,pathology, histological grade,depth of the primary tumor invasion,number of metastatic lymph nodes,metastatic lymph nodes ratio,status of lymphovascular and vessel invasion,TNM stage.The whole patients were divided into diffuse,intestinal and mixed type according to Lauren classification.The chi-square test was applied to analyze correlation between Lauren type and other clinicopathologic parameters.Univariate and multivariate analysis were performed to evaluate prognosis value of Lauren classification and the other clinicopathologic characteristics.Results: 1.The rate of disease-free survival and 5-year survival was 59% and 66% respectively in this whole group.2.According to Lauren classification,there were 302(26.4%)cases of diffuse-type,436(38.1%)intestinal-type and 406(35.5%)mixed-type gastric cancers.Lauren classification relates to patients gender and age,as well as tumor location,macroscopic appearance,tumor diameter,pathology,histological grade,depth of the primary tumor invasion,number of metastatic lymph nodes,metastatic lymph nodes ratio,status of lymphovascular and vessel invasion,TNM stage(P<0.001).3.Univariate analysis showed that Lauren classification was significantly correlated with the disease-free survival time and total survival time of patients after radical gastrectomy,and the difference was statistically significant.The rate of 5-year disease-free survival for diffuse,intestinal and mixed type was 49%,67% and 47%,while the rate of 5-year survival was 51%,69% and 47%.Moreover,it revealed that age,tumor location,macroscopic appearance,tumor diameter,histological grade,depth of the primary tumor invasion,number of metastatic lymph nodes,ratio of metastatic lymph nodes,status of lymphovascular and vessel invasion,TNM stage were significantly correlated with prognosis of gastric cancer.4.In multivariate analysis,only Lauren classification,tumor diameter,depth of primary tumor invasion,ratio of metastatic lymph nodes and status of lymphovascular and vessel invasion are independent prognostic factors for patients with gastric cancer after radical surgery.Conclusions: Lauren classification has clinical significance in the evaluation prognosis of gastric cancer.Simultaneously,the prognosis of patients with intestinal-type may be better than that of patients with diffuse type and mixed type.Part Two: The research of micro RNAs in prognosis of gastric cancer with difference Lauren classificationMethods: From January 2005 to December 2011,145 gastric cancer patients who underwent D2 radical gastrectomy from the first affiliated hospital of Nanjing Medical University were enrolled into this study.According to the type,the object and purpose of this research,we conducted an appropriate inclusion and exclusion criteria.Through the computer we made a retrieval in the Pubmed databases from the time of the database construction to January 2017 in published relevant literature.The preliminarily screened miRNAs were obtained according to the literature results.We detected the difference of miRNA expression in gastric cancer tissues with difference Lauren classification by quantificational reverse transcription-PCR(q RT-PCR),and then explore the prognostic value of miRNA in different Lauren typing of gastric cancer.Results: 1.A total of 145 cases of gastric cancer were included in this study,including 47 cases of diffuse type(32.4%),50 cases of intestinal type(33.1%),and 48 cases of mixed type(34.5%).2.By searching Pub Med databases,65 related articles were initially retrieved,and a total of 22 miRNAs were preliminarily screened according to the literature results.In this study,we detected the relative expression levels of these 22 miRNAs in gastric cancer tissues with difference Lauren classification by q RT-PCR.The results showed that the expression of miR-141-3p and and miR-200b-3p in diffuse type was significantly lower than that in intestinal type,and the expression of miR-105-5p in diffuse type was also significantly lower than that in diffuse type and mixed type.Analysis using kaplan-meier survival curve(log-rank method)showed that only miR-141-3p had a certain prognostic value,the patients with low expression of miR-141-3p in tissues tended to suffer worse OS and DFS.In multivariate analysis,ratio of metastatic lymph nodes,Lauren classification and miR-141-3p were the independent prognostic factors.4.The result also shows that,patients with high expression of miR-141-3p had significant longer OS and DFS than those with low expression in diffuse type(P<0.05).Conclusions: We identified miR-141-3p in gastric cancer tissue which could serve as a biomarker in the prognosis of GC. |
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