Relationship Between Subtypes Of Cardia Intestinal Metaplasia And Gastric Cardia Adenocarcinoma

Objective: To identify the relationship between subtypes of cardia intestinal metaplasia and gastric cardia adenocarcinoma by analyzing the expression of Ki67, das-1 and TFF3 proteins in subtypes of cardia intestinal metaplasia and cardia lesions at all levels.Methods: One hundred and seventy cases of cardia tissues by gastroscope and carida cancer tissues by surgery were collected in Linzhou area of Henan province. immunohistochemical S-P method has been employed to examine the expression of Ki67, das-1 and TFF3 proteins in 25 gastric cardia hilitis, 15 intestinal metaplasia without cancer, 65 intestinal metaplasia adjacent cancer 65 gastric cardia adenocarcinoma issue specimens. Eighty intestinal metaplasia issue specimens were typed by the Mucus staining method. The relationship between subtypes of cardia intestinal metaplasia and gastric cardia adenocarcinoma was analyzed by SPSS soft.Results: The positive rates of Ki67 protein in gastric cardia hilitis, intestinal metaplasia, and carcinoma tissues were 16.0%, 43.8%, and 53.8%, respectively. Statistical analysis using chi-square showed the expression level of Ki67 protein was different and correlated well with the pathological grading of the lesions (r=0.436, P<0.05). Eighty cases of gastric cardia intestinal metaplasia were classified three types by mucosal staining. The proportion of typeⅢIM was significantly higher for IM foci in tissues adjacent to GCA (55.4%) than in gastric cardia biopsy tissues with IM from the outpatient (13.3%) (P<0.01). The positive rates of DAS-1 protein and TFF3 protein in gastric cardia hilitis, intestinal metaplasia, and carcinoma tissues were 0%, 38.8%, 53.8%, and 24%, 65%, 53.8% respectively. Statistical analysis using chi-square showed the expression level of DAS-1 protein was different and correlated well with the pathological grading of the lesions (r=0.572, P<0.05). For TFF3 protein, statistical significance of the positive rates was showed only between cardia hilitis and intestinal metaplasia(χ2=34.031, P<0.05). Among three types of intestinal metaplasia, The positive rates of DAS-1 and TFF3 were 0%, 17.4%, 71.1% and 68.4%, 78.4%, 55.3% respectively. The positive rates of DAS-1 in IM increased gradually from typeⅠto typeⅢ(χ2=110.078,P<0.01), and TFF3 protein expression was not statistically significant(χ2=12.033, P>0.05). In the cardia inflammation and intestinal metaplasia tissues, TFF3 protein was mainly expressed striated border in columnar cells while Intestinal metaplasia with dysplasia and cancerous tissue, mainly expressed in the cytoplasm. The location of TFF3 expression correlated with the pathological types (Kappa=0.490).Conclusion: It is cardia intestinal metaplasia that prompted the course of carcinoma. It is because that the position rates of Ki67 protein in gastric cardia hilitis, intestinal metaplasia and cancerous tissue increased gradually, which indicated that the ability of cell differentiation reduced gradually with the histological changes gradually. Expression difference of Das-1 protein in the levels of gastric cardia tissues was involved in gastric cardia carcinogenesis and it could potentially become the important risk factors in detecting GCA. Furthermore, The typeⅢIM with over-expression of DAS-1 is closely related to GCA, which could potentially become one of important precancerous lesions for GCA at the high-incidence areas in Henan province. The transition in the location of TFF3 expression showed that the double role of TFF3 depends on its different expression location.