| 1 Background and PurposesCardiac cancer(gastric Cardia adenocarcinoma, GCA) is a gastrointestinal cancers with poor prognosis. In northern China, especially in Taihang mountain in Henan, Shanxi, Shaanxi, and other border regions with high incidence. With its incidence is on the rise in recent years, cardiac adenocarcinoma as one of the serious diseases threatening human health as an important public health problem was everybody’s attention. Pathogenesis of cardiac cancer is currently unclear, diagnosis of lack of unified standards in the world, unable to make a definite diagnosis, their treatment and prognosis have been severely affected. In China, between esophageal cancer and Cardia cancer symptoms are very similar, most progressive dysphagia, swallowing pain as the main symptom and cardiac and esophageal cancers(esophageal squamous cell carcinoma,ESCC) high geographical distribution(China significant epidemiological characteristics of cardiac carcinoma) in obstruction of upper digestive tract of high incidence of esophageal cancer is in the form of tumors, esophageal cancer by about 60 per cent%, And the rest for cardiac cancer. Early years and no clear diagnosis of adenocarcinoma of the Cardia is often grouped with the esophagus. For Carcinoma of gastric Cardia adenocarcinoma and clinical stages and types of Cardia cancer with esophageal or gastric cancer standards. In Northern Europe and the United States and some other Western countries, Cardia adenocarcinoma tumors is grouped with the esophagogastric junction, causes many gastro-esophageal reflux disease from an epidemiological perspective, esophageal and Cardia cancer and stomach cancer are three in the pathology, etiology, clinical treatment of diseases in various ways, such as to distinguish between research and analysis. Study large samples of gastric Cardia cancer database for gastric Cardia carcinoma: a clinicopathologic study on statistics and other features, verified clinical cases of adenocarcinoma of the gastric Cardia gastric cancer staging and classification of science. Enacted in 2010 7 edition of TNM staging of esophageal cancer, United States Joint Committee on cancer staging(American Joint Committee on Cancer Staging,AJCC) and the International Union against cancer(Union for International Cancer Control, UICC), based on a large number of epidemiological and clinical data analysis concluded that, the differentiation of the tumor(Degree of Differentiation) with its invasion, lymph node metastasis, distant metastases were the main factors affecting the prognosis of the disease. Cardia tumor differentiation and TNM staging could be considered the same as a standard to determine the diagnosis, treatment, and prognosis of the disease.Purpose: 28370 cases diagnosed, details and living conditions and survival in patients with adenocarcinoma of the gastric Cardia basic situation analysis and pathological types and verify the degree of tumor differentiation and other relative factors and its effects on survival, investigate the differentiation in gastric Cardia adenocarcinoma treatment and prognostic importance. 2 materials and methods 2.1 the object of studyThis study, 28370 patients with adenocarcinoma of the gastric Cardia using information from esophageal cancer in Henan province key laboratory of information databases, sample time spans 1973 to 2013, all are clearly pathological diagnosis in patients with adenocarcinoma of the gastric Cardia adenocarcinoma of the Cardia. 2.53:1 per cent of patients with high/low risk areas, the average age of onset of 60.72 ± 8.882, median age is 61 years old, age range 20-95 years and the ratio of 3.6:1. 2.2 diagnostic criteria 2.2.1 standard high/low risk areasCardiac cancer in accordance with high incidence of esophageal cancer high in China, this study uses high and low incidence areas for esophageal cancer. Zoning standards use the epidemiology of esophageal cancer mortality rates more than fifty-one hundred thousandths areas of high incidence of esophageal cancer. For more details see Appendix a. 2.2.2 age of onsetAll income is found for this disease in patients with adenocarcinoma of the gastric Cardia was are first diagnosed. Age combined with laboratory data characteristics were divided into six groups: aged less than 40 years, 40-49, 50-59, 60-69, 70-79 years of age, ≥ 80 years old. 2.2.3 age onsetLab repository based on patient age patients with income information spans 40 years(1973 – 2013), divided into four groups: 1973-1983, 1984-1993, 1994-2003, 2004-2013. 2.2.4 differentiationTumor differentiation in tumor tissue and normal tissue in cardiac pathology report morphological and functional similarities. Depending on the cell morphology and structure of cardiac differentiation of adenocarcinoma is classified as follows: well differentiated(Well differentiated,G1), differentiation(Moderately differentiated, G2), poorly differentiated(Poorly differentiated, G3), anaplastic(Undifferentiated G4). 2.2.5 invasion, metastasis and metastasisInvasion refers to the primary tumor, the situation, with the primary tumor, increased in volume, to travel and organizational depth and adjacent tissues affected by violations. The infiltration into Tis, T1, T2, T3, T4. Divided into lymph node positive lymph node metastasis N1, node-negative metastasis N0. 2.3 data collection and documentation 2.3.1 data sources and collectionAll data comes from our lab in high and low incidence areas of mass population surveys. Field epidemiology questionnaire access to basic information and treatment for patients with hospitals. In all cases of patients with hospital-acquired information, carefully selected revenue database. 2.3.2 patient survival status follow-upClinical data have addresses and phone numbers of patients were followed up for a lifetime, follow-up methods such as household surveys, in collaboration with local hospitals to understand survival information, telephone follow-up. 2.3.3 patient documentationPatients were using Microsoft Office Excel2007 repositories and above all kinds of data entry, data processing, statistical analysis and decision support operations. 2.4 statistical analysis methodsAll materials are used in statistical analysis SPSS 21.0, quantitative data in statistical methods by frequency description and analysis of single factor analysis of variance data, qualitative information with the X2 test using K-M survival curves(Kaplan-Meier survival curves), univariate Log Rank test to assess survival. There was a significant factor in survival analysis Cox regression models to be British introduced(Cox’s proportional hazards regression model), inspection independent factor affecting the prognosis. Inspection level of α = 0.05. 3 the results 3.1 high/low incidence area of gastric Cardia adenocarcinoma differentiation characteristicsThe complete data in patients with adenocarcinoma of the gastric Cardia(n=28370) classified statistics. Number was significantly higher in patients with adenocarcinoma of the Cardia low risk areas. Mean age ± 8.882 60.72. Males number was significantly higher in patients with female patients, male: female =3.6:1. Later in the male than the female. Age 40 years as aging, older people scaled in progressively increasing youth groups gradually decreases. 3.2 degree of differentiation of high and low incidence areas for esophageal cancer in patients with adenocarcinoma of the gastric Cardia’s relationship with basic information28370 patients with adenocarcinoma of the gastric Cardia, display low incidence areas of tumor differentiation in patients with high risk areas well. Age group middle and old age groups(≥ 70 years) differentiation of young and middle-aged groups(< 50 years old) is poor, the obvious differences in male patients. For 40 years, deterioration of adenocarcinoma of the gastric Cardia tumor differentiation. Degree of differentiation of male patients than their female counterparts. Relationship between family history and degree of differentiation was not statistically significant. 3.2.1 the differentiation and invasion, tumor size relationshipsHigh or low degree of tumor differentiation was positively correlated with invasion of the superficial and deep, worse the degree of tumor differentiation, invasion deeper into(x 2=1883.287,P<0.001), low risk areas of differentiation and invasion in patients with relatively high incidence of obvious correlation. Average length of the tumor size was 5.50 ± 2.2cm, gets worse with differentiation of tumor size increased. High correlation between tumor size and differentiation of the lower zone. 3.2.2 relationship of differentiation and distant metastasis of lymph node metastasis andGets worse with differentiation, lymph node positive rate increased from differentiated to undifferentiated and 43.7% lymph node-positive rate gradually rises to 82.8%, high incidence of lymph node metastasis in patients with positive rate was low in patients with low risk areas. 16229 cases described there is distant metastasis, but positive for distant metastasis(M1) with only 120 cases accounted for 0.7%, no statistically significant quantity is too small. 3.2.3 the relationship between differentiation and tumor typeEarly differentiation of the best, followed by nodule mushroom umbrella, ulcerative and degree of differentiation of diffuse invasive poorly. 3.3 tumor heterogeneityIn the present laboratory study of esophageal and gastric Cardia carcinoma in distribution, often have the same tumor in patients with the same pathology found in two or more of the differentiation of conditions, often shown significant differences in cell morphology, histology at different levels. This situation is called tumor heterogeneity, that is the same tumor can exist in many different genotypes or subsets of cells, tumor heterogeneity is one of the characteristics of malignant tumor. 3.4 the survival rateIn this study patients with adenocarcinoma of the gastric Cardia, the five-year survival rate was 20%, median survival time of 3.97. 3.5 basic one-way analysis of survivalNo statistically significant difference in survival between patients with high and low incidence areas, the difference is not obvious. Onset age of onset age and survival were statistically significant.3.6 clinical survival analysis single factorDifferentiation, invasion, lymph node metastasis, tumor size, gross type has an effect on survival, statistically significant differences. Distant metastasis positive number is too small, no statistically significant effect on lifetime. 3.7 multivariate survival analysisSingle factor associated with cardiac cancer survival survival analysis results, age, time of onset, degree of differentiation, invasion, lymph node metastasis, tumor size and type of cardiac cancer prognosis. 4. conclusions1)high and low incidence areas for esophageal cancer and Cardia adenocarcinoma in high and low incidence areas of different pathological situations. Patients with histologic differentiation features and high and low prevalence area, gender, age, time of onset, degree of infiltration and lymph node metastases, tumor size and type has some relevance. Distant metastases number of positive cases was too small to statistics, particularly relevant to tumor sites no.2)high/low incidence area for esophageal cancer and Cardia adenocarcinoma cell differentiation is the survival of independent factors, poorer the prognosis of patients with poorer differentiation, and shorter lifetimes. |
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