Family History And Clinical Pathological Features Of Primary Gastric Cardial Adenocarcinoma Have An Influence On Survival

1 Background and PurposeGastric cardia adenocarcinoma (GCA) is one of the most common malignancies that seriously threat to human life and health in northern China. The predominant epidemiological characteristic of GCA is its consistent geographic occurrence with esophageal cancer (EC). Especially the Taihang mountain regions at the junction of Henan, Hebei and Shanxi provinces, one high incidence area for EC, with higher occurrence and death ratio. Due to the concealed anatomy location, symptom-free in early stage, detection ratio below 10%, which result in poor prognosis. As report, not only The incidence of GCA is increasing dramatically in domestic and overseas, but also it take up great majority in gastric cancer. Clinically,5-year survival rate is more than 90% in patients with early GCA; in contrast, less than 10% in middle and later GCA, so it is very important to discover in early stage and screen for high-risk groups, which can reduce death rate. GCA factors not only include family history, but also connected with age, gender, high and low incidence area, obesity, drinking, smoking, nervous, lack of exercise, etc. The other significant epidemiological characteristic of GCA is apparent familial aggregation. Family history (FH), as an important inherit factor for GCA, yet research on its influence on lifetime is largely unknown.By means of inquiry on a large-scale GCA patients whether with FH or not, checked on clinical pathological data, follow-up on lifetime, analyze its incidence features, make sure that family history is one influence factor of prognosis.2 Object and Methods11,665 patients with GCA between 1972 and 2013 sum to 40 years involved in this research, who came from several hospitals at the junction of Henan, Hebei and Shanxi provinces, large-scale questionnaire survey and follow-up in spot. GCA patients with family history were enrolled in this study after strict check. Of the 11,665 cases, there were 9,080 males,2,085 females, maximum age 89, minimum age23, mean diagnosis age 60.59±8.977, medium age60, the ratio of male and female is 3:1. All the patients were confirmed GCA by pathology, have detailed common clinical data such as name, gender, onset day, nationality, date of birth, home address, telephone number, confirmed date, treatment hospital, treatment time, follow-up date, family history, survival situation, etc. pathology date such as tumor location, tumor diameter, tumor differentiation degree, tumor infiltration depth, tumor gross classification, lymph node metastasis, TNM stages, etc. follow-up was conducted mainly by telephone, the rest was conducted by interview face to face. The last time follow-up in OCT,2014. Death and relocate as the termination incident. Follow-up rate is 70.6%.All the data were analyzed by SPSS19.0 software. Described by frequency and analyzed by Chi-square tests, Kaplan-meier survival curve was adopted to evaluate the survival and prognosis, prominent test standard:α=0.05, P<0.05 makes statistics sense.3 Results3.1 11,665 cases of clinical and pathological features of patients with GCA3.1.1 11,665 cases of patients with GCA in general distributionMales patients with GCA more than women (77.8%> 22.2%), onset age 51-70 groups is the main (37.3%), followed by the 61-70 age group (33.9%), constitute ratio of patients with GCA in high incidence area is higher than the low-incidence area (89.4%> 10.6%), the positive rate of patients with FH is 29.1%, death constitute ratio is 34.15%, survival constitute ratio is 65.9%.3.1.2 11,665 cases of pathological features of patients with GCA distributionDiseased parts to cardia are more common (95.5%) to GCA, tumor types are generally dominated by ulcer (84.6%), followed by nodular fungating (11.4%), diffuse infiltrative least (0.6%); tumor differentiation are dominated by poor differentiation (48.5%), followed by medium differentiation (27.0%), undifferentiated least (0.5%); the degree of tumor infiltration mainly T2 (70.4%), followed by T1+T2 (21.1%), T4 least (8.5%); middle and advanced stage is more common (95.9%) to clinical stage, patients with lymph node metastasis rate (59.0%).3.2 11,665 cases of GCA patients with positive and negative FH pathological features distributionAccording to whether with FH, the GCA patients with FH were divided into positive and negative patients, compared and analyzed the two groups show:The main age of onset in GCA patients with positive FH between 51-60 years, patients with negative FH between 41-70 years (32.2% vs72.8%,χ2=61.890, P<0.05), age of onset in patients with positive FH earlier than patients with negative FH; the high- incidence of FH positive rate is higher than the low-incidence area (30.9% vs20.81%,χ2=90.850, P<0.05); differentiation of positive FH mainly high medium division, while differentiation of negative FH poor (35.9% vs71.2%, χ2=21.056, P<0.05); the degree of differentiation of positive FH higher than negative one; positive FH is mainly serous infiltration, while the negative is mainly muscular (38.6% vs72.0%,χ2=40.819, P <0.05); the lymph node metastasis rate of positive FH lower than negative one (28.8% vs71.2%, χ2=40.819, P<0.05); positive FH of early cancer cases more than the negative one(40.3% vs70.2%, χ2=40.819, P<0.05)3.3 GCA patients with positive and negative FH in high and low incidence areas pathological features distribution3.3.1 10,412 cases of GCA patients with positive and negative FH in high incidence area pathological features distribution In high incidence area, age of onset in patients with positive FH earlier than negative one (χ2=52.067, P<0.05); major differentiation of positive patients with positive FH higher than negative one (χ2=21.056, P<0.05); the degree of lymph node metastasis patients with positive FH lower than negative one (30.8% vs34.4%, χ2= 1.379, P<0.05); positive FH of early cancer cases more than the negative one (42.2% vs32.1%,χ2=10.829, P<0.05).3.3.2 1,239 cases of GCA patients with positive and negative FH in low incidence area pathological features distributionIn low incidence area, positive FH is mainly serous infiltration, while the negative one mainly in the sub mucosa (31.8% vs77.7%, χ2=7.646, P<0.05); the proportion of positive FH of early cancer is more than negative one (30.4% vs79.5%,χ2=2.632, P <0.05).3.4 GCA patients with positive and negative FH pathological features gender distribution3.4.1 9,080 cases of GCA male patients with positive and negative FH pathological features gender distributionThe positive FH of male mainly onset below 50, while negative FH primarily occurs above 70 years (32.8% vs77.1%,χ2=55.653, P<0.05); positive FH is mainly in the sub mucosa, while the negative one mainly serous infiltration (38.2% vs65.6%, χ2= 38.328, P<0.05); differentiation of positive FH mainly high medium division, while differentiation of negative FH poor (42.2% vs70.6%,χ2=11.628, P<0.05); the lymph node metastasis rate of positive FH lower than negative one (28.4% vs31.3%,χ2= 5.419, P<0.05); the proportion of positive FH of early cancer higher than negative one (40.5% vs29.3%,χ2=12.460, P<0.05); rate of positive FH in high incidence area rate higher than negative FH (30.6% vs20.2%,χ2=71.817, P<0.05).3.4.2 2,585 cases of GCA female patients with positive and negative FH pathological features gender distributionPositive FH of women mainly occur between 51-60 years old, while negative FH mainly occur more than 70 years old (33.7% vs66.3%,χ2=9.751, P<0.05); the main differentiation degree of positive FH higher than negative FH (57.1% vs73.0%,χ2= 9.751, P<0.05); rate of positive FH in high incidence area higher than low incidence area (31.7% vs19.8%,χ2=17.539, P<0.05).3.5 11,665 cases of GCA survival related factors analysisWith or without FH is an independent risk factor associated with survival. positive and negative FH median survival respectively were 168 and 96 months, Log Rank test χ2=34.171, P<0.05; in the high and low incidence area stratified analysis, the survival of patients with a positive FH higher than negative FH in high incidence area, median survival times respectively were 177 and 98 months, Log Rank test χ2=33.595, P <0.05; in the gender stratified analysis, the survival of female patients with positive FH longer than male, median survival time respectively were 177 and 98 months, Log Rank test χ2=10.419, P<0.05; the higher the degree of differentiation of tumor, the longer survival in patients with positive FH, Log Rank test χ2=7.498, P<0.05; the more superficial tumor infiltration, the longer survival in patients with positive FH, Log Rank test χ2=37.307, P<0.05; survival of patients with positive FH no lymph node metastasis longer, Log Rank test χ2=78.578, P<0.05; degree of tumor differentiation, tumor infiltration depth, the extent of lymph node metastasis in patients with a positive FH of GCA are independent factors associated with survival.4. Conclusion4.1 Patients in high-incidence areas got the high rate of FH(+),which indicates the patients there get the high genetic susceptibility.4.2 FH(+) may be one of the reasons that the patients got the disease in earlier age, and also may be the protective factor of the patients with cardia cancer.4.3 Tumor of the patients who got the FH(+) is likely to be high-and-middle differentiation, in early stage, low rate of lymph node metastasis, which may be due to they paid more attention to themselves.4.4 Family history is one of the important factors of cardia cancer and the FH(-) got the poor prognosis.4.5 Gender, high and low incidence areas, differentiation, infiltration, lymph node metastasis are the independence of cardia cancer prognosis related factors.