| Part I The Study of Different Preoperative Chemotherapy on the Pathological Remission Rate and Ultrastructure for Siewert II and Ⅲ Type of Gastroesophageal Junction AdenocarcinomaPurpose:To observe the ultrastructural of different regimen of preoperative chemotherapy for adenocarcinoma of gastroesophageal junction and evaluation of two regimen in the preoperative treatment of the pros and cons.To discussion the preferred regimen in patients with denocarcinoma of gastroesophageal junction.Methods:There are 76 cases of patients with adenocarcinoma of the gastroesophageal junction were treated with preoperative therapy in our hospital.Randomly divided into the ECF regimen and TP Regimen group.for the ECF regimen,the program:Epirubicin:50mg/m2 iv D1,Cisplatin:60/m2 iv D1,5-Fu:500mg/m2 iv D1-5,24h.for the TP regimen,the program:Paclitaxel:50mg/m2 iv D1,Cisplatin:60/m2 iv Dl.Observe pathological changes and ultrastructural changes of tumor tissue after chemotherapy.Results: ①microscope observation:a total of 15 cases of patients with visible pathological remission, the total effective rate:19.7%,12 cases of grade 1, accounting for 15.8%,3 cases of grade 2, accounting for 3.9%; among them,8 cases of ECF chemotherapy group,7 cases of grade 1,accounting for 9.2%; 1 cases of grade 2,accounting for 1.3%; TP Chemotherapy group visible in 7 cases,5 cases of grade 1,accounting for 6.6%,2 cases of grade 2,accounting for 2.6%. TP group pathologic remission rate was higher than that of ECF Chemotherapy group, but between the two groups, there was no significant difference (χ2=0.028 P> 0.05). Two groups were not found of the grade 3. ②Electron microscopic observation:the structural changes of the cells after preoperative chemotherapy:Mainly,destroy the structure of cell membrane, mitochondria swelling and microvilli reduce, chromatin decreased or disappeared, the karyoplasmic ratio becomes small and so on. ECF scheme in karyoplasmic ratio smaller (χ2=4.278, P< 0.05) than TP for severe injury; TP Regimen in cell membrane integrity (χ2=4.588,P< 0.05), chromatin decreased or disappeared (x2=4.726, P< 0.05), swelling of mitochondria (x2=4.163, P< 0.05) aspects than ECF injury serious.③Electron microscope observation, a total of 35 patients to assess the cell damage, the total effective rate:46.1%, Among them,15 cases were seen in the ECF group, accounting for 35.7%; TP program group showed 20 cases, accounting for 58.8%,The damage degree of TP was higher than that of ECF in the two groups,there was no significant difference (x2=0.086, P> 0.05). ④Spearman correlation analysis between tumor regression grading and cell injury score:The correlation coefficient between the degree of pathological remission and the cell injury score was 0.533 (P <0.05).⑤Compared with the side effects of chemotherapy, the two groups were mainly grade I to grade II, and the patients could not be tolerated. The degree of cell damage was higher than that of ECF scheme with TP scheme.Conclusions:(1)Under the observation of the ultrastructure, the changes of the cell structure of the Siewert II and III type gastric esophageal junction adenocarcinoma after chemotherapy can be seen. The observation of electron microscope can be used as a means to evaluate the short-term curative effect of neoadjuvant chemotherapy. (2) From the observation of the ultrastructure, the two method is different in the tumor cell organ damage, considering the different targets of different chemotherapy drugs. (3) From the observation on the ultrastructure and TP Chemotherapy on tumor cell organelles damage strong in ECF chemotherapy, suggesting that the curative effect of TP Regimen may be strong to the ECF regimen, but the injury score differences can bring survival benefit remains to be confirmed by further follow-up after operation. (4)Under the light microscope, there were 15 cases of patients with visible pathological remission, and 35 cases were evaluated by electron microscope. The patients were evaluated by electron microscope, and the changes were more sensitive after chemotherapy.(5) Spearman correlation analysis showed positive correlation between tumor regression grading and cell injury score.(6) Regardless of the ECF regimen or is TP Regimen for a cycle of preoperative chemotherapy, showed no pathological cases of complete remission, and the ultrastructure of still visible split phase tumor cells,neoadjuvant therapy the best model needs to be further research.pPart Ⅱ The Clinical Observation of The Gastroesophageal Junction Adenocarcinoma on Ultrastructure after ChemoradiotherapyObjective:From the ultrastructural observation the changes of tumor cell for the gastroesophageal junction adenocarcinoma patients after preoperative radiotherapy and evaluate the efficacy of the preoperative radiotherapy on gastroesophageal junction adenocarcinoma,explore the damage of mechanism on preoperative radiotherapy of gastroesophageal junction adenocarcinoma.Methods:A total of 9 patients with adenocarcinoma of gastroesophageal junction were collected from January 2013 to December 2014. The patients were admitted to the Jiangsu Province Traditional Chinese Medicine Hospital. Based on CT inaging evaluation and endoscopic findings,can not achieve radical resection.After preoperative radiotherapy treatment,based on the RECIST solid tumor evaluation criteria, evaluation of preoperative radiotherapy efficacy,of the patients,for which to get the opportunity to surgery, take cancer tissue electron microscope observation of ultrastructural changes.Results:Preoperative radiotherapy, according to the RECIST solid tumor evaluation criteria,7 cases of patients with tumor regression, the effective rate was 77.8%. After the re evaluation,4 patients achieved the opportunity of surgery, according to the postoperative pathological results, in which 3 cases achieved RO resection, the total resection rate was33.3%,. Under the observation of the ultrastructure, the cell organ damage caused by preoperative radiotherapy and chemotherapy is more obvious, and even the destruction of the nuclear structure.4 ultrastructure were observed under radiotherapy target lymph node visible organelles necrosis, cracking, even unable to recognize and postoperative pathological results showed that radiotherapy after the transfer of lymph nodes were significantly reduced. The main side effects include radioactive dermatitis, bone marrow suppression, gastrointestinal toxicity and during radiotherapy, the patient can be tolerated.Conc(?)(1) this study suggests that preoperative radiotherapy is safe, and can make some patie(?) not be removed be radical resection. (2) the ultrastructural changes of tumor cells wer (?)under the ultrastructural changes, and the potential of the tumor cells was evaluated as a new adjuvant therapy. (3) under the observation of ultrastructure, the preoperative radiotherapy is more obvious than the chemotherapy to the cell damage, the cell nucleus destruction is obvious, and it is proved to have a bigger killing effect on tumor cells.Part Ⅲ Expression and Clinical Significance of SATB1 in Adenocarcinoma of the Gastroesophageal JunctionObjective:To determine the expression of SATB1 in the specimens of adenocarcinoma of the stomach and esophagus with the technique of immunohistochemistry staining.To assess the sensitivity of neoadjuvant chemotherapy and to evaluate the relationship between the expression of immunohistochemistry and the biological behavior of gastric cancer.Methods:The protein expression of SATB1 in 80 patients with adenocarcinoma of gastroesophageal junction were detected by SP immunohistochemical technique, and the results were analyzed by the correlation analysis with the pathological features of the adenocarcinoma of gastroesophageal junction.Results:The positive expression rates of SATB1 were 37.5%,and 22.5% between Tumor tissue and normal tissue.lymph node metastasis and T stage is the expression of SATB1 gene protein factors.The results indicated that the expression of SATB1 was related to the response after radiotherapy.Conclusion:The positive expression rates of SATB1 in gastric carcinoma was stronger than that in normal gastric mucosa.lymph node metastasis and T stage is positivly correlated with SATB1 protein expression,which can be used as an indicator of prognosis.There was no correlation between the expression of SATB1 protein and tumor regression grading and cell injury score.The expression of SATB1 was significantly higher than that before radiotherapy, and SATB1 might be related to the radiation tolerance of the gastric esophageal junction adenocarcinoma. |
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