| BackgroundIt was well known that esophageal cancer was one of the most common malignant tumors,and ranked eighth for cancer incidence and sixth for cancer death around the world.Esophageal squamous cell carcinoma(ESCC)has been identified to be the most common pathologic type(more than 90%)until now in China.However,primary esophageal adenocarcinoma(PEAC)has been dignosed in western countries(more than 80%).The studies of PEAC mostly come from the western countries,and PEAC incidence is low in China,and almost no large sample research reports it.Nevertheless,the clinicalpathological characteristics and factors affecting the prognosis of PEAC has been unclear,and the clinicalpathological characteristics and prognosis of PEAC risk factor of PEAC has important significance for early diagnosis in China,so we have been focused on it.ObjectiveTo inverstigate the incidence of PEAC and the relationship between clinicalpathological characteristics and prognosis in China,we have identified 3655 cases of PEAC from Henan Key Laboratory for Esophageal Cancer Research.Moreover,we have detected CK5/6 and p63 protien from immunochemistry to analyze the expression of tomor biomarkers,and to provide the reference for the early diagnosis and treatment of PEAC.Methods1.Retrospective analysis of 3655 patients with PEAC who were diagnosed with1973-2015 during the past 42 years.Mainly information of patients included that name,gender,age,region,clinical diagnosis,tumor site,tumor length,morphologic type,differentiated degree,lymph node metastasis,lymph node based on the total number,positive lymph node metastasis,TNM stage,pathological classification,treatment and family history of cancer.2.All PEAC patients in this study are experienced staff and medical students who have been specially trained in the field of the high and low incidence area of esophageal cancer,the patient's home and hospital survey statistics.All the required clinical data were obtained after the hospital medical records were checked by the hospital medical records provided by the patients.The patients who diagnosed definitely esophageal adenocarcinoma in our study,we cleared out misdiagnosed and unclear diagnosed patients.3.We randomly selected 63 cases of esophageal adenocarcinoma specimens without radiotherapy and chemotherapy to perform immunohistochemical experiments in this study.The CK5/6 and p63 were chosen to analyze the association between clinicalpathological characteristics and these marks,and inverstigate prognosis of esophageal adenocarcinoma according to the expression of CK5/6 and p63.4.The SPSS21.0 software was selected to perform statistical analysis,using the ?2 test to analyze the relationship between protein expression and the clinical pathological characteristics.Spearman correlation analysis was used to analyze the correlation between CK5/6 and p63,and the Log-rank single factor test and COX multiple factors regression were used to survival analysis.P < 0.05 is considered to have statistical significance.Results1.The detection rate of PEAC patients was 1.45%(3655/251707),male patients were more than female(74.1% vs.25.9%),and the ratio of male to female was 2.86:1.Age ranged from 60 to 69 years old(36.7%),followed by 50 to 59 years old(31.1%).The positive rate of tumor family history was 25.6% in PEAC patients.Among 3655 PEAC patients,80.6%(2946 cases)were the most common pathological types of primary esophageal adenocarcinoma,followed by esophageal adenosquamous carcinoma 13.5%(494 cases).The tumor site was most common in the lower esophagus(64.8%),followed by the middle part(30.8%).The degree of differentiation was mainly low degree ofdifferentiation(54.2%),followed by secondary(35.4%).The gross type was the most ulcer type(63.8%),and the second was medulla type(22.5%).The positive rate of lymph node metastasis was 49.7%.Surgery alone was the most treatment(87.1%,2366/2717).2.The success rate was 82.1%(1670/2034)in 3655 patients with PEAC.The overall survival rate of PEAC patients was 1 years,3 years,5 years,10 years,15 years,20 years,25 years and 30 years were 85.4%,48.4%,37.2%,22.9%,17.3%,13.1%,11.7%,1.88%,respectively and the median survival time was 3.81 years.3.Kaplan-Meier univariate survival analysis showed that women were better than men in their living conditions(?2=8.029,P=0.004);Patients younger than 50 years of age were better than those older than 50 years(?2=37.63,P<0.0001);PEAC patients in the high incidence area were better than those in low incidence area(?2=7.16,P=0.007);adenoid cystic carcinoma of the esophagus is the best survival time(?2=8.174,P=0.043);lymph node metastasis negative patients were better than the positive patients(?2=25.357,P<0.0001);The longer the tumor length,the worse the survival of patients with PEAC(?2=12.171,P=0.002);infiltration depth in the T1 phase of the patient's survival is the best(?2=37.152,P < 0.0001);the survival of patients with surgery and radiotherapy(preoperative or postoperative radiotherapy)was the best(?2=61.289,P<0.0001),but the treatment effect of simple chemotherapy was the worst.4.On Cox regression of multivariate analysis,Sex,age,length of tumor,depth of invasion(T stage)and lymph node metastasis were independent factors influencing the survival of PEAC patients.5.Immunohistochemical expression in 63 cases of PEAC: the positive expression rates of CK5/6 and P63 were 41.3%(26/63)and 39.7%(25/63),respectively.6.The expression of CK5/6 was significantly correlated with the pathological type,tumor location,lymph node metastasis and infiltration degree(P<0.05);the expression of p63 protein was significantly correlated with the pathological type and tumor location(P<0.05);and there was a positive correlation between the expression of CK5/6 and p63(r=0.638,P<0.001).7.The median survival time of CK5/6 protein expression positive patients and negative expression patients was 3.85 years and 1.60 years,respectively.CK5/6 protein expression was positive in patients with 1 year,2 years,3 years survival rate was higher than the expression of negative patients(?2=5.780,P=0.016).The median survival time of patients with positive p63 protein expression and negative protein expression was 4 years and 1.65 years,respectively.The survival rate of p63 protein expression positive patients was higher than that of negative expression in 1 years,2 years and 3 years(?2=5.342,P=0.021).ConclusionThe detection rate of PEAC was low,the tumor was mainly occurred in male patients,older age,middle or lower esophagus,more frequently in the moderately and poorly degree of differentiation.Pathologic classification is mainly based on simple esophageal adenocarcinoma;the rate of lymph node metastasis is high in PEAC patientis afer aperation and the prognosis is poor.Sex,age,length of tumor,depth of invasion(T stage)and lymph node metastasis were independent risk factors influencing the survival of patients with PEAC.The expression of CK5/6 in PEAC was related to the pathological type,tumor location,lymph node metastasis and depth of invasion;the expression of p63 in PEAC tissue was related to the pathological type and tumor location.The expression of CK5/6 and p63 were positive in PEAC patients,and the prognosis would be better. |
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