| Objective: To study the clinical data and histopathological features of esophageal squamous cell carcinoma(ESCC),and to explore the survival factors of patients with esophageal squamous cell carcinoma.To compare the prognosis of patients with ESCC before neoadjuvant therapy(NACRT)and postoperative histopathology confirmed lymph node metastasis positive adjuvant chemotherapy or radiotherapy and related influencing factors.To determine the chemotherapeutic efficacy and prognostic effect of tumor stem cell(CSC)marker CD44 and cell proliferation-associated nuclear antigen(Ki-67)expression in patients with radical esophagectomy after NACRT.Methods:1 Retrospective analysis of January 2008 to December 2010 between the Fourth Hospital of Hebei Medical University of histopathological diagnosis of esophageal squamous cell carcinoma and then the operation of 1782 patients,followed up a total of 1550 cases,lost 232 The follow-up rate was 86.9%.The clinical data and histopathological features of esophageal cancer patients were recorded.SPSS 21.00 was used to analyze the recorded data.2 Retrospective analysis of 2006-2016 preoperative neoadjuvant treatment of 110 patients and no other treatment before surgery,direct esophageal radical resection and postoperative pathology confirmed lymph node metastasis which were combined with radiotherapy and chemotherapy in 106 patients.Surgery results were defined by the following R classification: R0,no residual tumor;R1,microscopic residual tumor;R2,macroscopic residual tumor.Statistical analysis wasperformed using the statistical software SPSS 21.00.3 Specimens were fixed with 10% formalin,conventional materials,paraffin embedded tablets,HE staining and immunohistochemical staining,light microscopy.According to the proportion of positive cells and staining intensity analysis: dyeing intensity to 0 for colorless,1 is divided into light yellow,2 is brown,3 is brown;1~2 Divided into weak positive,3 is strongly positive.Positive cells accounted for the proportion of 0 is negative,l is divided into positive cells <20%,2 for the number of positive cells in 21% to 60%,3 for the number of positive cells in 61% to80%,4 is positive Cell number> 80%;1 to 2 divided into low percentage,3 to 4 divided into high percentage.The percentage of positive cells and the intensity of staining were used as the criterion: negative for 0 points,1to 8 for low expression and 9 to 12 for high expression.The Kaplan-Meier method was used for single factor survival analysis and Cox regression for multivariate survival analysis.Log-regression tests were performed using Log-rank test and multivariate logistic regression analysis.P <0.05 for the difference was statistically significant.Results:1 In this study,1782 patients with ESCC,232 cases have been lost till the deadline the follow-up rate was 86.9%.Survival time of 1 to 108 months,the median survival time of 58 months,average survival time of57 months.The age of onset of patients is18 to 81 years,the median age of 60 years,mean age is 59.9 years old.The 1-year,3-year,5-year and7-year survival rates of patients with esophageal cancer were 88.7%,61.9%,48.3% and 30.4%,respectively,according to the date of operation and the date of death.The survival rates were 23.0%,1 year,3 years,5 years and 7 year survival rates of 97.0%,90.3%,82.9% and 58.8%,respectively.The survival rates of 747 patients,1 year,3 years,5 years and 7 years were92.7%,90.1%,82.7% and 33.9% respectively.The survival rates of 549 patients,1 year,3 years,5 years and 7 years were 79.8%,39.5%,24.2%and 14.5% respectively.The recurrence or lymph node metastasis rate was 38.58%(598/1550),the positive rate of vascular tumor thrombosis was 25.61%(397/1550),and the histopathological grade G1 was 121 There were 1161 cases of G2,268 cases of G3,281 cases of tumor infiltration depth of T1,25 cases of T2 and 1010 cases of T3.Kaplan-Meier univariate analysis showed that gender,tumor depth of invasion,histopathological classification,clinical stage,treatment,with or without vascular thrombosis and nerve invasion,with or without lymph node metastasis and esophageal cancer patients who are associated with the prognosis(P <0.05).The age of onset and location of tumor were not related to the prognosis of patients with esophageal cancer.Cox multivariate analysis showed that gender,depth of tumor invasion,clinical stage,histopathological grade,lymph node metastasis were the independent prognostic factors of esophageal cancer(P <0.05).Univariate analysis of lymph node metastasis: clinical stage,histopathological grade,depth of tumor invasion,with or without vascular thrombosis and nerve invasion and esophageal cancer patients with lymph node metastasis(P <0.05).Logistic analysis of multivariate analysis showed that the histopathological grade,the depth of tumor invasion,and the presence or absence of vascular tumor thrombus were the independent prognostic factors of lymph node metastasis in patients with esophageal cancer(P<0.05).3 CD44 or Ki-67 positive cells can be widely observed in neoadjuvant therapy combined with resection specimens.CD44 and Ki-67 positive cells can be widely observed in neoadjuvant therapy combined with resection specimens.CD44-positive cell clusters were observed in necrotic and fibrotic regions of ESCC excision tissue after NACRT in some cases with good chemotherapeutic effects.However,in the case of poor chemotherapeutic effects,CD44-positive cells were distributed in a flaky distribution.The prognosis of patients with ESCC with a high positive expression of CD44 after NACRT showed a worse prognosis(P <0.05)than those with a low positive expression of CD44.We also analyzed the effect of CD44 and Ki-67 combining expression on ESCC results and found that ESCC patients with CD44 positive and Ki-67 over expression showed a greater prognosis than patients with a low expression of CD44 or a low expression of Ki-67 difference.Conclusions:1 Gender,depth of tumor invasion,histopathological grade,clinical stage,treatment,with or without vascular thrombosis and nerve invasion,lymph node metastasis and prognosis of ESCC patients;and gender,depth of tumor infiltration,clinical stage,histopathological grade,lymph node metastasis is the independent prognostic factors of esophageal cancer patients.2 Clinical stage,histopathological grade,depth of tumor invasion,with or without vascular thrombosis and nerve invasion and esophageal squamous cell carcinoma in patients with lymph node metastasis;and histopathological grade,depth of tumor invasion,with or without vascular tumor thrombus Independent prognostic factors of lymph node metastasis in esophageal squamous cell.3 The survival prognosis of NACRT group was significantly lower than that of the untreated group(P <0.01).4 Survival analysis showed that the strong positive expression of CD44 and Ki-67 after NACRT was significantly correlated with the survival rate of patients with esophageal cancer(P <0.05).5 CD44 strongly positive and Ki-67 over expressed ESCC patients showed a worse prognosis than patients with low CD44 or Ki-67 expression,with a statistically significant difference(P <0.05). |
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