Survival And Influencing Factors Of Esophageal Cancer Patients In High And Low Incidence Area

Background and ObjectiveThe significant regional distribution difference is a typical epidemiological feature of esophageal cancer in China.This difference represents the number of carcinogenic incidence factors.This study refers to the book “Esophageal Cancer” and divides the area of esophageal cancer into high and low incidence regions.High and low incidence areas indicate that environmental factors play an important role in esophageal cancer.The occurrence of esophageal cancer in high and low incidence areas represents the environmental factors that cause esophageal cancer in both high and low incidence areas,but the factors that cause esophageal cancer in high and low incidence areas are different.However,the analysis and discussion are still not deep enough.We hope that in this discussion we will first understand whether patients with high and low incidence have the same disease or even the same period and whether they have differences in survival.However,comparative studies on high and low incidence areas of esophageal cancer are still very rare.This may be due to factors such as a low number of patients in lowincidence areas,small sample size,and difficulty in collecting data,which limits the research progress on risk factors for esophageal cancer in highand lowincidence areas.In view of the fact that this study has expanded the total sample size.Clinical pathological information and biological samples of 44,222 patients with esophageal cancer were collected,and a large number of lowincidence cases were scientifically included.Differences in survival and influencing factors of patients with esophageal cancer from high and low incidence areas were compared at each level.Past studies have shown that both P53 and CDH1 are closely related to esophageal cancer.P53 gene is an important human tumor suppressor gene,and its molecular changes are significantly associated with the onset of esophageal cancer.Part of the protein product produced by the mutated P53 gene has the effect of converting cells.The CDH1 gene product,E-cadherin,is a transmembrane protein involved in normal epithelial cell adhesion and plays an important role in cell stability and signal transduction.At the same time,differences in the environment may cause differences in environmental factors for genetic changes,and the molecules may be different,resulting in possible differences in clinical pathology and survival.In this study,CDH1 and P53 immunohistochemistry(IHC staining)were performed on tissues from patients with a high and low incidence of esophageal cancer to analyze the differences in the expression of P53 and CDH1 in patients with a high and low incidence of esophageal cancer and their corresponding clinical-pathological features and relationship with prognosis.In summary,this study compared 44,022 cases of esophageal cancer patients from high and lowincidence areas to investigate the differences in survival and influencing factors in patients from a high and low incidence area of esophageal cancer.At the same time,by combining the clinicopathological features and the expression of P53 and CDH1 in esophageal cancer patients from high and low incidence areas,to help the prevention,and treatment of esophageal cancer in different regions,also accurate diagnosis,precise treatment,and prognosis were conducted.Patients and Method 1 PatientsThe basic information,diagnosis and treatment history,pathological information and follow-up results of 44,022 esophageal cancer patients involved in this study were all from the key laboratory of esophageal cancer in Henan Province from 1970 to 2017.The clinical diagnosis and treatment information and biological sample database of esophageal cancer involved 44,022.All cases have clear follow-up results.There were 37,003 patients in the highincidence area and 7,018 in the lowincidence area.2 Method 2.1 We retrospectively analyzed the clinicopathological data of 37,003 cases from highincidence areas and 7,019 cases from lowincidence areas of esophageal cancer,including patient’s gender,the age of diagnosis,the location of the tumor,general type,the degree of differentiation,stump cancer,clinical and pathological indicators such as TNM stages.2.2 Select 5,925 tissue sample of patients from high and low incidence of esophageal cancer areas to do immunohistochemical staining,and detect the expression of P53 and CDH1,respectively,and analyze the relationship between the expression of P53 and CDH1 in esophageal cancer and the corresponding clinical pathological indicators,and then analyze the different expression of P53 and CDH1 in esophageal cancer tissues from high and low incidence area and its effect on the prognosis of patients.2.3 SPSS22.0 software was used for statistical analysis.Chi-square test was used for the clinicopathological parameters such as gender,diagnostic age,tumor location,differentiation,and TNM staging of patients with esophageal cancer in high and low incidence areas;Lifetime,using the life table method to calculate the survival rate of 1,3,5 years.The Cox regression model was used to analyze the clinicopathological parameters affecting the survival of esophageal cancer patients.The Kaplan-Meier method was used to analyze the difference in survival between esophageal cancer patients with high and low incidence.Results 1 Sex,diagnostic age,tumor location,and distribution of pathological features in lowand highincidence areas of esophageal cancerA total of 44,022 cases of esophageal cancer patients,including 7,019 cases of low incidence patients,15.9%,significantly lower than the high incidence area(37,003 cases,accounting for 84.1%).The ratio of male to female patients with esophageal cancer in low and high incidence areas was 2.2: 1 and 1.4: 1,respectively,and there was a significant difference in gender distribution.The incidence of esophageal cancer in low and highincidence areas is also different,but the proportion of esophageal cancer is the highest.The proportions of the four major types of esophageal cancer in low and highincidence areas were also statistically different(χ2=24.794,P=0.000),but the low and highincidence areas were ulcers(45.6% in lowincidence areas,high incidence 42.8% of the districts have the highest proportion.The proportions of lowincidence areas and highincidence areas differed in the degree of non-invasiveness(χ2=33.840,P=0.000),but the proportion of T3(57.7% in lowincidence areas and 54.8% in highincidence areas)was the highest.The distribution of different TNM stages in esophageal cancer patients in low and high incidence areas was also significantly different(χ2=37.979,P=0.000),of which the early stage I cancer in the lowincidence area(8.3%)was lower than that in the high incidence area(10.2%).).Among patients with esophageal cancer in highincidence areas,there was a significant family history of cancer(39.3%)more than in lowprevalence areas(26.1%)(χ2=398.671,P=0.000).2 Analysis of survival and clinicopathological features in patients with a high and low incidence of esophageal cancerLife table method results showed that the 1-,3-,and 5-year survival rates of esophageal cancer patients in the low and high incidence areas were 89.7%,69.4%,57.7%,and 89.8%,68.6%,and 54.6%,respectively.Log-rank and Kaplan-Meier analysis showed that the overall survival of patients with esophageal cancer in the lowincidence area was better than that in patients with high incidence area esophageal cancer(χ2=7.332,P=0.007).The stratified analysis of factors such as sex,age of diagnosis,and various pathological indicators showed that survival in males with low incidence was significantly better than that in males with high incidence(χ2=10.796,P=0.001);ulcerative esophageal cancer in lowincidence areas Patients survived better than the high incidence area(χ2=15.526,P=0.000);survival in patients with low incidence paraquat-type esophageal cancer was better than that in high incidence areas(χ2=4.331,P=0.037);patients with moderately differentiated esophageal cancer in low incidence areas The survival rate was higher than that in the highincidence area(χ2=8.987,P=0.003).The survival rate of T2 esophageal cancer in the lowincidence area was better than that in the high incidence area(χ2=5.248,P=0.022).The survival rate of the low incidence area T4 esophageal cancer was better than that of the high incidence area.Regional(χ2=11.951,P=0.001);Patients with negative esophageal cancer with low incidence of lymph node metastasis had better survival than those with high incidence(χ2=14.867,P=0.000);survival of positive patients with low incidence of tumor family history was significantly better than that of the family History negative patients(χ2 = 4.071,P = 0.044).3 Cox multivariate survival regression analysisCox multivariate survival regression analysis showed that the independent risk factors affecting the survival of patients with esophageal cancer in high incidence areas were gender,the age of diagnosis,general type,the degree of differentiation,the degree of infiltration,positivity of lymph node metastasis and family history of malignant tumor.Comprehensive analysis of patients with esophageal cancer in high and lowincidence areas showed that high incidence areas,men,constricted type,medulla type,poor differentiation,T3,T4,positive lymph node metastasis,and family history negative were independent risk factors for poor prognosis in patients with esophageal cancer.The low incidence area,female,ulcers,paraplegia,highly differentiated,T1,T2,negative lymph node metastasis,and positive family history of cancer are good indicators for prognosis of esophageal cancer patients.4 The expression of P53 and CDH1 in patients with a high and low incidence of esophageal cancerThe positive expression rates of P53 in esophageal cancer patients in low and high incidence areas were 36.5%(1,170/2,184)and 64.4%(2,114/3,655),respectively.The expression of P53 in esophageal cancer patients with high incidence was significantly higher than that in low esophageal cancer patients.Area of esophageal cancer patients with cancer(P=0.001).The positive rates of CDH1 protein expression in esophageal cancer patients in low and high incidence areas were 36.2%(1,683/2,104)and 81.5%(2,961/3,592),respectively.The expression of CDH1 was significantly higher in esophageal cancer patients from highincidence areas.Patients with esophageal cancer in low incidence areas(P=0.022).5 Positive expression of P53 and CDH1 in patients with high incidence and low incidence,respectivelyIn high incidence areas,patients with esophageal cancer with negative P53 expression have significantly better survival than patients with positive P53 expression;survival in patients with negative CDH1 expression is similar to survival with positive expression.In lowincidence areas,survival in patients with negative p53 expression is similar to positive survival;patients with negative CDH1 expression survive better than those with positive expression.Conclusion1 The overall survival of patients with esophageal cancer in low incidence areas is better than those in high incidence areas.2 High-incidence area,male,medulla type,constricted,poorly differentiated,T3,T4,positive lymph node metastasis and negative family history of cancer are independent risk factors for poor prognosis of esophageal cancer patients.3 The positive expression rate of P53 and CDH1 in cancer tissue of patients with esophageal cancer in highincidence areas was significantly higher than that in patients with esophageal cancer in lowincidence areas.It can be used as a molecular indicator for the detection of esophageal cancer.4 Patients with esophageal cancer with negative P53 expression in the highincidence area had significantly better survival than those with positive P53 expression.Patients with negative CDH1 expression in the lowincidence area survived better than those with positive expression.Therefore,patients with high incidence areas can use P53 as a prognostic indicator,and patients with lowincidence areas can use CDH1 as a prognostic indicator.