The Expression And Clinical Significance Of VEGF And C-Met Protein In Hepatoid Adenocarcinoma Of The Stomach

Background and objective: Hepatoid adenocarcinoma of the stomach(HAS)is a special type of gastric cancer(GC)with pathological indications of hepatoid differentiated regions,which is very rare in clinical,accounting for 0.17% ~ 0.73% of the common GC.The clinical characteristics of HAS are always accompanied by the increase of serum AFP,but its diagnosis is unrelated to the level of serum AFP,and pathological examination is the gold standard.Due to HAS the unique biological behaviour,leading to the vascular invasion,lymph nodes,liver,lungs and other distant metastasis rate than ordinary GC is high,the worse prognosis.At present,most of the domestic and foreign literature reports on HAS are individual cases of medical records or small sample data reports.Due to the relatively insufficient understanding and research means of HAS,misdiagnosis and missed diagnosis are likely to occur.Even if the correct diagnosis is made,relatively effective treatment means are also lacking,and the treatment effect is often unsatisfactory.For the early HAS,radical surgery is the main treatment method,but there is no standardized treatment plan for the progressive HAS at present.This study aims to explore the clinicopathological characteristics and molecular biological characteristics of HAS,so as to improve clinicians’ understanding of HAS and improve the clinical diagnosis and treatment effect of patients with HAS.Methods :To collect 2009 January to December 2017 in Qingdao municipal hospital and medical school affiliated hospital of Qingdao university,through the surgery and after a diagnosis of 28 specimens from the organization.To analyze the clinical data of28 HAS patients.VEGF and c-met immunohistochemical staining were performed on24 tissue samples that had not received preoperative anti-tumor therapy such as chemoradiotherapy or targeted therapy.We also took 48 gastric adenocarcinomas as a control group.The control group was selected by screening all hospitalized patients who underwent surgical treatment and were diagnosed with gastric adenocarcinoma:(1)patients who had received preoperative anti-tumor therapy such as radiotherapy and chemotherapy or targeted therapy were excluded;(2)patients with teratoma were excluded;(3)patients with a history of liver disease such as cirrhosis,acute and chronic hepatitis and primary hepatocellular carcinoma were excluded,and 48 patients from the remaining patients were randomly selected as the control group.A statistical analysis of the result of the final immunohistochemistry is expected to give a reference to the treatment of HAS.Results: 1.28 patients with HAS had a male patient and 3 female patients,with 18 patients with HAS patients(64.3)because of upper abdominal pain,and 8 patients with HAS patients(28.6%)have been to seek medical treatment due to hematemesis and blackened.Two patients with HAS(7.1%)had no obvious discomfort and were found to be admitted to the hospital due to GC examination.The tumor was located in the gastric sinus in 16 patients(57.1%),the cardia in 6 patients(21.4%),and the gastric body in 6 patients(21.4%).There are 20 patients with a maximum tumor diameter of 5cm and an average diameter of 6.71 cm.28 from the patient’s postoperative TNM stage,Ⅲ A period of 4 people,Ⅲ B period of 8 people,Ⅲ C 16 people.The lymph node metastases n1-3 for 28 people(100%).Among the 28 patients with HAS,18(64.3%)had low tumor differentiation,8(28.6%)had medium-low tumor differentiation,and 2(7.1%)had medium tumor differentiation.26 patients(92.6%)had intravascular carcinoma emboli.Total group follow-up 2-52(median 7.5)months,15 patients died and 4 persons survived and 9 were missing.2.The high expression ratio of c-met in the HAS and GC is 91.7%(22/24)and 63.3%(32/48)respectively;The high expression ratio of VEGF in HAS and GC tissues is 87.5%(21/24)and 53.3%(29/48)respectively;The expression of VEGF and c-met in the HAS group is significantly higher than in the gastric adenocarcinoma group(P < 0.05).Conclusion :1.Compared with GC,HAS is more prone to lymph node and liver metastasis,with shorter survival time and poor prognosis.Currently,the clinical treatment plan of HAS still advocates active surgical treatment,and if necessary,it is feasible to adopt radiotherapy and chemotherapy and targeted treatment.2.Compared with GC,VEGF and c-met are highly expressed in HAS.It is suggested that targeting drugs of VEGF and the c-met inhibitor may be beneficial for the treatment of HAS.