Clinicopathological Characteristics And Survival Influencing Factors Of Patients With Advanced Esophageal Carcinoma With Long-Term Survival(≥10 Years)

1 Background and objectiveEsophageal carcinoma is one of the six most malignant carcinomas in the world,with a poor prognosis and a 5-year survival rate of 12-20%.It is also a huge economic burden for the Chinese people.However,since the construction of esophageal carcinoma biological sample bank in the 1970s,our laboratory has visited tens of thousands of natural villages and found nearly 15000 patients who have survived for more than 10 years,accounting for about 3%of the 500000 esophageal/cardiac databases.The same treatment,but have different prognosis,some early patients died one year after surgery,some patients in the middle and late stage are still alive 10 years after surgery.This phenomenon has always been an important concern for clinicians and researchers.Therefore,this study selected the patients with advanced esophageal carcinoma for retrospective study,to explore the clinicopathological characteristics and CDH1 expression of patients with super long-term(≥ 10 years)survival and non super long-term esophageal carcinoma,To reveal the relationship between the clinicopathological features,CDH1 expression and long-term survival in patients with advanced esophageal carcinoma,and to provide strong support for clinical practice,so as to provide strong support for clinical practice.2 Materials and methods2.1 Object of studyIn this study,86260 patients with advanced esophageal carcinoma were included.The patient information was from the 500000 database of State Key Laboratory of Esophageal carcinoma Prevention&Treatment.Among them,14739 cases were esophageal carcinoma patients with long-term survival,and 71521 cases were esophageal carcinoma patients without long-term survival.50815 patients survived less than 5 years,20706 patients survived more than 10 years.2.2 Collection,verification and supplementation of clinical and pathological informationAccording to the patient’s inpatient number or pathological number,the relevant personnel of this research group will lead some medical volunteers to the corresponding treatment hospital to check and supplement the patient’s clinical data and pathological information.The supplementary contents mainly include:name,gender,age,address,contact person and method,drinking history,marriage history,family history,clinical diagnosis,pathological diagnosis details,treatment methods,etc.After that,the postgraduates in the laboratory will check the data.If any data error or missing is found,it will be modified,recorded and fed back one by one to ensure the accuracy and authenticity of the data.2.3 Statistical methods① The clinical data of esophageal carcinoma patients with long-term survival and non long-term survival were analyzed retrospectively,including gender,age,high and low incidence areas,urban/rural areas,drinking history,marriage history,family history,tumor location,differentiation degree,etc.②The expression of CDH1 protein in 6038 patients with esophageal carcinoma was detected by immunohistochemistry,and to analyze the relationship between the expression of CDH1 protein and the survival of patients with esophageal carcinoma.③Spss25.0 software was used for statistical analysis,chi square test was used for single factor analysis,prime logistic regression model was used for multi factor analysis,and Hosmer lemeshow test was used.The test level was α=0.05,P<0.05,with statistical significance.3 Results3.1 Comparison of clinical distribution characteristics between patients with esophageal carcinoma with and without long-term survival3.1.1 Comparison of clinicopathological distribution of T,N and m in patients with advanced esophageal carcinomaThe comparison results of the patients with survival≥ 10 years and 5 years≤survival<10 years show that the distribution of T stage(χ2=4.25,P=0.039),N stage(χ2=12.7,P<0.001),M stage(χ2=173.25,P<0.001)was statistically significant;The comparison results of the patients with survival≥ 10 years and survival<5 years show that the distribution of T stage(2=279.86,P<0.001),N stage(2=802.55,P<0.001),M stage(2=215.75,P<0.001)was statistically significant.3.1.2 Comparison of clinicopathological distribution of stage Ⅱ esophageal carcinomaThe comparison results of the patients with survival≥ 10 years and 5 years≤survival<10 years show that the distribution of gender(χ2=54.28,P<0.001),age(χ2=727.42,P<0.001),high and low incidence areas(χ2=455.49,P<0.001),urban/rural areas(χ2=128.84,P<0.001),drinking history(x2=83.77,P<0.001),marriage History(χ2=5.56,P=0.02),family history(χ2=17.96,P<0.001),tumor location(χ2=4.55,P=0.03),differentiation degree(χ2=73.11,P<0.001)was statistically significant.The comparison results of the patients with survival≥10 years and survival<5 years show that the distribution of gender(χ2=140.48,P<0.001),age(χ2=1513.01,P<0.001),high and low incidence areas(χ2=800.42,P<0.001),urban/rural areas(χ2=323.54,P<0.001),drinking history(χ2=138.29,P<0.001),marriage History(χ2=8.98,P=0.003),family history(χ2=65.31,P<0.001),tumor location(x2=18.28,P<0.001),differentiation degree(χ2=236.78,P<0.001)was statistically significant.3.1.3 Comparison of clinicopathological distribution of stage Ⅲesophageal carcinomaThe comparison results of the patients with survival≥ 10 years and 5 years≤survival<10 years show that the distribution of gender(2=26.29,P<0.001),age(2=207.92,P<0.001),high and low incidence areas(2=172.22,P<0.001),urban/rural areas(2=38.78,P<0.001),drinking history(2=19.92,P<0.001),marriage History(2=9.47,P=0.02),differentiation degree(2=43.69,P<0.001)was statistically significant;family history(2=0.007,P=0.933)and tumor location(2=0.5,P=0.479)were not statistically significant.The comparison results of the patients with survival≥ 10 years and survival<5 years show that the distribution of gender(2=141.88,P<0.001),age(2=533.71,P<0.001),high and low incidence area(2=446.4,P<0.001),urban/rural(2=130.02,P<0.001),drinking history(2=115.44,P<0.001),marriage history(2=19.41,P<0.001),tumor location(2=9.7,P=0.002),differentiation degree(2=96.91,P<0.001)was statistically significant;family history(2=3.2,P=0.074)was not statistically significant.3.1.4 Comparison of clinicopathological distribution of stage Ⅳesophageal carcinomaThe comparison results of the patients with survival≥ 10 years and 5 years ≤survival<10 years show that the distribution of age(2=12.65,P<0.001),high and low incidence area(2=12.07,P=0.001),tumor site(2=8.74,P=0.003),differentiation degree(2=4.29,P=0.038)was statistically significant;gender(2=2.96,P=0.086),urban/rural(2=1.92,P=0.166),drinking history(2=2.3,P=0.129),marriage history(2=0.03,P=0.86),family history(2=1.95,P=0.163)was not statistically significant.The comparison results of the patients with survival≥ 10 years and survival<5 years show that the distribution of gender(2=10.45,P=0.001),age(2=60.31,P=0.011),high and low incidence areas(2=21.11,P<0.001),urban/rural areas(2=6.53,P=0.011),drinking history(2=4.75,P=0.029),family History(2=15.22,P<0.001),tumor location(2=3.53,P=0.06),and degree of differentiation(2=4.54,P=0.033)were statistically significant;tumor location(2=3.53,P=0.06)and marriage history(2=0.01,P=0.906)were not statistically significant.3.2 Multivariate logistic regression analysis3.2.1 Multivariate logistic regression analysis of T,N,M in patients with advanced esophageal carcinomaThe logistic regression results of the patients with survival≥ 10 years and 5 years≤survival<10 years showed that compared with T4 stage,T1 stage is the risk factor of patients’ long-term survival(P<0.05),T2 stage is the independent protective factor of patients’ long-term survival(P<0.05),T3 stage has little relationship with patients’ long-term survival(P>0.05);There was no significant relationship between N stage and long-term survival of patients(P>0.05);in M stage,M0 stage was an independent protective factor for survival of patients.The logistic regression results of the patients with survival≥ 10 years and survival<5 years showed that in N stage,T1,T2 and T3 are independent protective factors of patients’ long-term survival compared with T4 stage;in N and M stage,NO and MO are independent protective factors of esophageal carcinoma’s long-term survival(P<0.05).3.2.2 Multivariate logistic regression analysis of patients with stage Ⅱesophageal carcinomaThe logistic regression results of the patients with survival≥ 10 years and 5 years≤survival<10 years showed that low incidence area and drinking history were the independent risk factors for the long-term survival of esophageal carcinoma patients(P<0.05);the age of diagnosis<60 years old and rural areas were the independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the tumor in the lower thoracic segment,the tumor in the upper thoracic segment was an independent risk factor for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the low differentiation,the high differentiation was an independent protective factor for the long-term survival of esophageal carcinoma patients(P<0.05).The logistic regression results of the patients with survival≥10 years and survival<5 years showed that male,low incidence area and drinking history were the independent risk factors for the long-term survival of esophageal carcinoma patients(P<0.05);the age of diagnosis<60 years old and rural areas were the independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the tumor in the lower thoracic segment,the tumor in the upper thoracic segment was an independent risk factor for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with low differentiation,medium differentiation and high differentiation were independent protective factors for the long-term survival of esophageal carcinoma(P<0.05).3.2.3 Multivariate logistic regression analysis of patients with stage Ⅲesophageal carcinomaThe logistic regression results of the patients with survival≥ 10 years and 5 years≤survival<10 years showed that male and low-risk areas were independent risk factors for long-term survival of esophageal carcinoma patients(P<0.05).Compared with low differentiation,medium differentiation and high differentiation were independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).The logistic regression results of the patients with survival≥ 10 years and survival<5 years showed that male,low incidence area and drinking history were independent risk factors for long-term survival of esophageal carcinoma patients(P<0.05);The age of diagnosis was less than 60 years old,the rural patients were esophageal carcinoma patients,and the good marital status was the independent protective factor for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the low differentiation,the high differentiation and medium differentiation were the independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).3.2.4 Multivariate logistic regression analysis of patients with stage Ⅳesophageal carcinomaThe logistic regression results of the patients with survival≥ 10 years and 5 years≤survival<10 years showed that the low incidence area was the independent risk factor for the long-term survival of esophageal carcinoma patients(P<0.05);the age of diagnosis less than 60 years was the independent protective factor for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the tumor in the lower thoracic segment,the tumor in the middle or upper thoracic segment was an independent risk factor for the long-term survival of esophageal carcinoma patients(P<0.05).Compared with the low differentiation,the medium differentiation and high differentiation were the independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).The logistic regression results of the patients with survival≥ 10 years and survival<5 years showed that male,low incidence area was the independent risk factors for the long-term survival of esophageal carcinoma patients(P<0.05);age of diagnosis<60 years old and family history positive were the independent protective factors for the long-term survival of esophageal carcinoma patients(P<0.05).3.3 The relationship between the expression of CDH1 protein and the clinical characteristics of esophageal carcinoma patients with long-term survival(≥10 years)There was no significant difference in the positive rate of CDH1 expression in the tumor tissues of esophageal carcinoma patients with long-term survival(≥10 years)in gender,age,high and low incidence areas,urban/rural areas,drinking history,marriage history,family history,tumor location,T stage and N stage(P>0.05),and there was statistical significance in the degree of differentiation(P<0.05).3.4 The relationship between the expression of CDH1 protein and the clinical characteristics of esophageal carcinoma patients with 5 years≤survival<10 yearsThere was no significant difference in the positive rate of CDH1 expression in the tumor tissues of esophageal carcinoma patients with 5 years≤survival<10 years in gender,age,high and low incidence areas,urban/rural areas,drinking history,marriage history,family history,tumor location,T stage and N stage(P>0.05),and there was significant difference in the degree of differentiation(P<0.05).3.5 The relationship between the expression of CDH1 protein and the clinical characteristics of esophageal carcinoma patients with survival<5 yearsThere was no significant difference in the positive rate of CDH1 expression in the tumor tissues of esophageal carcinoma patients with survival less than 5 years in gender,age,urban/rural areas,marriage history,family history,tumor location,etc.(P>0.05).There was significant difference in the high and low incidence areas,drinking history,differentiation degree,N stage(P<0.05).3.6 Immunohistochemical results of CDH1 protein expressionIn 6038 cases of esophageal carcinoma,the positive rate of CDH1 protein expression was 86.1%.In 744 cases of esophageal carcinoma with long-term survival(≥ 10 years),the positive rate of CDH1 protein was 83.6%;in 1106 cases of esophageal carcinoma with 5 years ≤survival<10 years,the positive rate of CDH1 protein was 85.2%;in 4188 cases of esophageal carcinoma with 5 years<survival,the positive rate of CDH1 protein was 86.8%.There was no significant difference in the expression of CDH1 protein between patients with super long-term survival(≥ 10 years)and those with 5 years ≤ survival<10 years(P>0.05).4 Conclusion①Different pathological stages of esophageal carcinoma patients have different influence factors on their long-term survival.②Different survival stages of esophageal carcinoma patients have different influence factors on their long-term survival.③The expression of CDH1 in patients with esophageal carcinoma is related to their long-term survival.The expression of CDH1 can be used as a reference index to evaluate the long-term survival of patients with esophageal carcinoma.