The Clinicopathologic Features And Survival Effects Of Lymph Node Metastasis With Gastric Cardia Adenocarcinoma And Its Relationship With CDH1 Expression

1 Background and objectiveGastric cardia adenocarcinoma is one of the most common malignancies of the upper digestive tract in the world.In recent years,the incidence of gastric cardia adenocarcinoma in western countries is on the rise,and the incidence of gastric cardia adenocarcinoma in many Asian countries including China has also increased.The prognosis of patients with gastric cardia adenocarcinoma is poor,the 5-year survival is in the range of 20%-54%,and the long-term survival result is not ideal.And the early diagnosis rate is low.Lymph node metastasis is an important sign of the development of the patients with gastric cardia adenocarcinoma.It is considered that lymph node metastasis is one of the main factors affecting the prognosis of patients.The prognosis of patients with lymph node metastasis was significantly decreased.It is of great clinical significance to make clear the characteristics of lymph node metastasis in patients with gastric cardia adenocarcinoma,which can not only more accurately evaluate the status of patients,but also help doctors to formulate a reasonable treatment plan and effectively evaluate the prognosis of patients.The evolution of tumor is a complex process,involving a variety of gene and protein changes.Understanding these factors may not only provide a new individualized precise treatment scheme,but also improve the overall prognosis of patients.Cadherin plays an important role in maintaining tissue structure and function.The lack or low expression of cadherin(CDH1)will lead to tumor invasion and metastasis,which will lead to poor prognosis of tumor patients.In the study,the author explored the relationship between lymph node metastasis and prognosis of patients with gastric cardia adenocarcinoma through large sample data,and further analyzed the expression rule and clinical significance of CDH1 protein in patients,hoping to provide guidance for early detection,clinical individualized treatment and prognosis of the patients with gastric cardia adenocarcinoma.2 Materials and methods2.1 SubjectsAll patients were from 500000 cases of esophageal cancer and gastric cardia cancer clinical information database(1973-2019)of the State Key Laboratory of Esophageal Cancer Prevention&Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital.The patients with gastric cardia adenocarcinoma confirmed by pathology were selected.At the same time,there were no other malignant tumors,and they were not patients with double or multi focus gastric cardia adenocarcinoma.They had clear lymph node classification records,clear tumor stage,and The basic clinical information is complete.2.2 Methods2.2.1 The clinical data of 38533 patients with gastric cardia adenocarcinoma were analyzed retrospectively,including name,sex,age,home address,smoking history,history of alcohol intake,family history,clinical diagnosis,pathological diagnosis,date of diagnosis,pathological diagnosis details,tumor length,differentiation degree,infiltration degree,lymph node metastasis,distant metastasis,treatment mode,etc.To analyze the relationship between lymph node metastasis and other clinicopathological factors,and to analyze the survival of patients.2.2.2 The expression of CDH1 protein was detected by immunohistochemi-stry in 5288 patients with gastric cardia adenocarcinoma,and the relationship between CDH1 protein expression and clinical pathological characteristics and prognosis was analyzed.2.3 Statistical analysisSpss25.0 was used for statistical analysis,and chi-square test was used for lymph node metastasis and CDH1 protein expression.Single factor survival analysis was based on Kaplan-Meier method,and log-rank test was used to analyze the difference of survival rate between groups;Cox proportional risk regression model was used to analyze the multiple factors affecting the prognosis of patients with gastric cardia adenocarcinoma.Inspection level:a=0.05.3 Results3.1 The clinicopathologic features and survival effects of lymph node metastasis with gastric cardia adenocarcinomaAmong the 38533 patients with gastric cardia adenocarcinoma included in this study,30152 were male,with an average age of 60.93±8.69 years;8381 were female,with an average age of 60.24±8.96 years.There was no difference in lymph node metastasis in gender,age,smoking history,drinking history and family history.There were significant differences in high-and low-incidence area,tumor length,differentiation degree,invasion degree,distant metastasis and lymph node metastasis.3.6%of patients with gastric cardia adenocarcinoma is early,96.4%is middle and late.Age,history of alcohol intake,degree of differentiation,T stage and N stage were independent influencing factors of prognosis.Lymph node metastasis,age increase,differentiation degree decrease and infiltration degree deepen are the risk factors for prognosis of patients with cardiac adenocarcinoma.3.2 The relationship between CDHl protein expression and lymph node metastasis in gastric cardia adenocarcinoma and its effect on survivalAmong the 5288 patients with gastric cardia adenocarcinoma included in this study,4159 were male,with an average age of 61.9318.65 years;1129 were female,with an average age of 61.47±8.87 years.The positive expression rate of CDH1 protein was 83.9%.There were significant differences in the expression of CDH1 protein in gender,tumor length,differentiation degree and T stage.There was no difference in age,high-and low-incidence area,smoking history,history of alcohol intake,family history,N stage,M stage,pathological stage.N stage,gender,age,high-and low-incidence area,tumor length and differentiation degree are independent factors of prognosis.Lymph node metastasis,male,age increase,tumor length increase and differentiation degree decrease are the risk factors of prognosis.The results of univariate survival analysis showed that CDH1 protein expression,tumor invasion and pathological stage were the risk factors for prognosis.4 Conclusions4.1 Lymph node metastasis is an independent risk factor for the prognosis of patients.With the increase of lymph node metastasis,the overall survival of patients is poor.4.2 In the reasonable range of lymph node dissection,increasing the number of lymph node dissection is conducive to the detection of positive lymph nodes,affecting the treatment plan of patients,and benefiting the survival of patients.4.3 The degree of tumor invasion and differentiation is closely related to lymph node metastasis,which are independent factors influencing the prognosis of patients with gastric cardia adenocarcinoma.4.4 CDH1 protein is a molecular marker for the prognosis of patients with gastric cardia adenocarcinoma.The low expression of CDH1 protein is the poor prognosis of patients with gastric cardia adenocarcinoma.4.5 CDH1 protein is related to invasion and metastasis of patients with gastric cardia adenocarcinoma.The expression of CDH1 protein will decrease with the increase of tumor length,the poor differentiation of tumor and the deepening of tumor invasion.