| BackgroundEsophageal cancer is one of the most common cancers in the world,and its incidence rate and mortality rate both rank sixth.China is a country where esophageal cancer has a high rate of incidence and mortality(ranking sixth and fourth respectively).Every year,nearly 500 thousand of esophageal cancer patients increase.Over 50% of them are from China,which is 100 times higher than that in western countries.Adenocarcinoma and squamous cell carcinoma are the two mainly histological types of esophageal cancer.In China,the incidence rate of esophageal squamous carcinoma accounts to 97%,and it's less than 2% as for esophageal adenocarcinoma;However,in western countries,the incidence of esophageal adenocarcinoma is the major part in esophageal cancer amounting to 80%,and while esophageal squamous carcinoma 20%.Most of the reports about esophageal adenocarcinoma appear in foreign countries,but esophageal cancer is different not only in China and the west,but also in tissue types.At present,there is still a lack of large-scale research on esophageal adenocarcinoma in China,especially comparative analysis on the prognostic factors of esophageal squamous cell carcinoma and esophageal adenocarcinoma.RB1 gene is the first tumor suppressor gene discovered by humans,which is related to the occurrence of retinoblastoma.And the first tumor suppressor gene successfully cloned by humans.It has antitumor properties and can inhibit the growth of tumor cells.There are many reports about the correlation between RB1 gene and its protein expression and tumor.Many studies have shown that the loss of gene heterozygosity and the loss of Rb1 protein expression may play an important role in the occurrence and development of tumor.However,there are few reports on the comparative study of the effects of Rb1 protein expression on the prognosis of esophageal squamous cell carcinoma and esophageal adenocarcinoma.ObjectiveThis study organized and analyzed clinical data from 3,837 cases of esophageal adenocarcinoma and 174,119 cases of esophageal squamous cell carcinoma collected from the 500,000 cases of esophagus and cardia cancer clinical information database jointly constructed by the Provincial and Ministry of Zhengzhou University First Affiliated Hospital.It inquired into the similarities and differences of the prognostic factors of esophageal adenocarcinoma and esophageal squamous cell carcinoma and the expression and significance of RB1 protein in the two,which provides scientific theoretical basis for the precise prevention and treatment of different histological types of esophageal cancer in China.Methods1.In this paper,the data of 3837 cases of esophageal adenocarcinoma and 174119 cases of esophageal squamous carcinoma with definite diagnosis time and address in the 500000 cases of esophageal cancer and cardiac cancer clinical information database(1973-2018)jointly established by the provincial and Ministry of the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The analysis mainly includes much clinical diagnosis and treatment information: gender,age of diagnosis,degree of differentiation,family history of tumor,tumor location,high / low incidence rate area,tumor length,lymph node metastasis,TNM staging,and treatment methods.And it discussed the difference of prognostic factors between esophageal adenocarcinoma and esophageal squamous cell carcinoma.2.It analyzed RB1 tissue chips from 225 cases of esophageal adenocarcinoma,343 cases of esophageal squamous cell carcinoma,and 150 cases of normal esophageal mucosa selected from the State Key Laboratory of Esophageal Cancer Prevention and Co-establishment of the Provincial and Ministry of Zhengzhou University First Affiliated Hospital.Histochemical staining method and tissue chip technology were used to detect the expression of RB1 protein,and analyze the expression differences of RB1 protein in esophageal adenocarcinoma,esophageal squamous cell carcinoma and normal esophageal mucosa,and analyze comparatively the relationship between esophageal squamous cell carcinoma and esophageal adenocarcinoma and clinicopathological parameters.3.Statistical analysis was performed on the data using SPSS 25.0 software.Chi-square test was used to analyze the distribution of clinicopathological characteristics of esophageal adenocarcinoma and esophageal squamous cell carcinoma.The survival time was calculated in years.The univariate survival analysis used the Kaplan-Meier method,and the survival curve was drawn.Difference testing is conducted with Log rank,and Cox risk ratio regression model was used to analyze the interaction of multiple factors,and the test level was ? = 0.05(both sides).Results1.Among the 177,956 esophageal cancer patients in this study,3837(2%)were esophageal adenocarcinoma and 174119(98%)were esophageal squamous cell carcinoma,proving that the incidence of esophageal squamous cell carcinoma in China was significantly higher than that of esophageal adenocarcinoma.Of the 3837 cases of esophageal adenocarcinoma,merely esophageal adenocarcinoma was 2561(66.8%),esophageal adenosquamous carcinoma(30.9%),esophageal adenoid cystic carcinoma 14(0.4%),and esophageal mucoepidermoid carcinoma 86(1.9%).2.The survival of patients with esophageal squamous cell carcinoma was better than that of patients with esophageal adenocarcinoma,and have statistical differences(P <0.001).3.Gender,diagnosis age,degree of differentiation,high and low incidence areas,marginal status,lymph node metastasis,TNM staging,clinical staging,and treatment methods are all factors that affect the prognosis of patients with esophageal adenocarcinoma(all P <0.05).4.Gender,diagnosis age,smoking,drinking,family history,tumor location,urban / rural,high and low incidence areas,tumor length,lymph node metastasis,degree of differentiation,marginal status,TNM staging,clinical staging,and treatment methods are all factors that influence prognostic situation of esophageal squamous cell carcinoma patients(all P <0.05).5.There were significant differences between esophageal adenocarcinoma and esophageal squamous cell carcinoma in terms of sex,age of diagnosis,urban/rural,high and low incidence area,smoking history,drinking history,family history,tumor location,tumor length,differentiation degree,cut margin status,lymph node metastasis,TNM stage,clinical stage,and operation mode.The differences were statistically significant(all P<0.05).6.Gender,diagnosis age,alcohol consumption,degree of differentiation,and TNM staging are independent factors affecting the prognosis of patients with esophageal adenocarcinoma(all P <0.05);gender,age,urban / rural,family history,tumor location,tumor length,The degree of differentiation and TNM staging are independent factors affecting the prognosis of patients with esophageal squamous cell carcinoma(both P <0.05);there are different independent factors affecting the prognosis of the two.7.Rb1 protein is expressed in esophageal adenocarcinoma,esophageal squamous cell carcinoma and esophageal normal squamous epithelium,and all are expressed in the nucleus.8.The expression of Rb1 protein in esophageal squamous cell carcinoma and esophageal adenocarcinoma was lower than that in normal esophageal mucosa(P <0.001).9.The positive expression of Rb1 protein was significantly different in esophageal adenocarcinoma and esophageal squamous cell carcinoma(P=0.002),and the expression of Rb1 protein in esophageal squamous cell carcinoma was higher than that in esophageal adenocarcinoma.10.The expression of Rb1 protein in esophageal adenocarcinoma is lower than that in normal squamous epithelium of the esophagus.There is a difference in expression between the two,and it is statistically significant(P <0.001);The expression in normal squamous epithelium of the esophagus is also different between the two,and it is statistically significant(P <0.001).11.Rb1 protein is not a prognostic factor for esophageal adenocarcinoma(P = 0.349);nor is it a prognostic factor for esophageal squamous cell carcinoma(P = 0.332).Conclusion1.Patients with esophageal squamous cell carcinoma survive better than that of esophageal adenocarcinoma.2.There are different independent factors affecting the prognosis of esophageal squamous cell carcinoma and esophageal adenocarcinoma.3.The expression of Rb1 protein in esophageal squamous cell carcinoma and esophageal adenocarcinoma is lower than that of normal esophageal mucosa,and the expression of Rb1 protein in esophageal adenocarcinoma and esophageal squamous cell carcinoma is statistically different,in which the expression of Rb1 protein is higher that of esophageal adenocarcinoma.4.Rb1 protein expression is not a factor affecting the prognosis of esophageal squamous cell carcinoma and esophageal adenocarcinoma. |
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