| Objective: The staining conditions of IL-6,PD-1 and PD-L1,p-Stat3 in gastric cancer and normal gastric mucosa were detected by IHC to explore the predictive ability of combined detection indexes on the survival prognosis of gastric cancer patientsMethods :(1)A total of 205 cases of postoperative gastric cancer in the First Affiliated Hospital of Shihezi University School of Medicine from 2008 to 2016 were collected,and paraffin tissue specimens and clinicopathological data of the patients were obtained;(2)The follow-up finished date of this study up to October 1,2019;(3)The gastric cancer tissues were arranged on paraffin tissue microarray,and the staining of IL-6,p-Stat3,PD-1 and PD-L1 in the chip was detected by IHC;(4)Excel was used to input data,and SPSS 22.0 was used for statistical analysis,including grade correlation analysis,survival analysis,ROC curve and Cox regression.Logistic regression combined with multi-indicator ROC curve was used to screen out the optimal combination of prognosis indicators for gastric cancer patients after surgery,and Kaplan-Meier method was used to evaluate the ability of multi-factor combined detection to distinguish low-risk group of postoperative prognosis of gastric cancer patients.Results:(1)The positive expression rate of IL-6 in gastric cancer tissues was 81.01%(145/179),which was higher than that in adjacent tissues(52.78%,95/180).The positive expression rate of p-Stat3 in gastric cancer tissues was 100%(187/187),which was higher than that in adjacent tissues by 93.41%(156/167).The positive expression rate of PD-1 in gastric cancer tissues was 58.58%(99/169),higher than that in adjacent tissues(40.12%,65/162).The positive rate of PD-L1 expression was 38.20%(68/178),which was higher than that of adjacent tissues(26.90%,46/171).(2)In gastric cancer,IL-6 was only correlated with distant metastasis(P=0.011)and tumor stage(P=0.001),but not with the tumor invasion,lymph node metastasis,gender,age,and degree of tumor cell differentiation(P>0.05).In gastric cancer,the tumor invasion(P=0.044),lymphatic metastasis(P<0.001),and clinical stage(P=0.001)were all associated with p-Stat3 expression,while gender,age,degree of cell differentiation,and distant metastasis were not associated with p-Stat3 expression(P>0.05).The expression of PD-1 in gastric cancer tissues was not correlated with gender,age,degree of cell differentiation,tumor invasion,lymph node metastasis,distant metastasis and TNM stage(P>0.05).The expression of PD-L1 in gastric cancer was correlated with the degree of cell differentiation(P=0.013),tumor invasion(P=0.008)and clinical stage(P<0.001),but the gender,age,lymph node metastasis and distant metastasis of the patients were not correlated with PD-L1(P>0.05).(3)The higher the expression of IL-6,the lower the OS of patients(P< 0.001);The higher the expression of p-Stat3,the lower the postoperative OS was(P=0.003).The expression of PD-1 was not correlated with the prognosis of patients with gastric cancer after operation(P>0.05).The higher the expression level of PD-L1,the lower the postoperative OS in gastric cancer patients(P=0.003).The lower the degree of cell differentiation,the worse the postoperative OS was(P<0.001).With the increase of TNM staging grade,postoperative OS of gastric cancer patients decreased(P<0.001).(4)Age,cell differentiation,tumor invasion,lymph node metastasis,distant metastasis,TNM stage,p-Stat3 and PD-L1 can all predict the postoperative survival prognosis of gastric cancer patients.TNM staging had the strongest predictive power(the largest AUC),followed by IL-6,which was slightly inferior to TNM staging in predicting postoperative gastric cancer.(5)Risk factors affecting prognosis of patients with gastric cancer after surgery include age(≥60years old),low degree of cell differentiation,tumor invasion(T3/T4),lymph node metastasis(N1-3),distant metastasis(M1),TNM stage(III/IV),IL-6(++/+++),p-Stat3(++/++)and PD-L1(+);Cox multivariate risk regression model found that independent risk factors affecting postoperative survival of gastric cancer patients were: age(≥60 years old),low degree of cell differentiation,tumor invasion(T3/T4),lymph node metastasis(N1-3),distant metastasis(M1)and IL-6(2+/3+).(6)Logistic regression combined with multivariate ROC method was used to establish the prediction based on the combination of cell differentiation+IL-6+ p-Stat3 +PD-1+ PD-L1,among which cell differentiation +IL-6+ p-Stat3 +PD-1 was the optimal combination for the combined prediction of postoperative survival of gastric cancer patients in this study.Conclusion:(1)The expression levels of IL-6,p-Stat3,PD-1 and PD-L1 were different in gastric cancer and adjacent normal tissues.(2)The expression levels of IL-6,p-STAT3 and PD-L1 were negatively correlated with the postoperative survival time of patients with gastric cancer.(3)The combination of "IL-6+ p-STAT3 +PD-1+ degree of tumor differentiation" was the optimal combination in this study,and the combination of multiple indicators was more effective in predicting the prognosis and survival status of patients than the single TNM stage. |
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