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AIM:To study the expression of vascular endothelial growthfactor C (VEGF-C) and chemokine receptor CCR7 in gastriccarcinoma and to investigate their associations with lymphnode metastasis of gastric carcinoma and their values inpredicting lymph node metastasis.METHODS:The expression of VEGF-C and CCR7 in gastriccarcinoma tissues obtained from 118 patients who underwentcurative gastrectomy was examined by immunohistochemistry.Among these patients,39 patients underwent multi-slicespiral CT (MSCT) examination.RESULTS:VEGF-C and CCR7 were positively expressed in52.5 and 53.4% of patients.VEGF-C expression was morefrequently found in tumors with lymph node metastasis thanthose without it (P<0.001).VEGF-C expression was alsoclosely related to lymphatic invasion (P<0.001),vascularinvasion (P<0.01),and TNM stage (P<0.001).However,there was no significant correlation between VEGF-Cexpression and age at surgery,gender,tumor size,tumorlocation,Lauren classification,and depth of invasion.CCR7expression was significantly higher in patients with lymphnode metastasis compared with those without lymph nodemetastasis (P<0.001) and was also associated with tumorsize (P<0.01),depth of invasion (P<0.001),lymphaticinvasion (P<0.001),and TNM stage (P<0.001).However,the presence of CCR7 had no correlation to age at surgery,gender,tumor location,Lauren classification,and vascularinvasion.Among the 39 patients who underwent MSCTexamination,only CCR7 expression was related to lymphnode metastasis determined by MSCT (P<0.05).In thecurrent retrospective study,the sensitivity,specificity,positivepredictive value (PPV),negative predictive value (NPV),andaccuracy of VEGF-C and CCR7 expression in the diagnosisof lymph node metastasis for patients with gastric carcinomawere 73.8%,70.2%,72.6%,71.4% and 72.0%,and 82.0%,77.2%,79.4%,80.0% and 79.7%,respectively.Aftersubdivision according to the combination of VEGF-C andCCR7 expression,receiver operating characteristic (ROC)analysis showed that the accuracy of the combinedexamination of VEGF-C and CCR7 expression in predicting lymph node metastasis was relatively high (area under ROCcurve [Az]=0.83).CONCLUSION:The expression of VEGF-C and CCR7 isrelated to lymph node metastasis of gastric carcinoma andboth of them may become new targets for the treatment ofgastric carcinoma.Furthermore,the combined examinationof VEGF-C and CCR7 expression in endoscopic biopsyspecimens may be useful in predicting lymph node metastasisof gastric carcinoma and deciding the extent of surgical lymphnode resection.
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