Correlation between expression of leptin and clinicopathological features and prognosis in patients with gastric cancer

BACKGROUND: The relationship between the expression of leptin in the tissue of gastric cancer and the clinicopathological features as well as patients' outcome were investigated. METHODS: Sixty-one gastric cancer specimens were investigated by immunohistochemical studies with anti-leptin and anti-vascular endothelial growth factor (VEGF) antibodies and by monitoring patients for at least 3 years after surgery. RESULTS: A positive rate of leptin expression was significantly associated with Borrmann classification (Borrmann type 1 and type 2 68.2% vs Borrmann type 3 and type 4 or unclassified 35.3%), tumor histology (well differentiated tumors 87.5% vs poorly differentiated tumors 48.9%), lymph node metastasis (with 69.0% vs without 36.8%) and stage (stage III + IV 69.0% vs stage I + II 36.8%).There was a significant association between leptin expression and VEGF expression. In the poorly differentiated group, the overall survival rate for patients with a weak expression of leptin (histochemistry score <0.5) was significantly higher than that in patients with a strong expression (histochemistry score =0.5). The Cox proportional hazards model identified serosal involvement, tumor size, metastasis, tumor histology, leptin expression, lymph node metastasis, age and postoperative chemotherapy as significant prognostic factors. CONCLUSIONS: The expression of leptin in the tissue of gastric cancer was significantly associated with tumor histology, Borrmann classification, lymph node metastasis and stage of gastric cancer. In patients with poorly differentiated gastric cancer, a poor prognosis was found in those with a strong expression of leptin.     

Regional lymph node metastasis as a predictor of peritoneal carcinomatosis in patients with Borrmann type IV gastric carcinoma

OBJECTIVE: Postoperative survival of patients with Borrmann type IV gastric carcinoma is significantly worse than that in patients with other Borrmann types of gastric carcinomas. The most common pattern of recurrence in patients with Borrmann type IV gastric carcinoma is peritoneal metastasis. We examined the predictors of developing peritoneal metastasis. METHODS: We retrospectively analyzed the relationship between peritoneal metastasis and Borrmann type IV gastric carcinoma. We also examined the dependence of the peritoneal metastasis on clinicopathological findings. RESULTS: Borrmann type IV was an independent prognostic factor of survival by multivariate analysis, and regional lymph node metastasis was an independent predictor of peritoneal metastasis in patients with Borrmann type IV gastric carcinoma. CONCLUSION: Because type of lymph node dissection was not associated with developing peritoneal metastasis, early detection of cancer without lymph node metastasis may be the only means of improving survival in patients with Borrmann type IV gastric cancer.     

Peritoneal carcinomatosis and lymph node metastasis are prognostic indicators in patients with Borrmann type IV gastric carcinoma

BACKGROUND/AIMS: Having observed a lower survival rate of patients with Borrmann type IV gastric cancer, we attempted to determine its prognostic indicators. METHODOLOGY: A total of 103 patients with Borrmann type IV gastric cancer were evaluated; 604 patients with Borrmann types I, II and III were used as references. RESULTS: The results showed that Borrmann type IV gastric cancer were larger, had deeper invasion, more lymphatic and vascular invasions, predominant diffuse type and scirrhous stromal reaction, extensive lymph node metastases and peritoneal carcinomatosis. The 5-year survival rate (11.3%) was significantly lower than that of others (44.7%, P < 0.001). Univariate and multivariate analyses of survival showed that peritoneal carcinomatosis and lymph node metastasis were independently associated with a relative risk of 1.8 and 1.4, respectively. The survival rates of 46 patients with potential curative disease were similar, regardless of various extents of resection. CONCLUSIONS: Peritoneal carcinomatosis and lymph node metastases are prognostic indicators in patients with Borrmann type IV gastric cancer. Optimal surgical strategy for Borrmann type IV gastric cancer remains unclear.     

Surgical outcome of curative resection in patients with Borrmann type IV gastric carcinoma with particular reference to the extent of lymph node metastasis

BACKGROUND/AIMS: The prognosis after curative resection for Borrmann type IV carcinoma, according to the extent of lymph node metastasis, is poorly understood. METHODOLOGY: The surgical outcome of curative resection was examined in 78 patients with T2-T3 Borrmann type IV gastric carcinomas, with particular reference to the extent of lymph node metastasis. RESULTS: The 5-year survival rate was 35.7% for the n0 patients, 27.8% for the n1 patients, 18.2% for the n2 patients and 0% for the n3 or n4 patients. The survival curve for the n3 or n4 patients differed significantly from those of the n0 (P < 0.0001), n1 (P = 0.0009) and n2 (P = 0.0203) patients. However, no other statistically significant differences between the curves were found. CONCLUSIONS: The results of the present study indicate that patients with Borrmann type IV carcinoma of the stomach may indeed be cured by curative surgery, and that the surgical outcome of this disease does not depend on the extent of lymph node metastasis under curative resection if lymph node metastasis is restricted to the n2 lymph nodes.     

Multivariate prognostic study on node-positive gastric cancer: is tumor size a prognostic indicator?

Background/Aims: We analyzed the clinicopathological factors of patients with node-positive gastric cancer, evaluated the prognostic factors associated with long-term survival and clarified the effect of tumor size on long-term survival. Methodology: The study included 591 patients who underwent curative resection for node-positive gastric cancer. Clinicopathological prognostic variables were evaluated as predictors of long-term survival by univariate and multivariate analyses. Results: The 5-year survival rate was influenced by tumor size, tumor location, depth on invasion, level of lymph node metastasis, Borrmann classification, histological type, liver metastasis, peritoneal dissemination and disease stage. Of these, independent prognostic factors were depth on invasion and lymph node metastasis. Tumor size is an influence but not independent factor for the prediction of long-term survival in patients with node-positive gastric cancer. Conclusions: In patients with node-positive gastric cancer, two independent prognostic factors were depth on invasion and the status of lymph node metastasis.     

黏膜下层早期胃癌淋巴结转移290例

目的:研究黏膜下层早期胃癌淋巴结转移的预测因素.方法:回顾性分析解放军总医院1996-2010年手术治疗的290例黏膜下层早期胃癌中与淋巴结转移相关的临床病理资料.结果:黏膜下层早期胃癌淋巴结转移率为21.4%.单因素分析表明影响黏膜下层早期胃癌淋巴结转移的因素主要有肿瘤大小、组织学类型、浸润深度和脉管浸润.多因素分析显示肿瘤大小、组织学类型和脉管浸润与黏膜下层早期胃癌淋巴结转移独立相关.结论:黏膜下层早期胃癌淋巴结转移与肿瘤大小、组织学类型和脉管浸润因素有关.内镜治疗等微创治疗可考虑应用于肿瘤<2cm同时为分化型的黏膜下层早期胃癌中.     

Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer

BACKGROUND/AIMS: Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer. METHODOLOGY: Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer. RESULTS: The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184). CONCLUSIONS: Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.     

Predictive factors of lymph node metastasis in patients with undifferentiated early gastric cancers

BACKGROUND: For intramucosal differentiated early gastric cancer that has little risk of lymph node metastasis, local treatment such as endoscopic mucosal resection has been generally accepted as an adequate treatment. We studied clinicopathological characteristics of undifferentiated early gastric cancer at our institution to identify the predictive factors for lymph node metastasis and qualify lesions that should be referred for gastrectomy and not endoscopic mucosal resection. METHODS: We retrospectively analyzed the clinicopathological features (patient age and gender, tumor size, location, macroscopic type and histological type, presence of ulceration, depth of tumor invasion, and lymphatic-vascular involvement) in 332 patients with undifferentiated early gastric cancer who underwent gastrectomy with regional lymph node dissection. RESULTS: Lymph node metastasis was observed in 45 patients (14%). Univariate analysis revealed that depth of tumor invasion (submucosa), tumor size (>30 mm), and lymphatic-vascular involvement (positive) were associated with lymph node metastasis. Only lymphatic-vascular involvement (positive) was found to have a significant association (odds ratio, 7.4; 95% confidence interval, 2.9-19.0) by multivariate analysis. CONCLUSIONS: Lymphatic-vascular involvement was the only independent predictive risk factor for lymph node metastasis. This pathologic factor was not useful for identifying patients at high risk of lymph node metastasis who should be offered gastrectomy rather than endoscopic mucosal resection.     

The prognosis of stage IV gastric carcinoma patients after curative resection

BACKGROUND/AIMS: In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far-advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients, without distant metastasis after curative resection and the role of surgery. METHODOLOGY: One hundred and ninety stage IV gastric carcinoma patients, without distant metastasis were reviewed after curative resection in our hospital from January 1987 to December 1996. RESULTS: Male sex, distal third location, diffuse or infiltrative type and histologically undifferentiated type were common. Of the 190 patients, 52 (27.4%) patients lived more than 3 years. The lymph node ratio (positive lymph node/retrieved lymph node) and combined resection independently affected survival (P = 0.0013, 0.0061, respectively). The perigastric lymph node ratio was well correlated with overall lymph node ratio (r = 0.794, P < 0.001). CONCLUSIONS: With the involvement of an adjacent organ and knowing the perigastric lymph node ratio, the surgeon can decide upon the extent of dissection and postoperative treatment. However, a prospective study is warranted.     

胃癌组织KAI 1和nm23-H1蛋白的表达意义

目的:观察胃癌组织中KAI 1和nm23-H1蛋白的表达与临床病理生物学的关系,探讨KAI 1蛋白在胃癌发生、发展中的作用．方法:应用兔抗人KAI 1多克隆抗体和鼠抗人nm23-H1 单克隆抗体对87例手术切除胃癌标本以PV-9000免疫组化二步法进行染色,用x2检验进行统计学分析．结果:伴有淋巴结转移的胃癌组织中KAI 1蛋白表达阳性率(60％,39／65)明显低于无淋巴结转移的胃癌组织(95％,21／22,P<0．05),早中期胃癌组织中KAI 1蛋白表达阳性率(94％,16／17)显著高于晚期胃癌组织(63％, 44／70,P<0．05),KAI 1蛋白高表达者其生存期亦较长 (P<0．05);伴有淋巴结转移的胃癌组织中nm23-H1蛋白表达阳性率明显低于无淋巴结转移的胃癌组织(18％ vs 77％,P<0．05),早中期胃癌组织nm23-H1蛋白表达阳性率明显高于晚期胃癌组织(65％vs26％,P<0．05)．结论:KAI 1和nm23-H1蛋白均与胃癌侵袭转移有关, 且KAI 1表达与胃癌患者预后密切相关,将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标．     

Correlation between serum levels of interleukin-6 and vascular endothelial growth factor in gastric carcinoma

BACKGROUND AND AIM: Vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) are associated with the disease status of gastric carcinoma. However, their relationship remains unclear. This study aims to determine and correlate serum levels of VEGF and IL-6 in gastric carcinoma. METHODS: A total of 107 patients receiving gastrectomy entered this study. Serum levels of VEGF and IL-6 were measured by using ELISA, and were analyzed by using the Student's t-test to compare means and by Pearson correlation analysis to calculate correlation coefficients with respect to pathological characteristics including depth of tumor invasion, Laurén's classification, tumor location, Borrmann classification, and the status of lymph node metastasis. RESULTS: Serum VEGF levels were significantly higher in patients with mixed type carcinoma (387.5 +/- 176.9 vs 255.3 +/- 154.1 pg/mL, P = 0.047) or lymph node metastasis (339.1 +/- 205.1 vs 223.2 +/- 197.4 pg/mL, P = 0.007). Serum IL-6 levels were significantly higher in patients with Borrmann type IV carcinoma, compared with Borrmann type II and III carcinoma. In general, no correlation was noted between serum VEGF levels and IL-6 levels (r = 0.142, P = 0.145), but significant correlation was found in patients with early gastric carcinoma (r = 0.627, P = 0.004) or mixed type carcinoma (r = 0.804, P = 0.016). CONCLUSIONS: This study supports the correlation between serum VEGF and IL-6 levels in distinct subsets of gastric carcinoma patients, and indicates that IL-6 may play a role for the angiogenesis of gastric carcinoma via modulation of VEGF.     

CDK4在胃癌中的表达及临床意义

目的研究CDK4在胃癌组织中的表达与临床病理特征之间的关系。方法采用免疫组化方法检测CDK4在70例胃癌组织及部分相应癌旁组织中的表达,结合患者的性别、年龄、肿瘤大小、部位、分化程度、Borrmann分型、浸润深度、淋巴结转移和TNM分期等临床病理参数进行综合分析。结果胃癌组织和癌旁组织中的CDK4蛋白阳性表达分别为65.71%、18.75%,差异有统计学意义(P0.05)。CDK4在低分化组阳性表达率为78.05%(32/41),中高分化组阳性表达率为48.28%(14/29),两组间比较差异有统计学差异(P0.05,χ2=6.693);CDK4在无淋巴结转移组中阳性表达率为44.83%(13/29),有淋巴结转移组中阳性表达率为80.49%(33/41),两者间比较有显著统计学差异(P0.01,χ2=9.587);CDK4在Ⅰ+Ⅱ期阳性表达率为53.13%(17/32),Ⅲ+Ⅳ期组阳性表达率为76.32%(29/38),两组间比较差异有统计学差异(P0.05,χ2=4.147);CDK4蛋白阳性表达与患者的性别、年龄、肿瘤大小、部位、Borrmann分型、浸润深度均无明显相关(P0.05)。结论 CDK4在胃癌组织中存在着过表达,在评估胃癌的发生、发展中有一定的临床价值。CDK4表达水平与肿瘤组织分化程度、淋巴结有无转移、TNM分期有关。     

Loss of heterozygosity and microsatellite instabilities of fragile histidine triad gene in gastric carcinoma

AIM: To detect the loss of heterozygosity (LOH) and microsatellite instabilities (MSI) of fragile histidine triad (FHIT) gene in gastric carcinoma and to study their association with the clinical pathological characteristics of gastric carcinoma. METHODS: LOH and MSI of FHIT gene were detected at four microsaterllite loci D3SI3H, D3S4I03, D3SI48I and D3S1234 using PCR in matched normal and cancerous tissues from 50 patients with primary gastric cancer. RESULTS: The average frequency of LOH and MSI of FHIT gene in gastric cancer was 32.4% and 26.4% respectively. LOH and MSI of FHIT gene in gastric cancer had no association with histological, Borrmann, and Lauren's classification. LOH of FHIT gene in gastric cancer was related to invasive depth. The frequency of FHIT LOH in gastric cancer with serosa-penetration was obviously higher than that in gastric cancer without serosa-penetration (73.5% vs 37.5%, P < 0.05). MSI of FHIT gene in gastric cancer was associated with the lymph node metastasis. The frequency of MSI in gastric cancer without lymph node metastasis was significantly higher than that in gastric cancer with lymph node metastasis (66.7% vs 34.3%, P < 0.05). CONCLUSION: LOH of FHIT gene is correlated with invasive depth of gastric carcinoma. MSI of FHIT gene is correlated with lymph node metastases. LOH and MSI of FHIT gene play an important role in carcinogenesis of gastric cancer.     

Lymph node metastasis in early gastric cancer with submucosal invasion： Feasibility of minimally invasive surgery

AIM:To explore the feasibility of performing minimally invasive surgery(MIS) on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis.METHOPS:A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995,Besides investigating many clinicopathological features such as tumor size,gross appearance,and differentiation,we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis.RESULTS:the rate of lymph node metastasis in cases where the depth of invasion was&lt;500μm,500-200μm,or&gt;2000μm was 9% (2/23),19%(7/36),and 33%(15/46),respectively(P&lt;0.05).In univariate analysis,no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age,sex,tumor location,gross appearance,tumor differentiation,Lauren‘s classification,and lymphatic invasion,In multivariate analysis,tumor size(&gt;4cm vs≤2cm,odds ratio=4。80,P=0.04)and depth of invasion(&gt;2000μm vs ≤500μm,odds ratio=6.81,P=0.02)were significantly correlated with lymph node metastasis,Combining the depth and size in cases where the depth of invasion was less than 500μm,we found that lymph node metastasis occurred where the tumor size was greater than 4 cm.In cases where the tumor size was less than 2 cm,lymph node metastasis was found only where the depth of tumor invasion was more than 2000μm.CONCLUSION:MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500μm in depth.     

Cullin1蛋白在胃癌中的表达及临床意义

目的:研究Cullin1在胃癌细胞及胃癌组织中的表达,并分析Cullin1、临床分期与患者生存率之间的相关性.方法:采用Western blot法检测SGC-7901、BGC-823胃癌细胞与正常胃黏膜上皮细胞GES-1中、胃癌组织与癌旁组织中Cullin1蛋白表达差异.我们利用已经构建的胃癌数据库,采用免疫组织化学法检测792例胃癌组织中Cullin1表达.结果:我们研究发现,SGC-7901、BGC-823胃癌细胞中Cullin1表达水平均高于胃上皮细胞株GES-1(P<0.01).胃癌组织中Cullin1蛋白表达水平均高于癌旁组织(P<0.01).Cullin1过表达与胃癌TNM分期(P=0.011)、浸润深度(P=0.035,T1-T3与T4)及淋巴结转移(P=0.036)显著相关.此外,我们发现Cullin1的高表达与胃癌患者较差的总生存时间及3年生存率明显相关(P=0.042,0.026).Cox回归分析显示,Cullin1表达是胃癌患者3年生存率的一个独立的预后因子(P=0.028).结论:我们的数据表明,Cullin1可作为胃癌淋巴结转移、预后以及潜在治疗的一个重要标志和研究目标.     

Correlation of human epidermal growth factor receptor 2 expression with clinicopathological characteristics and prognosis in gastric cancer

AIM:To investigate human epidermal growth factor receptor 2(HER2) gene amplification and protein expression in Chinese patients with resectable gastric cancer and the association with clinicopathological characteristics and survival.METHODS:One hundred and ninety-seven gastric cancer patients who underwent curative surgery procedures were enrolled into this study.HER2 gene amplification and protein expression were examined using fluorescence in-situ hybridization(FISH) and immunohistochemistry(IHC) analysis on formalin-fixed paraffinembedded gastric cancer samples from all patients.For scoring,Hofmann’s HER2 gastric cancer scoring system was adopted.All cases showing IHC3+ or FISH positiv-ity were defined as HER2 positive.Patient clinicopathological data and survival information were collected.Finally,χ 2 statistical analysis was performed to analyze the HER2 positivity rate amongst the subgroups with different clinicopathological characteristics including;gender,age,tumor location,Lauren classification,differentiation,TNM staging,depth of invasion,lymph node metastases and distant metastasis.The probability of survival for different subgroups with different clinicopathological characteristics was calculated using the Kaplan-Meier method and survival curves plotted using log rank inspection.RESULTS:According to Hofmann’s HER2 gastric cancer scoring criteria,31 cases(15.74%) were identified as HER2 gene amplified and 19 cases(9.64%) were scored as strongly positive for HER2 membrane staining(3+),25 cases(12.69%) were moderately positive(2+) and 153 cases(77.66%) were HER2 negative(0/1+).The concordance rate between IHC and FISH analyses was 88.83%(175/197).Thirty-six cases were defined as positive for HER2 gene amplification and/or protein expression,with 24 of these cases being eligible for Herceptin treatment according to United States recommendations,and 29 of these cases eligible according to EU recommendations.Highly consistent results were detected between IHC3+,IHC0/1 and FISH(73.68% and 95.42%),but l     

Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis

BACKGROUND: In Japan, the standard treatment policy for all potentially curable patients with gastric cancer is radical resection including extensive lymphadenectomy. This treatment strategy has been used for both early and advanced gastric cancers, and substantial increases in survival time have been reported. In advanced gastric cancer, lymphatic spread is reported to be one of the most relevant prognostic factors for gastric cancer resected for cure. The purpose of this study was to determine the factors affecting lymph node involvement and to establish guidelines for the extent of lymph node dissection most appropriate for the treatment of gastric cancer. METHODS: The clinicopathological features of 926 patients with gastric cancer were reviewed. Information on the clinicopathological features was obtained from the database of gastric cancer at the Department of Gastroenterological Surgery, Sendai National Hospital. Univariate and multivariate analyses of data for patients with gastric cancer tumors were performed to evaluate the prognostic significance of clinicopathological features. The independent risk factors influencing lymph node metastasis were determined by multiple logistic regression analysis. RESULTS: The following clinicopathologic factors were found to be correlated with prognosis of gastric cancer: (1) macroscopic type, (2) depth of invasion, (3) cancer-stromal relationship, (4) histological growth pattern, (5) lymph node involvement, (6) lymphatic invasion, (7) vascular invasion and (8) tumor site. However, a multivariate analysis revealed that macroscopic type, depth of invasion, lymph node involvement and tumor site are independent risk factors for the prognosis of gastric cancer patients. Among these factors, the prognosis of patients with gastric cancer was most strongly influenced by lymph node involvement (odds ratio, 4.632). According to a multiple logistic regression model, depth of cancer invasion and lymphatic invasion was significantly correlated with lymph node metastases. CONCLUSIONS: Lymph node involvement has the strongest influence on the prognosis of gastric cancer. Among the clinicopathological factors, depth of invasion and microscopically lymphatic invasion are important factors in predicting lymph node metastases. Thus, the ability to perform gastrectomy with dissection of lymph nodes is a basic requirement for gastric cancer surgeons.     

Prognostic and clinical evaluation of patients with T2 gastric cancer

BACKGROUND/AIMS: Little is known about the clinicopathological features of intermediate-stage T2 gastric cancer, defined as tumors invading the muscularis propria or subserosa. METHODOLOGY: Of 808 patients with gastric cancer, 210 patients (25.9%) who underwent gastrectomy for T2 gastric cancer were selected for this retrospective study. The clinicopathologic findings of these patients were analyzed retrospectively from their hospital records. RESULTS: Of all 808 patients with gastric cancer, 73 patients (9.0%) had tumors invading the muscularis propria (mp). The remaining 137 patients (16.9%) had tumors invading the subserosa (ss). Compared with ss gastric cancer, mp gastric cancer was associated with smaller tumor size, an absence of lymphatic spreading, and hematogenous and late recurrence [disease-free interval: 654.5 days (mp) vs. 365.5 days (ss)]. Univariate analysis of cases with curative operations showed that lymphatic invasion, and lymph node metastasis were significant prognostic factors in patients with T2 gastric cancer. Further examination by multivariate analysis demonstrated that pN2 or higher as classified by both the JCGC (Japanese Classification of Gastric Cancer) and the TNM lymph node staging systems was a predictor of poor prognosis. CONCLUSIONS: JCGC and TNM lymph node staging systems were the most reliable prognostic factors for T2 gastric cancer. Close follow-up should be required for patients with stage pN2 or higher gastric cancer. Long-term follow-up should be required for mp cancers, in particular.     

磷酸化STAT3蛋白与胃癌患者预后及临床病理特征关系的Meta分析

目的系统评价磷酸化STAT3蛋白(p-STAT3)与胃癌患者预后及临床病理特征的相关性。方法检索从建库至2019年6月在PubMed、Embase、The Cochrance Library、万方、中国知网、维普等数据库公开发表的关于胃癌中p-STAT3蛋白表达与临床意义的研究,根据纳入及排除标准筛选文献,提取相关数据,采用Revman 5.3和Stata 12.0软件进行Meta分析。结果共纳入13篇文献,共1307例胃癌患者。Meta分析结果显示:p-STAT3蛋白高表达与胃癌患者的不良预后有关(HR=2.38,95%CI:1.89~3.01,P<0.00001),其与胃癌分化程度(OR=3.08,95%CI:1.92~4.93,P<0.00001)、TNM分期(OR=2.87,95%CI:1.75~4.71,P<0.0001)、淋巴结转移(OR=2.53,95%CI:1.35~4.73,P=0.004)、远处转移(OR=0.17,95%CI:0.09~0.36,P<0.00001)、浸润深度(OR=2.74,95%CI:1.66~4.53,P<0.0001)具有相关性,而与性别(OR=0.97,95%CI:0.74~1.27,P=0.82)、年龄(OR=0.75,95%CI:0.53~1.06,P=0.10)、肿瘤大小(OR=0.76,95%CI:0.55~1.05,P=0.10)均无相关性。结论p-STAT3蛋白与胃癌患者不良预后及胃癌分化程度、TNM分期、淋巴结转移、远处转移及肿瘤浸润深度密切相关,提示其对胃癌的发展起调控作用,可能作为预测胃癌的一个分子标志物。