Clinicopathological Features and Increased Expression of Toll-Like Receptor 4 of Gastric Cardia Cancer in a High-Risk Chinese Population.

Guangcan Chen,Guo Dan,Muming Xu,Jingyao Chen,Liangli Hong,Wenting Lin,Shukun Zhao,Guohong Zhang,Shuhui Liu

doi:10.1155/2018/7132868

Abstract

The incidence of gastric cardia cancer (GCC) is high in China. However, the clinicopathological characteristics and the carcinogenesis of GCC are unclear. Toll-like receptor 4 (TLR4) is an important innate immunity receptor and has a role in non-GCC (NGCC). We compared the clinicopathological characteristics of GCC patients from a high-risk area in China to esophageal cancer (EC) patients. Immunohistochemistry for TLR4 was performed in 201 histological samples of normal gastric cardia mucosa (n = 11), gastric cardia inflammation (n = 87), and GCC (n = 103). We included 84 patients with EC and 99 with GCC. GCC tissue was more poorly differentiated than EC tissue and more invasive, with more histomorphologic variation. Lymph node metastasis was more frequent in GCC than in EC. The Helicobacter pylori infection rate was higher but not significantly with GCC than EC. Survival was shorter with lymph node metastasis. We found a statistically significant trend for progressive increase of TLR4 expression from normal mucosa to inflammation in GCC. GCC in this high-risk area displays clinicopathologic characteristics different from those of EC and different from those of gastroesophageal junction carcinomas in other countries, although this was not analyzed statistically. Increased TLR4 expression in gastric cardia lesions may be associated with GCC tumorigenesis.

Highlights

Gastric cancer is the fifth most common malignancy, with an estimated 952,000 new cases in 2012 worldwide [1]
We compared clinical-pathological features between esophageal cancer (EC) and gastric cardia cancer (GCC) and described for the first time Toll-like receptor 4 (TLR4) expression restricted to the gastric cardia epithelium
Patients with GCC were significantly older and had a higher male : female ratio than patients with EC, the difference in the latter variable was not considerable. 92.92% (92/99) of GCC patients were older than 50 years, and 72.62% (61/84) of EC patients were older than 50 years, indicating middle age and elderly people are high-risk group for both GCC and EC, especially for GCC

Summary

Introduction

Gastric cancer is the fifth most common malignancy, with an estimated 952,000 new cases in 2012 worldwide [1]. Our previous epidemiological study showed an extremely high incidence of EC (74.47/100,000) and GCC (34.81/ 100,000) on Nan’ao Island in the Chaoshan area from 1995 to 2004 [11]. GCC in high-risk areas is different from carcinomas of the GEJ studied primarily in Caucasian populations, which are believed to be related to gastroesophageal reflux disease (GERD) [3] and Barrett’s esophagus (BE) [17, 18]. Our previous study suggested that persistent H. pylori infection and the related chronic inflammation may contribute to the high incidence of GCC in the Chaoshan high-risk area [29]. We compared the clinicopathologic features of GCC and EC in the Chaoshan high-risk area in China. Despite different classifications and definitions of cancers originating around the GEJ [39, 40], we defined GCC as carcinoma in which the epicentre is ≤2 cm below the GEJ, the most accepted definition in China [16]

Results

Discussion

Methods