P-0049 Expression Of Vegf-D, Hif-1а, Anxa7 Associated with Lymphovascular Tumor Emboli and Lymph Node Metastasis in Early Gastric Cancer

Abstract

IntroductionLymph node metastasis is one of the most important factors of prognosis in EGC. Also lymphovascular tumor emboli are a predictor of lymph node metastasis. Although the prognosis of early gastric cancer (EGC) is usually excellent, patients with lymph node metastasis have worse prognosis than those without metastasis. Evaluation of factors associated with lymph node metastasis in EGC is therefore very important. Angiogenesis is one of the key steps in tumor growth and metastasis and tumor suppressor gene is also very important factor in tumorigenesis. VEGF (vascular endothelial growth factor)-D and HIF (hypoxia inducible factor)-1а are angiogenic factor and ANXA7 (annexin A7) exhibits biological and genetic properties expected of a tumor suppressor gene. MethodsWe performed a retrospective analysis in 978 cases that underwent curative resections in Chungnam National Hospital from March 2005 to December 2009 in order to analyze the various clinicopathological factors and the expression of VEGF-D, HIF-1а, ANXA7 associated with lymph node metastasis and lymphovascular tumor emboli. ResultsLymph node metastasis were present in 116cases (11.9%). Lymph node metastases were found in 12 of 438 cases of mucosal invasion (1.2%), in 12 of 141 cases of submucosal (SM 1, the cancer in the upper one thirds of submucosal layer) invasion (1.2%). The tumor size, histologic differentiation were associated with lymph node metastasis in the mucosal invasion (p<0.05). In the submucosal invasion (SM1), the tumor size was related with lymph node metastasis (p<0.05). In the Mucosal and SM 1 invasion, the minimal size of elevated lesion and flat depressed lesion without lymphovascular tumor emboli and lymph node metastasis was 1.8cm & 0.5cm, respectively. In the Mucosal and SM 1 invasion, the minimal size of cancer of good differentiation and poor differentiation without lymphovascular tumor emboli and lymph node metastasis was 0.8cm & 0.5cm, respectively. In immunohistochemical staining in the group of LN metastasis, expression of VEGF-D is higher and expression of ANXA7 is lower than in the group of non- LN metastasis but HIF-1а is not stained in both group so we evaluated statistically VEGF-D and ANXA7 staining. VEGF-D and ANXA7 were significantly correlated with LN metastasis but EGC morphology, size, histology is not positive relationship of VEGF-D and ANXA7 staining ConclusionThe tumor size, depth of invasion, histologic differentiation were associated with lymph node metastasis in early gastric cancer. Also this study demonstrates a close relationship between LM metastasis and expression of VEGF-D and ANXA7. In small EGC, we must pay attention to lymph node metastasis and the presence of lymphovascular tumor emboli, because lymph node metastasis and lymphovascular tumor emboli may exist even in small EGC, especially in flat depressed type cancer.