الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
This study aims at histopatholgical study of gastric carinoma lesions, to determine of the prognostic value of P27 expression and AgNORs quantitification in patients of gastric carcinoma and to compare and correlate the findings with other clinicopathological variants such as, tumor grade , stage and 2 year-survival. Statistical analysis and correlations were made for all these variants.
This retrospective study was carried upon 49 cases of different types of gastric carcinoma and 6 cases of apparently normal gastric mucosa were taken as control during the years between 2003 to 2005 .
The gastric carcinoma cases included 23 adenocarcinoma cases , 11 mucoid adenocarcinoma cases and 15 signet ring cell carcinomas cases.
The studied cases included 32 males and 17 females with male to female ratio 1.75:1 and age ranged between 33 to 79 years (mean 55.5, Sd±12.11)
The studied gastric carcinomas were divided into 18 low grade tumors and 31 high grade tumors. Grading was done according to WHO grading system (2004).Nine cases (39.1%) of Adencarcinoma, 7 cases (63.6%) of mucinous adenocarcinoma and all cases of signets ring cell were high grade.
TNM staging system was applied for studied carcinoma cases; eight cases encountered in stage (I) group, 5 cases encountered in stage (II) group, 20 cases encountered in stage (III) and 16 cases encountered in stage (IV) group. So the majority (73.5%) of the studied 49 cases were stage III and IV of the different histopathogloical types.
Two year survival was recorded for the studied (49) carcinoma cases .Nighteen cases (38.8%) were disease free 2 years after gastrectomy while 30 cases (61.2%) had disease recurrence or died. In this study, a highly statistically significant correlation was found between L.N metastasis, distant metastasis, depth of tumor invasion, TNM stage, histological grade and 2-year survival.
P27¬ protein expression in control and carcinoma cases was detected by immuno histochemical staining technique as a brown immunostaing of cell nuclei. The cases were divided according to cut of value (=47) into 2 groups; group of low or absent P27 expression (< 47%) and group of high expression (>47%).
This study revealed a statistically significant correlation between histopathlogical grade and P27 expression as (66.7%) of low garde cases and only (25.8%) of high grade cases showed high P27 expression (> 47).
Also a statistically significant correlation was found between 2 year survival and P27 expression as 63.1% of 2-year free cases showed high P27 expression while 73.3% of cases who had disease recurrence or died showed low or absent P27 expression.
However, No statistically significant correlation was found between TNM stage. LNs metastasis, depth of invasion or distant metastasis and P27 expression.
proliferative activity was evaluated by quantitification of mean
AgNORs counts/cell. The median value of (5.91) was taken as a cut off point to divide cases into 2 categories; category of low score (<5.91) & category of high score (> 5.91).
A statistically significant correlation was found between All clinicopatholgical variables (histopathological grade, depth of invasion lymph node metastasis , distant meatstasis and TNM stage ) and 2 year survival and mean AgNORs counts per cell .
Conclusions
-Gastric carcinoma is a malignant tumor of a poor prognosis.
-TNM staging system is the best histopathological parameter for estimating tumor progression and outcome of patients with gastric carcinoma.
-In gastric carcinoma, low p27 protein expression is associated with poorly differentiated tumors, and is a negative prognostic factor of potential clinical outcome.
-AgNORs count was highly statistically significant with grade, TNM stage, and lymph node metastasis, depth of tumor invasion, distant metastasis and 2-year survival. It can be considered an independent prognostic factor in gastric carcinoma.
-p27, a cyclin dependent kinase inhibitor, is a negative regulator of cell cycle progression and considered to be a tumor suppressor gene. In malignant tumors, loss of p27 function is caused mainly by accelerated its degradation leading to high aggressiveness and poor prognosis of the tumors.
-AgNORs count was superior to p27 immunoassaying method in detecting the prognosis of gastric carcinoma as it is cheap, simple, quick and reliable adjuvant to routine histopathology.