الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Gastric carcinoma (GC) is the fifth most frequent cancer in the world, and it is also the fourth leading cause of cancer-related death. GC is the tenth most prevalent cancer in both sexes in Egypt, accounting for 2.5 % of all malignancies and 3 % of all cancer deaths. Surgical excision with sufficient lymphadenectomy is the only possibly curative therapy option for people with GC. Drug resistance, treatment efficacy, and survival rates are still higher in metastatic GC patients.
The pathogenesis of GC is still unclear and is influenced by a variety of factors, including environmental and genetic factors. During gastric carcinogenesis, dysregulation of multiple genes and pathways is crucial. Many pathways have been discovered in GC, including EMT, Wnt/β-catenin signaling, Hedgehog signaling, Hippo pathway, Notch signaling, NF-, and epidermal growth factor receptor.
EMT is one of the most critical pathways in GC in which epithelial cells acquire the mesenchymal phenotype. Exit of tumor cells from the main tumor site, invasion of the neighboring stroma, diffusion via blood or lymph circulation, and exit from vessels into the parenchyma of distant organs are all part of the EMT mediated invasion-metastasis cascade (metastases). Epithelial cells lose epithelial markers during EMT, particularly E- Cadherin, which is the primary molecule of stable epithelial adherens junctions, and gain additional markers. It is mostly suppressed by the interaction of certain EMT transcription factors and other protein families.
Therefore, this study aimed to evaluate immunohistochemical expression of RORα, LAPTM4B, and E-cadherin in GC and CG specimens and correlate their expression with the available clinicopathological parameters trying to investigate their role in pathogenesis and prognosis of GC.
This is a retrospective study with 240 cases, 167 of which were CG (control group) and 73 of which were GC. The median age of the CG group was 48 years, with a 50.9 % female gender predominance. The majority of CG patients (66.5%) had a moderate inflammatory infiltration, with moderate active inflammation (40.1%) and mild inflammation (38.1%). H.pylori was found in 95.2 % of the CG cases studied, with 13.2 % having intestinal metaplasia, 1.8 % having atrophic changes, and 21% having hyperplastic changes.
The median age of GC patients was 56 years, with a 64.4 % male gender predominance, 49.3 % of GC tumors measured more than 5 cm in maximum diameter, 49 % were located at the distal gastric part, and 41.1 % were pangastric. The majority of GC cases (70%) manifested as ulcerative growth. According to the Laurén classification, 64.4 % were of intestinal type, 21.9 % of diffuse type, and only 13.7 % of mixed type.
According to WHO 2019 classification, 57.5% of cases were tubular adenocarcinoma, 6.8%cases were mucinous adenocarcinoma, 21.9% of cases were poorly cohesive carcinoma and 13.7% cases were adenocarcinoma with mixed types. No other histological variants could be detected.
Most of GC cases 60% were of high grade, LVI present in 72.6% of cases, 55% showed positive perineural invasion, 49.3% showed necrosis.
As regard T staging most of the studied cases 53.4% were T3, 24.7% were T4 and the remaining (17.8% &4.1%) were T2&T1 respectively. About 65% of GC cases showed positive lymph node invasion, N1 (13.7%), N2 (27.4%) and N3(24.7%). Regarding M stage, 19.2% (14/73) of cases showed distant metastasis. About 44% of cases were stage