Cases Of Esophageal Carcinoma Research Articles

Pyogenic liver abscess caused by direct invasion of esophageal squamous cell carcinoma to the liver: Report of a case

We report a case of esophageal squamous cell carcinoma (ESCC) directly invading the liver and causing a pyogenic liver abscess. The patient was a 66-year-old man who presented with dysphagia. Esophagography, endoscopic study, and computed tomography (CT) showed a mass lesion in the lower third of the esophagus. A high fever developed on hospital day 17 and another CT scan revealed a liver abscess, 50 × 45 mm, in the left lateral lobe of the liver. Although imaging demonstrated a liver abscess continuous with the tumor, we performed percutaneous transhepatic drainage, followed thereafter by distal esophagectomy and total gastrectomy with a left lateral segmental resection of the liver. The pathological findings confirmed a diagnosis of ESCC with direct invasion (T4N1M0, stage IVa in the TNM classification). The patient had an uneventful postoperative recovery. Microscopic examination of the resected specimen revealed the expansive growth of tumor cells into the hepatocellular tissues. To our knowledge, this is the first report of the direct invasion of esophageal cancer to the liver causing a pyogenic liver abscess; however, it should be borne in mind when a patient with esophageal cancer becomes febrile.

O6-2.1 Use of smokeless tobacco and the risk of oesophageal squamous-cell carcinoma: a multicenter case-control study

IntroductionOesophageal cancer remains an important public health problem worldwide. This multicenter matched case-control study examined chewing of betel quid, areca nut, snuff dipping and cigarette smoking as the risk factors...

Chewing areca nut, betel quid, oral snuff, cigarette smoking and the risk of oesophageal squamous-cell carcinoma in South Asians: A multicentre case–control study

Oesophageal cancer remains an important public health problem worldwide. This multicentre matched case–control study examined the chewing areca nut alone, betel quid with tobacco, oral snuff (snuff dipping) and cigarette smoking as the risk factors for oesophageal squamous-cell carcinoma. We enrolled 91 cases of oesophageal squamous-cell carcinoma and 364 matched controls from three tertiary-care hospitals in Karachi, Pakistan. A structured questionnaire was used to collect the data through face-to-face interview of the participants. Multivariable conditional logistic regression model showed that after adjusting for the effect of ethnicity, ever chewed areca nut alone (adjusted matched odds ratio (mORadj)=3.7; 95% confidence interval (CI): 1.6–8.5), ever chewed betel quid with tobacco (mORadj=12.8; 95% CI: 6.3–26.2), ever practiced snuff dipping (mORadj=4.3; 95% CI: 1.6–11.7) and ever smoked cigarettes (mORadj=2.9; 95% CI: 1.4–5.9) were significantly and independently associated with oesophageal squamous-cell carcinoma status. The adjusted summary population attributable risk (PAR) percent for all four substances together was 67.0. Furthermore, despite incomplete synergy, there was manifold increase in the risk of oesophageal squamous-cell carcinoma, if the respondents ever smoked cigarettes and ever chewed betel quid with tobacco (mORadj=21.4; 95% CI: 6.3–72.4) or if they ever smoked cigarettes and ever practiced snuff dipping (mORadj=14.4; 95% CI: 2.3–91.1). The adjusted PAR (%) was higher for the dual practice of smoking cigarettes and chewing betel quid with tobacco (64.3) than the dual practice of smoking cigarettes and snuff dipping (32.2). Public awareness to curtail the addiction to these substances may result in a substantial reduction in the incidence of oesophageal squamous-cell carcinoma and related mortality in this and similar settings.

Expression of Phosphatase Regenerating Liver-1 in Esophageal Squamous Cell Carcinoma Associated with Metastasis

Expression of PRL-1 protein was examined with immunohistochemistry in 60 cases of esophageal squamous cell carcinoma (ESCC) with matched lymph node metastasis (n=40) and 6 cases of esophageal adenocarcinoma. Its association with ESCC metastasis was also explored. The results showed that PRL-1 protein was more frequently expressed in ESCC with metastasis (31/40, 77.5%) than in ESCC without metastasis (10/20, 50%,P=.031) and more in metastatic ESCC (39/40, 97.5%) than primary ESCC (68.3%,P=.003). PRL-1 protein expression significantly correlated with the stage of ESCC, 79.4% (27/34) in stage III ESCC and 33.3% (1/3) in stage 1 ESCC (P=.003). PRL-1 protein was characteristically expressed in the nuclei, in addition to the cytoplasm, of 3 out of 4 (66.7%) poorly differentiated esophageal adenocarcinoma. These findings suggest that PRL-1 may serve as the potential biomarker to predict the metastasis of ESCC and a better biomarker than PRL-3 in the differential diagnosis of poorly differentiated ESCC.

SU‐E‐T‐855: The Correlation Analysis of IMRT Dosimetry Errors and Parameters of Beams

Purpose: To study the relationships of IMRT plansˈ beam characteristic parameters, furthermore in order to research the effect of parameters settings on the absolute dose accuracy. Methods: Forty‐three esophageal carcinoma cases were planned with the Pinnacle 7.6c TPS using appropriate optimization parameters and dose constraints. All the plans were transplanted into solid water phantom. DOSE1 dosimeter and 0.13cc ion Farmer Chamber (IBA Corp) were used to measure the absolute dose and obtained the dosimetry errors later. The parameters of the 43 casesˈ statistics were collected, and their relations were analyzed. Then we summarized the dosimetry errors, made comparison and analyzed the relativity between the beam parameters and absolute dose verification errors. Results: 1. The describing parameters of beams feature were related. (1) Beam numbers were significantly correlated with beam segment numbers and total MUs, both p‐values were equal to 0.000, but were not distinctly connected with average beam segment numbers and average MUs. (2) Beam segment numbers were prominently interrelated with average beam segment numbers, total MUs and average MUs. (3) Average beam segment numbers were negatively correlated with average MUs and the statistical correlation coefficient was −0.358, yet had no relationship with total MUs. (4) The relationship between total MUs and average MUs was significantly correlated, and the p‐value was 0.003. 2. There was an obvious interrelation between dose accuracy and parameter settings, all of the p‐values were almost 0.000. Dose deviation was positively correlated with the total number of fields, segments, MUs and average segment numbers, while was negatively connected with average MUs.Conclusions: For the purpose of decreasing the absolute dose verification errors, the quantity of beam angles and beam segments should be reduced, considered the aspect of the designing of treatment plans.

SU‐E‐T‐791: Applications of RapidArc in Cervical Esophageal Cancer Radiation Therapy: A Comparison with Fixed‐Field IMRT in Dosimetry and Implementation

Purpose: Comparing fixed‐field intensity‐modulated radiotherapy (f‐IMRT) with intensity‐modulated arc therapy (IMAT) treatment plans in dosimetry and practical application for cervical esophageal carcinoma.Methods: For ten cervical esophageal carcinoma cases, f‐IMRT plan (7 fixed‐fields) and two IMAT plans, namely RA (co‐planar 360° arcs) and RAx (co‐planar 360° arcs without sectors from 80° to 110°, and 250° to 280°). DVHs were adopted for the statistics of above parameters, as well as conformal index (CI), homogeneity index (HI), dose‐volumetric parameters of normal tissues, total accelerator output MUs, and total treatment time.Results: There were differences between RAx and f‐IMRT as well as RA in PTV parameters such as HI, V95% and V110%, but not in CI. RAx reduced lung V5 from (50.9±9.8)% in f‐IMRT and (51.4±10.8)% in RA to (49.3±10.4)% in RAx (P<0.05). However, lung V30, V40, V50 and MLD increased in RAx. There was no difference in the mean heart dose in three plans. Total MU was reduced from 1174.8±144.6 in f‐IMRT to 803.8±122.2 in RA and 736.2±186.9 in RAx (P<0.05) Conclusions: Compared with fIMRT, IMAT reduced low dose volumes of lung and total MU on the basis of meeting clinical requirements.

Expression and significance of EGFR, Her-2 and TOPO II in esophageal canceration course

Objective To investigate the expression of EGFR, Her-2 and TOPO Ⅱ in esophageal canceration course, analyze the correlation between the expression and clinical pathological parameters and the correlation of the three genes. Methods EGFR, Her-2 and TOPO Ⅱ were detected by Tissue microarray technology and Envision immunohistochemistry method in 107 cases of esophageal carcinoma, including normal esophageal epithelium, esophageal intraepithelial neoplasia and esophageal squamous cell carcinoma. Results The positive expression rates of EGFR and TOPO Ⅱ display an improving trend from normal esophageal epithelium, intraepithelial neoplasia to carcinoma (P =0.031) in the above four groups. The positive expression rates of EGFR were 8.41 %, 7.94 %, 27.27 %, 50.47 %, and TOPO Ⅱ were 3.74 %, 4.76 %, 20.45 %, 43.93 %. Furthermore, the expression showed gradually incresing with histological grades advance (P =0.009). There was no correlation between EGFR or TOPO Ⅱ and gender, age, lymph node or distant metastasis (P >0.05). There was a positive correlation between EGFR and TOPO Ⅱ (r 1=0.410, P 0.05), no correlation was obtained between Her-2 and gender, age, the depth of invasion or lymph node metastasis (P >0.05), no relationship between Her-2 and EGFR or TOPO Ⅱ either. Conclusion EGFR and TOPO Ⅱ are closely related to the occurrence and development of esophageal squamous cell carcinoma, their expressions all make a qualitative change in the esophageal high-grade intraepithelial neoplasia. The role of Her-2 in the development of esophageal squamous cell carcinoma is still not definite in Shanxi province. Key words: Esophageal neoplasms; Receptor, epidermal growth factor; Human epidermal growth factor receptor 2; Topoisomerase Ⅱ

Motor vehicle exposure and risk of oesophageal adenocarcinoma

ObjectiveThe introduction of motor vehicles in industrialised countries during the mid 20th century seems to fit with the increasing incidence and the strong male predominance of oesophageal adenocarcinoma. The aim of the study was to test this new hypothesis in a large case–control study. MethodsA nationwide, Swedish, population-based case–control study included 189 and 262 cases of oesophageal and cardia adenocarcinoma, respectively, 167 cases of oesophageal squamous-cell carcinoma and 820 frequency-matched controls during 1995–1997. Tumours were uniformly classified. Exposure data were collected at face-to-face interviews. Odds ratios (ORs), with 95% confidence intervals (CIs), were estimated and adjusted for confounding in multivariable logistic regression models. ResultsThere were no associations between regular contact with cars or airplanes regarding duration, frequency and age of contact and risk of oesophageal adenocarcinoma. The adjusted ORs for oesophageal adenocarcinoma, cardia adenocarcinoma and oesophageal squamous-cell carcinoma among persons spending at least two hours per day in cars were 1.3 (95%CI 0.7–2.3), 1.2 (95%CI 0.7–1.8), and 0.7 (95%CI 0.4–1.3), respectively. The corresponding ORs among frequent airplane passengers were 0.8 (95%CI 0.2–2.3), 1.1 (95%CI 0.5–2.2), and 0.9 (95%CI 0.3–2.5), respectively. ConclusionThis large, population based case–control study does not support the hypothesis that frequent contact with motor vehicles has contributed to the increasing incidence or the male predominance of oesophageal adenocarcinoma.

Oral disease and risk of oesophageal and gastric cancer in a nationwide nested case-control study in Sweden

The association between the exposure to oral disease and the outcomes of oesophageal and gastric cancer was examined in a Swedish nationwide inpatient register-based nested case-control study in 1964–2008. The study included 6,156 oesophageal squamous-cell carcinoma cases that were compared with 29,993 controls, 2684 oesophageal adenocarcinoma cases that were compared with 15,036 controls and 38,308 gastric cancer cases that were compared with 99,991 controls. For oesophageal squamous cell carcinoma, the age and sex adjusted odds ratio (OR) among patients with a history of oral disease was 1.3 (95% confidence interval (95% CI): 0.9,−1.9), and 1.1 (95% CI 0.8,−1.7) after adjustment for diseases related to alcohol consumption or tobacco smoking. For oesophageal adenocarcinoma, the age and sex adjusted OR was increased (OR 1.7, 95% CI 1.1–2.6), and remained increased (OR 1.6, 95% CI 1.0–2.4) after adjustment for diseases related to smoking or alcohol consumption, gastroesophageal reflux, obesity and ulcer disease. For gastric cancer, no statistically significantly increased risk was observed (age and sex adjusted OR 0.9, 95% CI 0.7–1.1, and fully adjusted OR 0.9, 95% CI 0.7–1.1). In conclusion, this study supports the hypothesis that oral disease increases the risk of oesophageal adenocarcinoma, but not for oesophageal squamous cell carcinoma or gastric cancer. Further investigations are warranted.

Prevalence and association of human papillomavirus 16, Epstein-Barr virus, herpes simplex virus-1 and cytomegalovirus infection with human esophageal carcinoma: A case-control study

Recent research shows esophageal carcinoma (EC) as the ninth most common malignancy in the world. The association of viral infection and EC has been reported in the last 30 years. However, geographic variation in infection rates and the key mechanisms of the viral action have yet to be resolved. This study aimed to determine the prevalence and association of human papillomavirus 16 (HPV-16), herpes simplex virus 1 (HSV-1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infection in the etiology of EC in the area of Shantou, Guangdong, China. Nested PCR was used to detect viral DNA in the mucosa of 70 cases of EC and in paracancerous tissues, as well as 100 cases of normal esophagus mucosa. Data were analyzed by χ2 test, Fisher's exact test and bivariate correlation analysis. The infection rates of HPV-16, HSV-1 and EBV were 40.0, 30.0 and 30.0%, respectively, in EC mucosa, and were significantly higher than those in normal mucosa. However, no CMV DNA was detected in either EC or normal mucosa. HPV-16 or EBV infection was mainly detected in EC patients 48-58 years old, and the infection rate was positively associated with pathological grade of EC (P<0.05). Tobacco smoking and alcohol consuption were high risk factors for HPV-16 infection for male patients [odds ratio (OR), 5.9; 95% confidence interval (CI), 1.4-24.6; OR = 3.8; 95% CI, 1.1-13.8]. Rates of infection with a mixture of these 3 viruses were all more than 10.0% in cancerous mucosa and closely related to the pathological grade of EC (P = 0.001). Infection with HPV-16, HSV-1 or EBV may be an important etiological factor in EC.

Esophageal squamous cell carcinoma co-existing with achalasia: report of two cases

Esophageal achalasia is a primary motility disorder of the esophagus. Although various treatments can relieve the symptoms, esophageal cancer arising in patients with achalasia is the most important problem for long-term survivors. We encountered 2 cases of esophageal squamous cell carcinoma co-existing with achalasia that had been diagnosed 27 and 30 years earlier, respectively. Neither patient had been aware of dysphagia due to dilatation of the esophagus. Both patients underwent esophagectomy via right thoracotomy. Although esophagectomy with radical lymphadenectomy was performed successfully in one case of submucosal cancer, the primary tumor in the other case was more invasive and aggressive than indicated by the preoperative clinical diagnosis, and could not be completely resected. Regular endoscopic examination should be scheduled for long-term survivors of achalasia in order to detect esophageal cancer early and evaluate any changes in the esophagus carefully.

Investigation of dose verification of esophageal carcinoma intensity modulated radiotherapy

Objective To compare the results of three dose verification solutions of esophageal carcinoma IMRT plans. Methods Seven esophageal carcinoma cases were planned with Pinnacle 8.0 h.The MATRIXX and Delta4 were chosen as the two-dimensional dosimetry and three-dimensional dosimetry.IMRT plans and Delta4 phantom plans were also recalculated by Monte Carlo. Gamma values were evaluated for MATRIXX and Delta4 with 3 mm/3% gamma criteria. For the comparison of Pinnacle, Delta4 and Monte gamma maps, the dose distribution in central plane, dose profiles and dose-volume histograms were used to evaluate the agreement. Results The gamma maps comparison show that with 3 mm/3% gamma criteria an over 98% pass ratio was obtained by MATRIXX measurement. A 94. 4% gamma pass ratio whicl.contains 4 fields gamma pass ratio lower than 90%, was obtained by Delta4 measurement. A 97.6% and 99. 8% gamma pass ratio was obtained between the Delta4 measurement and Monte Carlo simulation with 2 mm/2% and 3 mm/3% gamma criteria. The dose distribution in central plane and dose profiles from Pinnacle calculation were almost in agreement with both the Monte Carlo simulation and Delta4 measurement. The DVH plot have slightly differences between Pinnacle and Delta4 measurement as well as Pinnacle and Monte Carlo simulation, but have excellent agreement between Delta4 measurement and Monte Carlo simulation. Conclusions It was shown that all the three methods can be used very efficiently to verify esophageal carcinoma IMRT delivery, Delta4 and Monte Carlo simulation no data missed. The primary advantage of Delta4 is the fact it can measure true 3D dosimetry while Monte Carlo can simulate in patients CT images but not in phantom. Key words: Esophageal neoplasms/intensity modulated radiotherapy; Two-dimensional dosimetry verification; Three-dimensional dosimetry verification; Monte Carlo method

Applications of IMAT in cervical esophageal cancer radiotherapy: a comparison with fixed‐field IMRT in dosimetry and implementation

This study aimed to compare fixed‐field, intensity‐modulated radiotherapy (f‐IMRT) with intensity‐modulated arc therapy (IMAT) treatment plans in dosimetry and practical application for cervical esophageal carcinoma. For ten cervical esophageal carcinoma cases, f‐IMRT plan (seven fixed‐fields) and two IMAT plans, namely RA (coplanar 360° arcs) and RAx (coplanar 360° arcs without sectors from 80° to 110°, and 250° to 280°), were generated. DVHs were adopted for the statistics of above parameters, as well as conformal index (CI), homogeneity index (HI), dose‐volumetric parameters of normal tissues, total accelerator output MUs and total treatment time. There were differences between RAx and f‐IMRT, as well as RA in PTV parameters such as HI, V95% and V110%, but not in CI. RAx reduced lung V5 from (50.9%± 9.8% in f‐IMRT and (51.4%± 10.8% in RA to (49.3%± 10.4% in RAx (p<0.05). However, lung V30,V40,V50 and MLD increased in RAx. There was no difference in the mean heart dose in three plans. Total MU was reduced from 1174.8±144.6 in f‐IMRT to 803.8±122.2 in RA and 736.2±186.9 in RAx (p<0.05). Compared with f‐IMRT, IMAT reduced low dose volumes of lung and total MU on the basis of meeting clinical requirements.PACS numbers: 87.55.D, 87.55.dk, 87.55.ne

A Case of Esophageal Lymphoepithelioma-like Carcinoma Resected after Neoadjuvant Chemotherapy

A Case of Esophageal Lymphoepithelioma-like Carcinoma Resected after Neoadjuvant Chemotherapy

Radiotherapy of 180 cases of operable esophageal carcinoma.

To compare the validity of radiotherapy and surgery for operable esophageal carcinoma in 180 patients with pathologically proven esophageal carcinoma who had been accepted for surgery, but for various reasons were given radical radiation therapy instead. The reasons for abandoning surgery were poor cardiac function (n = 21), poor pulmonary function (n = 36), poor general condition (n = 9), senility (age 69-81 years, n = 32), and refusal by the patient (n = 82). They were treated by the isocenter technique alone or anteroposterior plus isocenter irradiation at a total dose of 50-70 Gy/5-7 wk. The 1-, 3-, and 5-year survival rates were 64%, 34%, and 23%, respectively. The 3- and 5-year survival rates showed that lesions in the upper third esophagus responded better than lesions in the middle and lower third (P < 0.05). The 5-year survival rate following radiation alone (44.5%) of upper third lesions was slightly better than that following surgery. The effect on lesions following radiation to middle third lesions was slightly inferior to that of surgery, and that for lower third lesions was even poorer. The results from radiation treatment alone for operable esophageal carcinoma are similar to that of surgery.

Expression and clinical significance of the DNA repair enzyme MYH in esophageal squamous cell carcinoma

MYH is an important enzyme in combating DNA oxidative stress in the occurrence and development of various types of tumors. To investigate the correlation between expression of the DNA repair enzyme MYH in esophageal squamous cell carcinoma and 8-oxoguanine (8-oxoG) oxidative damage, as well as the clinical significance of altered MYH expression, tissues from 175 esophageal carcinoma cases were investigated in the present study. MYH expression and 8-oxoG oxidative damage in squamous cell carcinoma and adjacent normal tissue were assessed by immunohistochemistry and Western blotting. In 82.9% (145/175) of the cases, MYH protein expression in esophageal squamous cell carcinoma was lower than that of adjacent normal tissue (t=4.24, P<0.001). Additionally, 8-oxoG staining was higher in the tumors than in the normal tissue. Lower expression of MYH in esophageal squamous cell carcinoma was associated with depth of invasion, venous invasion, TNM stage and lymph node metastasis (P<0.05). In conclusion, a lower MYH expression level in esophageal cell carcinoma tissue was inversely associated with more severe 8-oxoG oxidative damage, suggesting that changes in MYH activity correspond to increased DNA damage in tumor cells. The use of MYH expression as a postoperative index for esophageal squamous cell carcinoma may guide the formulation of individualized chemotherapy for patients after surgery.

Abstract B85: Childhood obesity and risk of adult squamous-cell carcinoma of the esophagus in a high risk area

Abstract Background: Esophageal squamous cell carcinoma (ESCC) is the most common type of esophageal cancer worldwide and the first cause of cancer morbidity and mortality in parts of the world, including northeastern Iran. While obesity has been shown to be a risk factor for esophageal adenocarcinoma, little is known about the association between childhood obesity and ESCC. Methods: As part of the Gastroesophageal Malignancies in Northern Iran (GEMINI) project, a case-control study was conducted between December 2003 and March 2007 in Golestan Province, in northeastern Iran. Newly-diagnosed histologically-proven cases of esophageal squamous cell carcinoma were recruited from the only GI specialty clinic in the region. Two neighborhood controls, matched by age and sex, were recruited for each case. We collected demographic and health-related information from participants using structured questionnaires. In addition, each individual was shown a standard pictogram validated for this population to report the body size at present and at age 15, starting with picture 1 (very slim) to 7 in men and 9 in women (very obese). We used conditional logistic regression (matched on age, sex and current place of residence) to analyze the association between cancer and body size at 15. The model was further adjusted for ethnicity, education, number of siblings, smoking, as well as childhood place of residence, use of piped water, physical activity, therapeutic opium use, early smoking age, and oral health. Results: There were 300 cases and 571 age and sex-matched controls. Twenty-seven percent of cases and 26% of controls were urban residents, and 57% versus 55% were from Turkmen ethnicity, respectively. 10.4% of cases and 4.4% of controls had been very obese at the age of 15 (p&amp;lt;0.001). In the adjusted model, women reporting the highest level of obesity at age 15 had an OR of 2.9 (95%CI: 1.3-6.6) for developing ESCC. In men, this was not significant (OR=1.3, 95% CI: 0.3-5.2) For all participants, body size at 15 showed a positive association with the risk of ESCC (OR=1.1 for each level of increase, 95% CI: 1.05-1.2). In addition, physical activity level during childhood was inversely associated with ESCC risk (OR=0.8, 95%CI: 0.7-0.9). Conclusion: Children, especially girls, with higher weight and low physical activity may be at increased risk of developing squamous cell carcinoma of the esophagus as adults. This underlines the importance of lifestyle modifications much earlier than what is generally considered for ESCC prevention. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B85.

Incidence of Esophageal Carcinoma Among Malays in North-Eastern Peninsular Malaysia: An Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

Obesity, gastroesophageal reflux, and Barrett's esophagus have all been linked to esophageal adenocarcinoma. In addition, the decline in Helicobacter pylori (H. pylori) infection in affluent societies has also been suggested to be a major factor in the recent rise in the incidence of esophageal adenocarcinoma. If H. pylori infection has a protective role, populations with a naturally low prevalence of H. pylori infection such as the ethnic Malays of Northeastern Peninsular Malaysia should have high rates of esophageal adenocarcinoma. To test this hypothesis, we investigated the incidence of esophageal carcinoma among the ethnic Malays of the state of Kelantan in Northeastern Peninsular Malaysia. The pathology services in the state of Kelantan are provided by two main hospitals. The histopathological records of both hospitals were systematically examined to retrieve all cases of esophageal carcinoma diagnosed between 2004 and 2008. Incidence rates were determined based on the most recent population census. The age-standardized incidence rates (per 100,000 population) of esophageal adenocarcinoma among Malay men and women were 0.75 and 0.69, respectively. The corresponding rates for squamous cell carcinoma of the esophagus were 0.66 and 1.34, respectively. The low rates of adenocarcinoma and squamous cell carcinoma of the esophagus in the study area, despite the fact that H. pylori infection is virtually absent, does not support the hypothesis that the absence of H. pylori infection is a pivotal factor in the pathogenesis of these cancers.

Expression of p16, cyclinD1 protein and clinicopathological significance in esophageal squamous cell carcinoma

Objective To investigate the expressions of p16, cyclinD1 protein in esophageal squamous cell carcinoma and its clinic significance. Methods The expressions of p16 and cyclinD1 protein in 55 esophageal carcinoma cases were detected by immunohistochemical technique. Results The positive expression of p16 protein in 55 patients was 49.1%(27/55). The loss of p16 protein was significantly related to lymph node metastasis (P ＜0.05), and the positive expression of p16 had the higher five-year survival rate.Conversely, the positive expression of cyclinD1 in 55 patients was 74.5 % (41/55), and had the lower five-year survival rate compared to the negative expression cases. Conclusion Loss of p16 protein in human ESCC is a frequent event and correlates significantly with the lymph node metastasis. The loss of p16 and the over expression of cyclinD 1 in esophageal carcinoma may serve as a risk prognosis factors. Key words: Esophageal neoplasms; Neoplasms, squamous cell; Genes, p16

Dietary acrylamide intake and risk of esophageal cancer in a population‐based case‐control study in Sweden

Acrylamide is a potential carcinogen, which commonly occurs in some food items. The relation between acrylamide and esophageal cancer deserves attention. In a Swedish nationwide, population-based case-control study, data were collected on diet among other variables in 1995-1997 through personal interviews. Included were 189 cases of esophageal adenocarcinoma (participation rate 88%), 262 cases of gastroesophageal junctional adenocarcinoma (84%), 167 cases of esophageal squamous cell carcinoma (73%), and 820 control participants (73%). Dietary intake of acrylamide exposure was assessed from a food-frequency questionnaire and categorized into quartiles based on the consumption among the control participants. Unconditional logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI), with multivariable adjustment for known risk factors. Among participants in the highest quartile of acrylamide exposure compared to the lowest, the adjusted risk of all esophageal tumors combined was increased (OR 1.23; 95% CI 1.02-1.75), particularly among overweight or obese persons (OR 1.88; 95% CI 1.06-3.34). Increased point risk estimates were found for each type of esophageal cancer, but the association with esophageal squamous cell carcinoma seemed stronger and was statistically significant, particularly among nonsmokers in the highest quartile of acrylamide exposure (adjusted OR 2.82; 95% CI 1.16-6.87). Regarding squamous cell carcinoma only, a dose-response association was identified (p for trend 0.01). Dietary intake of acrylamide might be a risk exposure for esophageal cancer, a stronger association among overweight or obese persons was indicated.