Cases Of Esophageal Carcinoma Research Articles

Successful reconstruction of an intrathoracic tracheal defect using a muscle flap and conchal cartilage graft

Malignant invasion of the respiratory tract is a common complication in advanced cases of esophageal carcinoma. Resection and reconstruction can be extremely challenging, particularly when the invasion is intrathoracic. A circumferential tracheal resection with direct tracheal closure or mediastinal tracheostomy is often performed, but the outcome is not always favorable, with high morbidity rates, loss of vocal function, and reduced quality of life. We present our experience in performing an intrathoracic tracheal reconstruction in which a conchal cartilage graft was used in combination witha pectoralis major muscle transposition. This was successfully done following the noncircumferential resection of the intrathoracic trachea due to mural invasion by a metastatic lymph node of esophageal carcinoma. We believe this report will contribute to the growing body of clinical expertise on procedures for intrathoracic tracheal reconstruction.

The expression of p53 protein and its clinicopathological features and prognosis of esophageal spindle cell carcinoma

Objective: To evaluate the association of p53 protein expression with clinicopathological features and prognosis in esophageal spindle cell carcinoma. Methods: A total of 4 439 esophageal squamous cell carcinoma (ESCC) patients who underwent radical esophagectomy without neoadjuvant therapy between May 2010 and May 2019 were included. The HE slides and clinicopathological parameters were reviewed. Among these, there were 63 cases of esophageal spindle cell carcinoma; p53 protein expression was evaluated by immunohistochemistry (IHC) and its correlation with clinicopathological parameters and patients' outcome was analyzed. Results: The 63 esophageal spindle cell carcinoma accounted for 1.4% (63/4 439) of all ESCC. Of the 63 patients there were 55 males and 8 females, male to female ratio was 7∶1. The p53 protein mutation expression rate was 77.8% (49/63), including 14 cases with wild-type expression, 22 with nonsense mutation expression, and 27 with missense mutation expression. The concordance rate of p53 protein expression between carcinoma components and spindle cell components was 100%. Survival analysis showed that p53 protein mutation expression was significantly correlated with overall survival (OS, P=0.044), patients with p53 protein mutation expression had poorer OS. Conclusion: p53 protein expression is highly concordant in the squamous cell carcinoma components and spindle cell components of esophageal spindle cell carcinoma; its mutation expression is associated with poor outcome of the patients.

Is the Histopathological Subtype Important for Tumor Response to Irradiation in non-metastatic Esophageal Cancers

Esophageal cancer is still a health problem in middle income countries. The up-front treatment in localized disease is crucial for a better survival. Data from literature are in favor of a better response to radiotherapy of squamous histology. We have run a retrospective study to compare the response of histological subtypes of esophageal cancer to radiotherapy according to irradiation. Of 44 cases (53.7%) of squamous cell localized esophageal carcinoma and 38 (46.3%) of adenocarcinoma, the response after radiotherapy containing multimodal neoadjuvant treatment was 29.5% (13pts) versus 39.5% (15pts) (p=0.475). No correlation was found between histology and tumor shrinkage. Survival was found similar between the two subgroups. Indeed, median relapse free survival was 11 months for both groups with 95% CI [8.86-13.13] or 95% CI [4.526-17.47], log rank 0.394 and median overall survival was 12 months, 95% CI [9.44-14.55] in squamous versus 15 months, 95% [8.30-21.69] in adenocarcinoma cases, log rank 0.195. In univariate regression, the median relapse free survival was significantly associated with irradiation dose and the concomitance of chemotherapy to radiotherapy, while in multivariate analysis only the last variable remained significant: HR 0.425, 95% CI [0.225-0.806], p=0.009. Our analysis showed a tendency to a better response in adenocarcinoma esophageal cancer after multimodal radiotherapy containing treatment.

KRT 15 as a prognostic biomarker is highly expressed in esophageal carcinoma.

Aim: To investigate the expression and prognostic value of KRT 15 in esophageal carcinoma. Materials & methods: The expression levels of KRT 15 were measured in 128 cases of esophageal carcinoma and matched adjacent normal tissues by immunohistochemistry and Western blot assays. Results & conclusion: Western blot analysis shown the expression levels of KRT 15 in esophageal carcinoma were significantly higher compared with those in matched adjacent normal tissues (p < 0.001). immunohistochemistry result shown the high-expression rate of KRT 15 in esophageal carcinoma were 56.3%, which was significantly higher than those in normal tissues (35.9%; p = 0.002). KRT 15 high-expression correlated with T stage, lymph node metastasis, tumor node metastasis stage and prognosis (p < 0.05). These data indicate KRT 15 as a prognostic biomarker is highly expressed in esophageal carcinoma.

Removal of tumor thrombus from the azygos vein in an esophageal squamous cell carcinoma patient

BackgroundEsophageal squamous cell carcinoma with tumor thrombus in the arch of the azygos vein has not been reported to date. Neoadjuvant chemotherapy can decrease the stage in patients with advanced preoperative tumor staging, regaining surgical opportunities and significantly prolonging progression-free survival and overall survival. Herein, we present a case of esophageal squamous cell carcinoma accompanied by tumor thrombus in the arch of the azygos vein, and the patient underwent radical surgery after neoadjuvant chemotherapy.Case presentationA 63-year-old male with esophageal squamous cell carcinoma was found to have tumor thrombus formation in the arch of the azygos vein. Four courses of neoadjuvant chemotherapy with the TP regimen (paclitaxel plus nedaplatin) were given. Reexamination revealed a significant reduction in tumor and tumor thrombus volume. Therefore, McKeown radical resection for esophageal cancer and removal of the tumor thrombus in the arch of the azygos vein were performed. Postoperative pathology suggested complete remission of the esophageal tumor and the presence of small focal cancer tissues in the arch of the azygos vein.ConclusionWe report a case of esophageal squamous cell carcinoma with tumor thrombus formation in the azygos vein. We conducted radical resection after 4 rounds of neoadjuvant chemotherapy, and the pathological results revealed complete remission of the tumor. We report our experience addressing this rare case, and we hope to find the underlying mechanism of tumor thrombus formation and whether it has any effects on prognosis in our future study.

Tumoral Expression of CD166 in Human Esophageal Squamous Cell Carcinoma: Implications for Cancer Progression and Prognosis.

Accumulating data showed that cancer stem cells (CSCs) identified by cell surface markers contribute to the initiation, progression, and prognosis of human cancers. In this study, the expression of CSC candidates CD166, CD44, and Lgr5 in 65 cases of esophageal squamous cell carcinoma (ESCC) and 16 cases of control esophageal tissues were examined with immunohistochemistry (IHC). The correlation between tumoral expression levels of these CSC candidates and clinicopathological variables was analyzed. IHC results showed that the expression of CD166 in esophageal control tissues was completely negative, but it was in 87.69% (57/65) ESCC tissues. The expression of CD44 and Lgr5 did not differ between esophageal control tissues and ESCC tissues (p > 0.05). In addition, there were not correlations found among the expression levels of CD166, CD44, and Lgr5 in ESCC tissues. Clinicopathological analysis revealed that the tumoral expression level of CD166 correlated with lymph node involvement and TNM staging in patients with ESCC, and lower tumoral expression of CD44 was found in patients with advanced TNM staging. Kaplan-Meier survival curves suggested that expression level of CD166 appeared to have a negative impact on overall survival rate after surgery in patients with ESCC. Such impact was not found in other two CSC candidates. The authors therefore conclude that CD166 is a potential prognostic biomarker and correlates with advanced progression features in patients with ESCC.

Body mass index and risk of upper gastrointestinal cancer: A 30-year follow-up of the Linxian dysplasia nutrition intervention trial cohort

BackgroundAlthough a number of previous studies have noted the association between body mass index (BMI) and upper gastrointestinal (UGI) cancer risk, little evidence exists in the Chinese esophageal squamous dysplasia population. This prospective study investigated the association between BMI and UGI cancer risk in the Linxian Dysplasia Nutrition Intervention Trial (NIT) cohort. MethodsA total of 3298 participants were included in the final analysis. Asian-specific BMI cut-offs were used to define BMI subgroups: underweight <18.5 kg/m2, normal ≥18.5 to <24 kg/m2 and overweight or obese ≥24 kg/m2. Hazard ratios (HRs) and 95 % confidence intervals (95 %CIs) were estimated using the Cox proportional hazard model. ResultsDuring over 30 years of follow-up we identified 654 incident esophageal squamous-cell carcinoma (ESCC) cases and 434 gastric cancer cases which included 88 gastric non-cardia carcinoma (GNCC) and 346 gastric cardia carcinoma (GCC) cases. Relative to normal weight, overweight or obesity were associated with a significantly reduced risk of ESCC (HR 0.69, 95 %CI 0.48–0.98) after multivariate adjustment, including age at baseline, gender, smoking, drinking, family history of cancer, education and consumption of fresh fruit. Subgroup analyses found that clear effects were evident in women and subjects with a family history of cancer. No association with gastric cancer was observed in any subjects or subgroups. ConclusionOverweight/obesity was associated with decreased risk of ESCC in this dysplasia population, particularly in women and persons who had a family history of cancer. Future studies are needed to confirm these findings.

A Case of Esophageal Carcinoma who Developed Disturbance of Consciousness due to Hyperammonemia during Neoadjuvant Chemotherapy

A Case of Esophageal Carcinoma who Developed Disturbance of Consciousness due to Hyperammonemia during Neoadjuvant Chemotherapy

Case of Concurrent Esophageal Neuroendocrine Carcinoma and Squamous Cell Carcinoma

Case of Concurrent Esophageal Neuroendocrine Carcinoma and Squamous Cell Carcinoma

A Resected Case of Esophageal Basaloid Squamous Cell Carcinoma Demonstrating a Complete Response to Neoadjuvant Chemotherapy of 5-FU and Nedaplatin

A Resected Case of Esophageal Basaloid Squamous Cell Carcinoma Demonstrating a Complete Response to Neoadjuvant Chemotherapy of 5-FU and Nedaplatin

Clinical Features and Advantages of a Novel Percutaneous Endoscopic Gastrostomy Method.

BackgroundTo study the clinical characteristics of novel percutaneous endoscopic gastrostomy.Material/MethodsWe retrospectively analyzed the hospital records of 173 patients undergoing various methods of gastrostomy (a novel PEG, traditional PEG, and surgical gastrostomy). Clinical characteristics were analyzed. For the novel PEG, the operation was as same as the traditional method for initial steps until the annular guide wire was inserted. The following steps were different: water was injected through an injection port to expand the capsule, then the water sac was confirmed to be close to the gastric wall under endoscope, and, finally, the incision was sutured and covered.ResultsPatient ages ranged from 42 to 93 years (60.8±9.2 years, 91 males and 82 females). Among all patients, there were 27 cases of brain trauma, 42 cases of cerebral infarction, 74 cases of esophageal or cardiac carcinoma, 21 cases of laryngocarcinoma, and 9 cases of Alzheimer disease. Clinical features were significantly better for novel PEG compared to traditional PEG: duration of operation (19.75±3.14 min vs. 37.86±5.33 min and 54.12±9.48 min, P<0.001), intraoperative blood loss (27.14±3.63 ml vs. 43.53±6.24 ml and 75.78±12.41 ml, P<0.001), postoperative pain score (1.12±0.19 pts vs. 3.85±0.44 pts and 6.22±1.06 pts; P<0.001), infection rate (1.35% vs. 3.77% and 2.17%, P<0.001), length of hospital stay (3.16±0.42 d vs. 5.68±0.78 d and 8.29±1.31 d, P<0.001), and time to free activity (2.24±0.26h vs. 3.74±0.48 h and 14.85±2.38 d, P<0.001). The incidence of complications such as wound infection (1.35% vs. 3.77% and 4.76%), vomiting (1.35% vs. 5.66% and 6.52%), and nausea (2.70% vs. 1.88% and 6.52%) in the novel PEG group was lower than in the other groups (P<0.0001). Improved outcomes were obtained without increased medical costs in the novel PEG group.ConclusionsFor patients with difficult postoperative oral nutrition, the novel PEG treatment resulted in overall better clinical outcomes than traditional PEG.

Comparison of survival between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy followed by surgery for esophageal squamous cell carcinoma

Objective To compare the effect of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on the survival of patients with esophageal cancer. Methods Clinical data of 275 cases of thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were analyzed retrospectively. The data of treatment and follow-up were complete and analyzable. There were 70 cases in the NCRT group and 205 cases in the NCT group. The survival rate was calculated by Kaplan-Meier method and statistically compared by log-rank test, and multivariate analysis was performed by Cox regression model. Results The median follow-up time was 32(3-84) months. The median survival time and recurrence-free survival time was 42(3-84) months and 30(3-84) months, respectively. The overall 3-and 5-year survival rates were 56.8% and 45.9%, respectively, and the 3-and 5-year recurrence-free survival rates were 45.1% and 38.9%, respectively. The median survival time in the NCRT and NCT groups was 46(7-84) and 40(4-74) months, and the median recurrence-free survival time was 31(3-84) and 28(3-69) months, respectively. The 3-and 5-year overall survival of the two groups were 59.1%, 47.1% and 56.3%, 47.5%(P=0.515), and the 3-and 5-year recurrence-free survival were 44.5%, 40.1% and 47%, 39%, respectively. There was no significant difference in the survival between two neoadjuvant therapy modes (P=0.554). Multivariate analysis showed that postoperative pathological TNM staging was an independent factor affecting the prognosis of patients with esophageal cancer (P=0.001). Conclusions The survival results of NCRT are similar to those of NCT. Postoperative pathological staging is an independent survival factor. Key words: Esophageal neoplasm/neoadjuvant radiotherapy; Esophageal neoplasm/neoadjuvant chemotherapy; Prognosis

138P - Incidence of supracarinal lymph node positivity in operated cases of total esophagectomy: Short term results from a tertiary cancer centre

BackgroundThe extent of lymphadenectomy in esophageal carcinoma (EC) has been subject of debate since several decades. Published literature is lacking in concrete evidence of supracarinal pathological lymph node (LN) involvement in middle and lower third EC, and its impact on oncologic outcomes. We present short-term institutional data for the rate of pathological supracarinal LN positivity in operated cases of EC. MethodsA prospective study was conducted with ethics approval from April 2017 to August 2018. Patients of mid or lower third EC who were candidates for surgery were included. A supracarinal dissection was carried out separately in all the patients in addition to the standard two-field lymphadanectomy. Harvested nodal stations were labeled individually according to the Japanese Esophageal Classification and sent for histopathological examination. Outcomes were recorded in the postoperative period as well as during follow-up. ResultsOf the 76 patients that underwent an esophagectomy, 73 were squamous cell carcinomas whereas only 3 were adenocarcinomas. 44 (57.9%) of patients were stage II, 22 (28.9%) were stage III, and 7 (9.2%) were stage IB. 44 (57.9%) patients had prior chemoradiation, 9 (11.8%) had neoadjuvant chemotherapy whereas 18 (23.6%) did not receive any therapy prior to surgery. 26 (34.2%) cases were found to have pathological mediastinal nodes, of which supracarinal pathological nodes were found in 20 (26.3%) patients. Pathological supracarinal nodes were found in 16/51 (31.37%) patients with tumors of the middle one-third, and in 4/25 (16%) patients with lower one-third tumors. Average supracarinal LN yield was 10.33 (range- 2-32) nodes. 5 (6.5%) patients had only supracarinal LN positive for malignancy. 5 (6.57%) patients had pulmonary complications, 4 (4.52%) had RLN injury/ permanent hoarseness, and 6 (7.8%) had an anastomotic leak. In-hospital mortality was 4(5.2%). ConclusionsExtended two field with supracarinal lymphadenectomy is strongly recommended in cases of middle third EC, who have received neoadjuvant treatment, although it should be considered even for lower third or gastroesophageal junction tumors. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Immunohistochemical analysis of tumor budding as predictor of lymph node metastasis from superficial esophageal squamous cell carcinoma.

Tumor budding is known predictors of lymph node metastasis from esophageal squamous cell carcinoma. However, it is not easy to detect such small cell clusters on hematoxylin-eosin (HE) staining. Therefore, we evaluated tumor budding using immunohistochemistry (IHC) for epithelial cell markers. We analyzed tumor budding in 50 cases of superficial esophageal squamous cell carcinoma. We evaluated the impact of clinicopathological factors and tumor budding to predict lymph node metastasis. A total of 565 tumor sections were assessed using HE staining and IHC for cytokeratin 5/6. Based on receiver operating characteristic curves, the cut-off values for high-grade tumor budding evaluated using HE staining or IHC were 2 and 11, respectively. High-grade tumor budding evaluated using HE staining (P = 0.007) and IHC (P ≤ 0.001) were significantly correlated with lymph node metastasis. For tumors with pT1a-MM to pT1b-SM1, high-grade tumor budding evaluated using IHC was correlated with lymph node metastasis (P = 0.050). Tumor budding was significantly associated with lymph node metastasis. The optimal cut-off values of tumor budding on HE staining and tumor budding on IHC were 2 and 11, respectively. Even though both tumor budding on HE staining and tumor budding on IHC were significantly associated with lymph node metastasis, tumor budding on IHC tend to be more associated with lymph node metastasis.

1843 A Rare Case of Large Cell Neuroendocrine Carcinoma of the Esophagus

INTRODUCTION: Neuroendocrine Tumors (NETs) are a rare form of esophageal malignancy with an incidence ranging from 0.4 and 2% of all malignant esophageal tumors (1). Among esophageal NETs, the vast majority are small cell esophageal carcinomas. A recent literature review found only 35 cases of large cell esophageal carcinoma have been reported since 1952 (2). CASE DESCRIPTION/METHODS: Patient is a 48-year-old male with past medical history of HTN, diabetes, and HLD who presented with 6 weeks of progressive dysphagia predominantly to solids. The dysphagia was initially infrequent, but eventually occurred every time he ate. ROS was pertinent for a 20 lb weight loss. Social history was pertinent for 1-2 drinks of alcohol per month and daily use of chewing tobacco. Family history revealed a mother with a brain mass and a grandmother with pancreatic CA. PE was normal. He underwent an EGD which showed a large, ulcerative distal esophageal mass extending into gastric cardia. Biopsies revealed a poorly differentiated carcinoma most compatible with large cell neuroendocrine carcinoma. CT imaging of chest, abdomen, and pelvis showed nonspecific lower esophageal mural thickening with no evidence of esophageal mass. PET scan showed hypermetabolic distal esophageal mass measuring 6 x 5 x 3 cm with peri gastric lymph node involvement. The patient underwent neoadjuvant treatment with radiation, cisplatin and etoposide followed by a distal esophagectomy with gastric pull-through. Surgical path revealed Stage III large cell neuroendocrine carcinoma involving the distal esophagus, proximal stomach, and peri gastric lymph nodes. Patient is currently recovering from the surgery with plans for postoperative chemotherapy. DISCUSSION: This case illustrates an rare form of a malignant esophageal neuroendocrine tumor. Esophageal NETs tend to be more aggressive than NETs found in other parts of the GI tract, so early diagnosis and treatment is critical in order to prolong survival. Due to a paucity of cases in the literature, there is a need for more cases to be presented in order to better understand the course of the disease and determine the best modalities for treatment.

2863 Epidemiological and Clinical Characteristics of Esophageal Carcinoma: A Four-Year Experience From Largest Referral Centre of Karachi, Pakistan

INTRODUCTION: Esophageal cancer (EC) is an aggressive tumor that carries a poor prognosis. EC is the fourth commonest malignant tumor reported in Pakistan. Objective of this study was to assess epidemiological and clinical characteristics of EC, identified over a 4-year period at the largest referral centre of Karachi, Pakistan. METHODS: This retrospective study covered all histopathologically confirmed cases of esophageal carcinoma from endoscopic biopsy, seen within the 4-year period from January 2015 to December 2018. RESULTS: Over the period of 4 years, 548 patients with EC had been identified, 45 patients were excluded due to incomplete records. Their ages ranged from 15 to 92 years with a mean of 49.20 years (SD ± 14.35). Female were 286 (56.9%) and male 217 (43.1%). Dysphagia and weight loss were the most common symptoms. Most of the patients were belong to the province of Sindh 420 (83.5%). Beetle nuts, pan and gutka were the most predominant risk factors in 378(75.1%) of patients. The most common cancer subtype was squamous cell carcinoma (SCC), which included 417(83%) patients. Adenocarcinoma (AC) was diagnosed in 86 (17%) of patients. EC predominantly involved mid to distal esophagus (64%). CONCLUSION: Esophageal carcinoma is one of the most prevalent cancers in Pakistan, and its incidence is increasing day by day. The reason for raised incidence was associated with increased consumption of beetle nuts and gutka in certain parts of the country. It is hoped that this study will be an important step towards developing a comprehensive laws against consumption of gutka and beetle nuts.

Clinical Significance of Serum Chemokines in Esophageal Cancer.

BackgroundThe aim of this study was to detect the expression levels of chemokines (CX3CL1, CXCL-11, CXCL-12, CCL3, CCL4, and CCL20) in the serum of esophageal cancer patients and a normal control group, and to explore the correlations of those expression levels with the pathological type, progression, and metastasis of esophageal cancer.Material/MethodsA total of 50 normal people and 50 untreated patients initially diagnosed with esophageal cancer (including 17 cases of non-metastatic esophageal cancer, 33 cases of metastatic esophageal cancer, 36 cases of esophageal squamous cell carcinoma and 14 cases of esophageal adenocarcinoma) were collected. The liquid chip (Luminex) technology was applied to detect the expression levels of the above-mentioned serum chemokines in the two groups. The results were analyzed using Statistical Product and Service Solution 20.0 software.ResultsThe expression levels of CX3CL1, CXCL-12, and CCL20 in esophageal cancer group were evidently higher than those in normal control group (P<0.001, P<0.001 and P=0.003, respectively). There were no statistically significant differences in chemokine expressions between metastatic esophageal cancer group and non-metastatic esophageal cancer group (P>0.05). The expression level of serum CCL4 in esophageal adenocarcinoma group was remarkably higher than that in esophageal squamous cell carcinoma group [18.45 (11.94) versus 13.37 (9.29), Z=−2.039, P=0.031]. In esophageal cancer group and normal control group, the serum CX3CL1 was positively correlated with CCL20 (r=0.649, P<0.001, r=0.758, P<0.001).ConclusionsThe expressions of serum CX3CL1, CXCL-12, and CCL20 are increased markedly in the patients, which may promote the occurrence, development and metastasis of esophageal cancer.

Gross tumor volume is an independent prognostic factor in patients with postoperative locoregional recurrence of esophageal squamous cell carcinoma.

Many cases of esophageal squamous cell carcinoma (ESCC) involve lymph node and distant metastases after esophagectomy, and most patients relapse within 2 years. Intensity-modulated radiotherapy (IMRT) is an important treatment for these cases of recurrence in ESCC and is widely used in clinical practice. A retrospective study of 137 postoperative patients with locoregional recurrences of ESCC who received IMRT was carried out. Kaplan-Meier survival curves and log-rank tests of univariate analysis was performed to assess whether there was a significant association between demographic and clinical features and death after recurrence. For multivariate analysis, the statistically significant results from the Kaplan-Meier method were subjected to Cox regression analysis. A total of 109 male and 28 female patients were included. There were 21 (15.3%), 58 (42.3%), 36 (26.3%), 3 (2.2%), 17 (12.4%), and 2 (1.5%) recurrences in the anastomotic, supraclavicular, mediastinal, tumor bed, polyregional, and abdominal regions, respectively. Univariate analysis showed that the gross tumor volume (GTV) of radiation (<27 vs. ≥27 cm3) and the number of lymph nodes were significantly associated with survival. The survival rates of patients at 1, 2, 3 and 5 years with GTV<27 cm3 were 72.7, 51.5, 37.1 and 25.9%, respectively, and with GTV≥27 cm3 were 63.7, 26.9, 17.9 and 0%, respectively. The significant independent prognostic factor was GTV [<27 vs. ≥27 cm3; hazard ratio (HR), 1.746; 95% confidence interval (CI), 1.112–2.741]. In conclusion, GTV of radiation (<27 vs. ≥27 cm3) is an independent factor in predicting locoregional recurrence after ESCC. Patients with GTV<27 cm3 are likely to have a better prognosis.

Interventional therapy of late onset tracheal stenosis after implantation of 125Iodine seed esophageal stent

This study reported a case of late-staged esophageal carcinoma, complicated by severe dyspha late onset tracheal stenosis after treating with 125 Iodine seed stent implantation. The patient had progressive stenosis of the lower segment (left main trachea) at 6, 26, and 47 days postoperatively. The cause of stenosis might be related to direct press by stent, tumor proliferation, the aortic arch with violate pulsate and the complications caused by other therapies. Due to its short clinical utilization, 125 Iodine seed stent may present some fatal complications. Therefore, the long-term efficacy of 125 Iodine seed stent remains to be studied. Keyword: 125 Iodine seed, esophagus stent, late onset, tracheal stenosis, complication

Expression of PLOD2 in esophageal squamous cell carcinoma and its correlation with invasion and metastasis

Objective: To investigate PLOD2 expression in esophageal squamous cell carcinoma, and to explore the potential mechanism by which PLOD2 promotes tumor metastasis. Methods: The expression of PLOD2 in 60 cases of esophageal squamous cell carcinoma (the patients were collected at the first Affiliated Hospital of Xinxiang Medical University, from January 2016 to December 2017) was investigated by immunohistochemistry. Fibrillar collagen formation and collagen deposition were detected by picrosirius red staining. Correlation of PLOD2 expression with clinical pathologic features of the patients was performed using χ(2) test and Kaplan-Meier analysis. After EC-109 cells were transfected with LV-vector and LV-over/PLOD2, the expression of PLOD2 was detected by real time PCR and the impact of POLD2 on invasion in EC-109 cells was determined by transwell migration and invasion assays. The expression of PLOD2/AKT epithelial-to-mesenchymal transition signal pathway related proteins was detected by Western blot. Results: The expression level of PLOD2 in esophageal squamous cell carcinoma was 81.7% (49/60 cases),higher than their paired noncancerous tissues(8.3%, 5/60; P<0.01), and correlated significantly with tumor depth of invasion and nodal metastasis (P<0.01). Picrosirius red staining showed that collagen deposition was increased and the degree of fibrillar organization was enhanced in carcinoma tissues that had higher PLOD2 expression. Transwell migration and invasion assays showed that PLOD2 significantly promoted the migration and invasion ability of EC-109 cells. Western blot showed that PLOD2 significantly increased the expression levels of p-FAK, p-AKT and vimentin in EC-109 cells. Conclusions: Esophageal squamous cell carcinoma has a high expression of PLOD2 that correlates with tumor invasion and lymph node metastasis. PLOD2 promotes invasion and metastasis of esophageal squamous cell carcinoma through epithelial-to-mesenchymal transition via FAK/AKT signal pathway.