Esophageal Carcinoma Patients Research Articles

Survival comparision of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma

PurposeRadiotherapy is the main treatment method for patients with locally advanced, unresectable esophageal cancer. The aim of this study is to compare overall survival (OS) using 3D radiotherapy (3DRT) alone with concurrent chemoradiotherapy (CCRT) in 296 non-surgical esophageal carcinoma patients. Patents and methodsOver 10 years, of the 480 patients with esophageal carcinoma treated with 3DRT with or without chemotherapy, 148 patients each comprised 3DRT and CCRT groups after propensity score matching. ResultsThe 5- and 10-year OS (P=0.337) and PFS (P=0.715) rates for 3DRT alone were 22.0%, 14.4% and 26.1%, 23.2%, respectively, compared with 28.8%, 18.6% and 34.7%, 29.1% for CCRT, respectively. CCRT did not improve 5-year and 10-year OS or PFS in 60–70Gy group (OS: 27.5% and 25.2%; 17.9% and 17.0%, P=0.938; PFS: 38.3% and 31.8%; 31.9% and 27.8%, P=0.890) nor reduce 10-year hematogenous metastasis (31.7% and 28.3%, P=0.698). CCRT improved 5-year OS and PFS of 50.0–59.9Gy group (OS: 33.3% and 12.0%, P=0.029; PFS: 33.1% and 10.6%, P=0.081). For 3DRT, the 5-year OS and PFS rates were significantly better in the 60–70Gy group (P=0.017) compared with 50.0–59.9Gy group (P=0.002). For CCRT group, 5-year OS and PFS favored the 50.0–59.9Gy group, but the difference was insignificant. Major toxicities were greater with CCRT compared with 3DRT. ConclusionFor non-surgical esophageal carcinoma patients, 3DRT combined with CCRT was effective in prolonging both OS and PFS.

Identification of upper gastrointestinal malignancy in patients with uncomplicated dyspepsia referred under the two-week-wait cancer pathway: a single-centre, 10-year experience.

In the United Kingdom, the National Institute for Health and Care Excellence 2015 guidance recommend that for suspected gastric or oesophageal cancer, general practitioners consider a non-urgent, direct-access endoscopy in patients over 55 years with only uncomplicated treatment-resistant dyspepsia. In practice, patients are referred under the urgent 2-week-wait cancer pathway. We compared the frequency of gastric or oesophageal carcinoma in patients referred to our centre on the 2-week-wait pathway with uncomplicated dyspepsia to those who have a combination of additional alarm symptoms. The four most common indications for endoscopy referral on the 2-week-wait pathway and all combinations of those indications were examined: Dyspepsia ('ulcer-like', 'non-ulcer-like' or 'reflux-like' dyspepsia), anaemia, weight loss or dysphagia. Over 10 years, 9012 two-week-wait gastroscopies were performed, and a tumour was identified in 256 patients (2.84%). One thousand and three hundred six gastroscopies performed for uncomplicated dyspepsia and only 6 patients (0.46%) had a tumour. Therefore, uncomplicated dyspepsia alone had a poor positive predictive value of detecting gastric or oesophageal cancer. Our findings suggest dyspepsia had no significant cumulative effect on the number of patients with anaemia or weight loss found to have a lesion at endoscopy but indeed significantly decreased the likelihood of finding a tumour in those with dysphagia. Dyspepsia as a parameter to investigate gastric or oesophageal cancer contributes significantly to the growth in number of 2-week-wait referrals at a time when endoscopy units battle to meet demand. Our data show patients with uncomplicated dyspepsia rarely have gastric or oesophageal cancer and should not undergo endoscopies under the urgent 2-week-wait pathway.

Evaluation of Roles of MicroRNA-21 and MicroRNA-18a in Esophageal Squamous Cell Carcinoma and Comparison of Their Changes in Expression Post-Chemoradiotherapy.

BackgroundA number of circulating microRNAs (miRNAs) have been reported to be highly expressed in several cancers; whether their expression is associated with clinicopathological factors and prognosis in patients of esophageal squamous cell carcinoma (ESCC) is still under investigation. Although studies have demonstrated their overexpression in tissues of ESCC, there are limited data for circulating miRNAs. Aim of this study was to evaluate the expressions of miRNA-21 and miRNA-18a in patients of ESCC and the effect of chemoradiotherapy (CRT) on expression of these miRNAs.MethodsThis was a case-control study conducted from September 2014 to December 2015 at Sri Aurobindo Medical College and Postgraduate Institute, Indore, India. We compared the expression of miRNA-21 and miRNA-18a in 30 ESCC patients and 30 healthy controls using TaqMan probe-based quantitative real-time polymerase chain reaction (qRT-PCR) and changes in the expression in 16 patients of ESCC, who completed CRT.ResultsBoth miRNA-21 and miRNA-18a had significantly higher levels of expression in ESCC patients than healthy controls (95% confidence interval (CI): 5.73 - 34.79; P < 0.002 and 95% CI: 3,361.36 - 6,744.23; P < 0.001), respectively. Receiver operating characteristic (ROC) curve analysis showed that combination of serum miRNA-18a and miRNA-21 overexpression could efficiently distinguish patients of ESCC from healthy controls. The miRNA-21 expression positively correlated with tumor invasion (P < 0.004), lymphatic metastasis (P < 0.011), distant metastasis (P < 0.038), and tumor stage (P < 0.001); however, there was no such association observed with miRNA-18a. In the treatment phase (post-CRT), a significant reduction (P < 0.001) was observed in both miRNAs (73.4% in miRNA-18a and 81.02% in miRNA-21).ConclusionsBoth miRNA-21 and miRNA-18a were highly overexpressed in patients of ESCC and their expressions changed significantly with CRT. These miRNAs may be useful tools for the diagnosis and assessment of treatment response in ESCC patients. Further studies will be needed to validate these findings using large number of patients.

Development and Validation of an Individualized Nomogram for Predicting Survival in Patients with Esophageal Carcinoma after Resection.

An accurate estimation of prognosis of the esophageal carcinoma patients after surgery is urgently needed. Clinical nomogram has been developed to quantify risk by incorporating prognostic factors for individual patient. Based on the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013, a total of 4566 patients were selected. Of those, 3198 patients were assigned to training set to construct the nomogram, which incorporated age, gender, histology, grade, T stage, N stage, nodes examined, radiation and chemotherapy. The calibration curve for probability of survival showed good agreement between prediction by nomogram and actual observation. The C-index of the nomogram was 0.71(95%CI 0.70-0.72), which was statistically higher than the TNM staging system. The results were then validated using bootstrap resampling and a validation set of 1368 patients in the SEER database. Besides, in the esophageal squamous cell carcinoma and esophageal adenocarcinoma subgroups, the nomogram discrimination was superior to the TNM staging system. It is likely that these results would play a supplementary role in the current staging system and help to identify the high risk population after surgery.

Overexpression of METTL3 associated with the metabolic status on 18F-FDG PET/CT in patients with Esophageal Carcinoma.

Background: To investigate the expression of methyltransferase 3 (METTL3) and its relationship with 18F-FDG uptake in patients with esophageal carcinoma (ESCA).Materials and methods: This study analyzed the expression of METTL3 in ESCA and its relationship with clinicopathological features by The Cancer Genome Atlas (TCGA) database. Immunohistochemical staining was performed on 57 tumor tissues of ESCA patients who underwent PET/CT scan before surgery to evaluate the expression of METTL3, glucose transporter 1 (GLUT1), and hexokinase 2 (HK2) in tumor tissues and peritumoral tissues. Analyze the relationship between SUVmax with METTL3, HK2, and GLUT1 expression.Results: The expression of METTL3, GLUT1, and HK2 was significantly increased in ESCA tissues compared with normal tissues (p < 0.001). The expression of METTL3 was correlated with tumor size and histological differentiation (p < 0.05), and there was no significant difference between age, sex, pathological types, tumor staging, or lymph node metastasis (p > 0.05). The SUVmax was significantly higher in tumors with high METTL3 expression (17.822±6.249) compared to low METTL3 expression (9.573±5.082) (p < 0.001). There was a positive correlation between the SUVmax and METTL3 expression in ESCA (r2 = 0.647, p < 0.001). Multivariate analysis confirmed the association between SUVmax and METTL3 expression (p < 0.05). GLUT1 and HK2 expression in ESCA was positively correlated with 18F-FDG uptake and METTL3 status (p < 0.001).Conclusions: The high expression of METTL3 is related to the high SUVmax in ESCA, and METTL3 may increase 18F-FDG uptake by regulating GLUT1 and HK2.

Study on incidence of oesophageal carcinoma in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital

Background: Oesophageal carcinoma is one of the leading causes of cancer related deaths worldwide and is also associated with high morbidity. Hence early diagnosis and treatment are the only effective way to improve survival and quality of life in oesophageal carcinoma patients. Early-stage oesophageal carcinoma are often asymptomatic and may also present with common upper gastrointestinal symptoms hence diagnosis of early oesophageal carcinoma is only based on detection of suspicious lesions through endoscopy and histopathological evaluation of biopsies from these suspicious lesions. The study is designed to see whether using alarming upper gastrointestinal symptoms, risk of oesophageal carcinoma in patients can be predicted.Methods: Present study comprises of 200 patients presenting with upper gastrointestinal symptoms at JSS Hospital, Chamarajanagar (both out patients and referred patients) during the period of October 2018 to December 2019, who underwent upper gastrointestinal endoscopy.Results: Out of 200 patients, 135 patients were males and 65 patients were females. According to the study, dysphagia was found to be a significant predictive factor and in contrary to the global statistics this study showed females aged more than 60 years were significantly at higher risk of developing oesophageal carcinoma.Conclusions: We recommend to do an early endoscopy for any patient presenting with upper gastrointestinal symptoms and to take multiple biopsies from any suspicious lesion especially for male gender older than 50 years and female gender older than 60 years presenting with dysphagia.

Expression and clinical significance of ribosome-binding protein 1 in esophageal carcinoma

Objective To investigate the expression and clinical significance of ribosome-binding protein 1 (RRBP1) in esophageal carcinoma. Methods A total of 120 esophageal carcinoma patients admitted to Yulin First Hospital of Shaanxi Province from January 2010 to December 2014 were enrolled in this study. RRBP1 expression was detected in esophageal carcinoma and matched adjacent normal tissues by real-time quantitative PCR (qRT-PCR), Western blotting and immunohistochemical staining. The relationships of RRBP1 expression with clinicopathological futures and prognosis were statistically analyzed. Results RRBP1 expression level was significantly higher in esophageal carcinoma tissues compared with matched adjacent normal tissues. In the mRNA level, the relative quantitative expression in tumor tissues was 3.5±1.3, and 1.0±0.3 in adjacent normal tissues, with a significant difference (t=19.130, P<0.001). In the protein level, the relative quantitative expression in tumor tissues was 1.0±0.4, and 0.3±0.1 in adjacent normal tissues, with a significant difference (t=4.225, P<0.001). The immunohistochemical results showed that RRBP1 high expression was found in 71 (59.2%) tumor tissues, and the proportion dropped to 11.7% (14/120) in adjacent normal tissues, with a significant difference (χ2=59.182, P<0.001). In addition, RRBP1 expression was correlated with lymph node metastasis and TNM stage (χ2=10.631, P=0.001; χ2=31.212, P<0.001). Survival analysis revealed that RRBP1 expression, lymph node metastasis and TNM stage were significantly correlated with patients′ prognosis (χ2=9.455, P=0.006; χ2=14.542, P<0.001; χ2=11.987, P<0.001). Cox regression analysis showed that high expression of RRBP1 (RR=2.441, 95%CI: 1.267-4.702, P=0.008), lymph node metastasis (RR=4.024, 95%CI: 2.180-7.424, P<0.001) and high TNM stage (RR=3.054, 95%CI: 1.452-6.421, P=0.003) were the risk factors for poor prognosis of esophageal carcinoma patients. Conclusion RRBP1 is highly expressed in esophageal carcinoma and can serve as a potential biomarker to predict patients′ prognosis. Key words: Esophageal neoplasms; Prognosis; Survival analysis; Ribosome-binding protein 1

Reduced miR-203 predicts metastasis and poor survival in esophageal carcinoma.

We analyzed data from two non-coding RNA profiling arrays made available by the Gene Expression Omnibus (GEO) and found 17 miRNAs with remarkable differential expression between malignant and normal esophageal tissue. Correlation analysis between expression of these 17 miRNAs and patients’ clinicopathological characteristics showed that miR-203 was down-regulated in esophageal carcinoma (EC) tissues and was significantly associated with lymph node metastasis and poor overall survival. Overexpression of miR-203 significantly attenuated cellular proliferation, migration and invasion by EC cells in culture. Additionally, gene expression profiles and bioinformatics analysis revealed KIF5C to be a direct target of miR-203, and KIF5C overexpression partially counteracted the tumor inhibitory effects of miR-203 on EC cells. We also observed that miR-203, reduced KIFC5 protein levels, promoted cytoplasmic accumulation of Axin2, and reversed the invasive phenotype of EC cells. Taken together, these data demonstrate that miR-203 is a tumor suppressor in EC cells and its expression level could potentially be used as a prognostic indicator for EC patient outcomes.

Adjuvant radiotherapy for patients with pathologic node-negative esophageal carcinoma: A population based propensity matching analysis.

BackgroundThe impact of adjuvant treatment for esophageal carcinoma with tumor‐negative lymph nodes after upfront radical esophagectomy is still uncertain. This study investigated the effects of postoperative radiotherapy in pT1‐3N0 esophageal carcinoma after radical resection.MethodWe retrospectively identified pT1‐3N0M0 esophageal carcinoma patients between 2000 and 2016 from the Surveillance, Epidemiology, and End Results database. Patients with upfront esophagectomy were categorized as having received surgery alone (SA) and surgical resection followed by adjuvant radiotherapy (SA + RT). Propensity score matching, univariate and multivariate analysis were performed to compare overall survival (OS) and cause‐specific survival (CSS).ResultsA total of 2862 patients were identified, of whom 274 received SA + RT and 2588 received SA. The median follow‐up was 60.4 months (95%CI, 58.7–62.1 months). The five‐year OS and CSS were better for SA group compared with SA + RT group (P < 0.001, respectively). Furthermore, after matching, the OS and CSS were still significantly better for SA patients. For T subgroup analysis, postoperative radiotherapy was an independent prognostic factor only for pT1 patients with worse OS, without survival differences for pT2 and pT3 patients. However, after multivariate cox analysis, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm (P = 0.03; 95%CI, 0.29–0.94).ConclusionsAmong pT1‐3N0M0 esophageal carcinoma patients, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm. However, there are no survival benefits for pT1‐2 patients after SA + RT procedure. This finding may have significant implications on the use of adjuvant radiation in patients with pN0 disease.

ADC correlation with Sirtuin1 to assess early chemoradiotherapy response of locally advanced esophageal carcinoma patients

AimsTo determine the biological correlation between apparent diffusion coefficient (ADC) values and Sirtuin1 (SIRT1) levels of tumour tissues in patients with esophageal carcinoma (EC), and to ascertain the treatment biomarker of ADC in predicting the early response of patients undergoing definitive chemoradiotherapy (CRT).MethodsA total of 66 patients were enrolled, and the specimens of tumour tissues were collected before treatment to perform immunohistochemical (IHC) examinations and quantify the levels of SIRT1. Then all patients were given two esophageal magnetic resonance imaging (MRI) examinations with diffused weighed imaging (DWI) including pretreatment and intra-treatment (1~2 weeks after the start of radiotherapy). The regions of interest (ROIs) were contoured according to the stipulated rules in advance using off-line software, and the values of the ADC in the ROIs were generated automatically. Then, the values of the ADC at baseline and intra-treatment were labeled as pre-ADC and intra-ADC respectively, and ΔADC, ADCratio were calculated. Pearson’s correlation coefficients were acquired to estimate the correlation between each of ADC values and SIRT1 levels. Spearman’s rank correlation coefficients were acquired to estimate the correlation between early response and the values of each ADC. Receptor operation characteristics (ROC) curves were constructed to estimate the accuracy of the ADC in predicting the early response of CRT.ResultsThe findings of this study showed different correlations between ADC values and the levels of SIRT1 (ΔADC: r = − 0.943, P = 0.002; ADCratio: r = − 0.911, P = 0.000; intra-ADC: r = − 0.748, P = 0.002; pre-ADC: r = 0.109, P = 0.558). There was a positive correlation between ΔADC and early response to treatment (ρ = 0.615, P = 0.023), and multivariable logistic regression revealed that ΔADC was significantly associated with short-term response of CRT in esophageal carcinoma patients.ConclusionsIn summary, early increases in ADC may facilitate the predication of early CRT response in patients with esophageal squamous cell carcinoma (ESCC), which may be attributed to the different correlation between ADC changes and SIRT1 expression.

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.

LncRNA CASC11 promotes the development of esophageal carcinoma by regulating KLF6.

The aim of this study was to investigate the expression level of long non-coding RNA (lncRNA) CASC11 in esophageal carcinoma (ECa), and to further explore its relationship with clinical progression, pathological parameters, and prognosis of ECa patients. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to examine the level of lncRNA CASC11 in 45 pairs of ECa tissues and adjacent normal tissues. The relationship between the lncRNA CASC11 level and clinical progression, pathological parameters, and prognosis of ECa patients was analyzed. Meanwhile, the level of lncRNA CASC11 in the ECa cell lines was verified by qPCR as well. In addition, lncRNA CASC11 knockdown model was constructed using lentiviral transfection in ECa cell lines. Subsequently, the cell counting kit-8 (CCK8), colony formation assay, and flow cytometry were used to explore the effect of lncRNA CASC11 on the biological functions of the ECa cells. Finally, the Western Blot and the recovery experiments were used to explore the potential mechanism. In this work, the qPCR results showed that the expression level of lncRNA CASC11 in the ECa tissues was remarkably higher than that of the adjacent normal tissues, and the difference was statistically significant (p<0.05). Compared with patients with a low level of lncRNA CASC11, the pathological stage of patients with high expression was significantly higher, while the overall survival rate was lower (p<0.05). Compared with negative control (NC) group, the proliferation ability of the cells in the lncRNA CASC11 knockdown group CASC11 significantly decreased, whereas cell apoptosis remarkably increased (p<0.05). The Western Blot results revealed that protein expression of KLF6 was remarkably up-regulated after lncRNA CASC11 knockdown. In addition, the recovery experiments found that lncRNA CASC11 and KLF6 had mutual regulation, thereby promoting the malignant progression of ECa. LncRNA CASC11 expression was remarkably up-regulated in ECa, which was associated with the pathological stage and poor prognosis of ECa. In addition, lncRNA CASC11 could promote the malignant progression of ECa by mutual regulation of KLF6.

Effectiveness and safety of bovine pericardium patch repair for cervical anastomotic leakage after oesophagectomy for cancer.

The objective of this study is to evaluate the effectiveness and safety of bovine pericardium patch (BPP) repair for cervical anastomotic leakage after esophageal squamous cancer. Intractable cervical anastomotic leakage developed in 7 patients of esophageal squamous cell carcinoma undergoing cervical anastomosis. These patients received the BPP repair. The necrotic tissue around the cervical anastomosis was removed during the operation, and the defect was repaired with BPP according to the size of the leakage. The operative duration was 60-90 min (median, 75 min). There were no signs of recurrent anastomotic leakage in each patient undergoing BPP repair. Oral intake was initiated 5-8 days (median, 6 days) after the BPP repair operation without any discomfort. The BPP repair is a safe and effective processing scheme for patients with cervical anastomotic fistula after resection of esophageal squamous cell carcinoma. This method may be recommended for appropriate patients with intractable cervical anastomotic fistula.

Systemic Immune Inflammation Index, Lowest Total Lymphocyte Count and Hemoglobin Level Are Prognostic Factors in Patients with Postoperative Recurrence of Esophageal Carcinoma Treated with Salvage Radiotherapy and Chemotherapy

To analyze the effects of clinical features, chemoradiotherapy related factors, hematological different nutritional indexes, and inflammatory indexes on the survival of postoperative recurrence of esophageal carcinoma treated with salvage chemoradiotherapy, and to explore the predictive factors of treatment-related toxic and side effects. A total of 242 postoperative esophageal carcinoma patients with local/regional recurrence during January 2008 to December 2016 treated with chemoradiotherapy were analyzed. Recurrence included anastomotic recurrence and regional lymph node metastasis (supraclavicular, mediastinal, and abdominal lymph node metastasis involved). The clinical features (sex, age, tumor location, T stage, N stage, TNM stage, regional recurrence site, number of recurrence areas, postoperative recurrence time), chemoradiotherapy related factors (post-recurrence treatment, radiotherapy target area, radiotherapy dose, chemotherapy regimen, chemotherapy cycle), hematological inflammation related indicators, including the absolute monocyte count (AMC), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation score (SIS), and hematological nutrition-related indicators, including total lymphocyte count (TLC), hemoglobin (HB), albumin (ALB), prognostic nutritional index (PNI)，body mass index (BMI) on survival, toxic and side effects were analyzed. The median survival time was 16.6 months, and the 1-, 2-, 3-and 5-year survival rates were 65.6%, 36.7%, 25.5% and 11.5%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, chemotherapy cycle, NLR level, PLR level, LMR level, SII level, HB level, PNI level before chemoradiotherapy, and the minimum level of TLC during chemoradiotherapy were the influencing factors of OS. Multivariate analysis showed that the minimum level of TLC during chemoradiotherapy, SII and HB level before chemoradiotherapy were independent influencing factors of OS (P=0.001; P=0.009; P=0.009, respectively). AMC level, HB level and TLC minimum level were the main factors affecting hematological toxicity. The incidence of grade 2 hematological toxicity in the high AMC group was similar to that in the low AMC group, and the incidence of the non-anemia group and the G0-2 group in the lowest TLC was even lower than that in the corresponding group. No factors affecting hematological toxicity and radiation pneumonia were found in hematology. The minimum level of TLC during chemoradiotherapy, the level of SII and HB before chemoradiotherapy were the independent prognostic factors for postoperative esophageal carcinoma patients treated with salvage chemoradiotherapy.

The role of prostaglandin E receptor 2 and epidermal growth factor receptor in esophageal squamous cell carcinoma patients with (pN+) regional lymph node metastasis

Background: To find the relationship between prostaglandin E receptor 2 (EP2) and epidermal growth factor receptor (EGFR) in esophageal squamous cell carcinoma (ESCC) patients with regional lymph nodes metastasis (pN+) who had undergone curative resection, and to analyze them in the role of judging prognosis. Methods: Sixty-three patients with ESCC who underwent attempted curative esophagectomy with lymph node metastasis were collected. Immunohistochemistry (IHC) was used to analyse the expression of EP2 and EGFR in tumor tissues. We analyzed the relationship between the two markers. Furthermore, we analyzed the role of EP2 and EGFR in disease-free survival (DFS) and overall survival (OS). Results: The expression rate of EP2 and EGFR in this study were 73.0%, 85.7%, respectively. And the EP2 status was closely related with the expression of EGFR in tumor tissues (χ 2 =0.260, P=0.011). The patients with EP 2 or EGFR positive expression had a shorter DFS and OS than the negative group. Further analysis found EGFR is an important prognostic factor for DFS and OS (P 0.05). Conclusions: The expression of EP2 and EGFR were high in tumor tissues of (pN+) ESCC, and they are playing a key role in the prognosis of ESCC patients with local lymph node metastases.

Total mesoesophagus excision by thoracoscopy and laparoscopy for a 53-year-old esophageal carcinoma patient

Total mesoesophagus excision by thoracoscopy and laparoscopy for a 53-year-old esophageal carcinoma patient

Effect of tumor length on clinical stage for non-operative esophageal squamous cell carcinoma patients—multicenter retrospective data analysis (3JECROG R-01D)

Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients. Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed. The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC. Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively. The Cox multivariate analysis showed that treatment moda, aga, alinical stage and tumor length were independent prognostic factors. The median, 1-, 3-, and 5-year OS were 28.9 months, 77.3%, 45.0%, and 36.3% versus 21.9 months, 69.9%, 37.9%, and 28.1% for patients with ≤5 cm and patients>5 cm respectively (P 5 cm group (P=0.303). And for stage Ⅲ patienta, ahe median OS were 23.9 and 19.3 months respectively in ≤5 cm group and>5 cm group (P 5 cm group (P<0.001). Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy. The tumor length may be helpful in clinical staging of ESCa, aspecially for stage Ⅲ and N1. Key words: Esophageal neoplasms/radiotherapy; Tumor length; Clinical stage; Prognosis

Outcomes of combined modality neoadjuvant chemoradiotherapy (CRT) and surgery in resectable esophageal carcinoma patients treated at a tertiary cancer care centre

Outcomes of combined modality neoadjuvant chemoradiotherapy (CRT) and surgery in resectable esophageal carcinoma patients treated at a tertiary cancer care centre

Rac GTPase-Activating Protein 1 (RACGAP1) as an Oncogenic Enhancer in Esophageal Carcinoma

Purpose: Rac GTPase-activating protein 1 (RACGAP1) is associated with cell proliferation, and there is much evidence of its oncogenic role. This study investigated the clinical importance and functional role of RACGAP1 in esophageal carcinoma (EC). Methods: A total of 81 EC patients were enrolled in the study. We assessed the immunohistochemical score of EC tissues and adjacent normal esophageal mucosae, and then performed multiple cell function tests by means of in vitro experiments to elucidate the functional role of RACGAP1 using RNA interference technology in EC cell lines. Results: RACGAP1 was significantly overexpressed in EC tissues compared with the adjacent normal esophageal mucosae (p < 0.0001). Moreover, RACGAP1 overexpression was significantly correlated with poor overall survival (p = 0.032) and disease-free survival (p = 0.012) in EC patients. High RACGAP1 expression was also significantly correlated with the presence of lymphatic invasion (p = 0.012), vessel invasion (p = 0.003), and advanced TNM (tumor-node-metastasis) stage (p = 0.046) in EC patients. In vitro analysis demonstrated that RACGAP1 was involved in the proliferation, tumorigenicity, invasion, migration, and anoikis resistance in EC cells. Conclusions: RACGAP1 plays a pivotal role in EC development, suggesting that it could be used as an indicator of prognosis in EC patients.

Prediction of lymph node metastatic status in superficial esophageal squamous cell carcinoma using an assessment model combining clinical characteristics and pathologic results: A retrospective cohort study.

It is important to identify the risk of lymph node metastasis (LNM) in patients with superficial esophageal squamous carcinoma (SESC) who have received endoscopic resection (ER). We aimed to develop a risk-predicting model for metastasis of SESC to lymph nodes using clinicopathological features and pathological results. Clinical data on 539 consecutive patients who underwent esophagectomy for SESC in our hospital were collected. Their post-surgical pathological results were assessed and analyzed. Multivariate logistic regression was used to identify all independent risk factors associated with LNM that then were incorporated into the prediction model. LNM was identified in 53 of 366 patients and 30 of 173 patients by positive histopathological results in the training and validation cohorts. The risk factors associated with LNM were large tumor size, poor tumor grade, deep invasion, and presence of angiolymphatic invasion. The model achieved good discriminatory ability of 0.80 (95%CI, 0.74-0.86) and 0.81 (95%CI, 0.75-0.86) in predicting LNM in the training and validation cohorts respectively. A LNM-predicting nomogram was formed with an area under curve of 0.80 (95% CI, 0.74-0.86), which had well-fitted calibration curves. A prediction model was constructed to generates 3 categories for estimated LNM risk in SESC patients. It provides a practical way of estimation of LNM risk in SESC patients who had received ER.