Staging Of Esophageal Carcinoma Research Articles

Correlation of inflammatory indices with staging of esophageal carcinoma: A prospective study at Dr. Ruth K. M. Pfau Civil Hospital, Karachi.

To determine the correlation between inflammatory indices and the Tumour-Node-Metastasis stage of oesophageal carcinoma. The prospective study was conducted from January 2021 to January 2023 at the Department of Upper Gastrointestinal Surgery, Dr Ruth K.M. Pfau Civil Hospital, Karachi, and comprised patients of either gender aged 18- 60 years with biopsy-proven oesophageal cancer. Blood samples were drawn and on the basis of plasma obtained, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, lymphocyte-tomonocyte ratio and platelet-to red cell distribution width ratio were calculated. Modified Glasgow Prognostic Score was calculated on the basis of C-reactive protein and albumin levels. Values were compared with tumour length, depth of invasion, lymph node status, vascular involvement, metastasis, pathological subtype and grade of differentiation. Data was analysed using SPSS 24. Of the 220 patients aged 46.1±14.2 years, 120(54%) were females and 100(46%) were males. C-reactive protein-to-albumin ratio demonstrated the highest predictive power for advanced disease stage (p=0.003). Elevated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (p=0.010 and p=0.044) were positively correlated with node stage, while elevated platelet-to-lymphocyte ratio was associated with advanced clinical stage (p=0.046). C-reactive protein-to-albumin ratio exhibited positive association with higher tumour stage (p=0.033), node stage (p<0.001) and clinical stage IV (p<0.001). Modified Glasgow Prognostic Score was significantly associated with advanced clinical stage (p<0.001). Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, and Modified Glasgow Prognostic Score could be used effectively as a predictor of advanced oesophageal cancer.

Spatial heterogeneity and prognostic significance of TAMs and TILs infiltrates in different staging esophageal squamous carcinoma

BackgroundThe prognostic value and clinical relevance of tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) in esophageal squamous cell carcinoma (ESCC) remain unclear. AimsTo investigate the prognostic value and functional involvement of TILs in ESCC. MethodsWe included 40 patients across different stages of ESCC from Xinjiang. Multiplex fluorescent immunohistochemistry characterized TILs and TAMs. TILs in different tumor regions were quantified and correlated with overall survival (OS) using log-rank test and Cox regression analyses. ResultsInvasive ESCC exhibited increased CD4 T cells and Tregs compared to carcinoma in situ, with a higher Tregs/CD4 T cells ratio (p < 0.05). TAMs, primarily in stromal regions, were significantly associated with Foxp3+ cells (p < 0.05). Higher infiltration of stromal TAMs and a higher CD4/CD8 T cells ratio correlated with poorer OS, while a higher CD8 T/Foxp3+ cells ratio indicated better survival. Multivariate Cox analysis revealed TNM stage, tumor length, and stromal CD4/CD8 T cells ratio as independent prognostic factors (p < 0.05). An immune prognostic risk score-based nomogram was constructed to predict patient outcomes. ConclusionsThe spatial distribution and abundance of TILs significantly correlated with prognosis, providing a useful immune classification for ESCC.

CACA guidelines for holistic integrative management of esophageal carcinoma

Esophageal carcinoma (EC) is a common malignant tumor of the upper digestive tract worldwide. An analysis of the latest data from cancer centers in China showed that the incidence of EC and the number of deaths due to EC in China in 2015 were 266,000 and 188,000, respectively, ranking sixth (6.3%) and fourth (8.0%) among all malignant tumors. The early diagnosis and treatment of EC and standardized diagnosis and treatment are important tasks for EC healthcare professionals in various centers across the country. At present, the 8th edition of the EC staging system jointly released by Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) is the most recent, authoritative and widely used EC staging standard. The EC professional committee of the Chinese Anti-Cancer Association also organizes the "EC Standardization Campaign in China" every year to promote the development of EC diagnostic and treatment norms throughout the country. Since 2011, the EC Committee of the Chinese Anti-Cancer Association has published the Guidelines for Standardized Diagnosis and Treatment of EC. Considering the increasing number of EC clinical studies and the continuous progress in diagnostic and treatment technologies in recent years, the updated Guidelines will include the latest progress in the diagnosis and treatment of EC, with a goal of promoting the forward development of EC diagnosis and treatment in clinical practice.

Potential use of high-resolution T2-weighted MRI with histopathologic findings in staging esophageal cancer

Magnetic resonance imaging (MRI) has shown promising capabilities in diagnosing local esophageal carcinoma. This study investigated the clinical value of high resolution (HR; small field of view and continuous thin section) axial T2-weighted MRI (HR-T2WI) as a noninvasive method for esophageal carcinoma tumor staging (T staging). Forty-two patients with biopsy-proven esophageal cancer were investigated using HR-T2WI. The discrepancies between the esophageal wall layers and tumor tissue were assessed for MRI T staging using a visual MRI signal intensity scale (low, intermediate, and high intensities). The computed tomography (CT) and MRI T staging was compared with whole-mount histopathological sections in all patients who underwent resection. HR-T2WI provided a thorough view of the esophageal wall and the tumor's anatomic layers. Of the 42 patients with histological tumors (HTs), there were 6 cases with tumors classified as HT-1a, 5 cases with HT-1b, 14 cases with HT-2, and 17 cases with HT-3/4, and their MRI T stages were 5 MRI-T1a, 6 MRI-T1b, 14 MRI-T2, and 17 MRI-T3/4, respectively. After analyzing the imaging presentation at different HT staginess, we found that HR-T2WI enabled a more accurate classification than was possible with CT. The difference in accuracy between CT and T2WI was statistically significant (P<0.05) in the entire sample and in HT1-2 tumors and HT3-4 tumors. HR-T2WI clearly identified normal esophageal wall layers; it had high diagnostic accuracy when evaluating tumor invasion and in MRI-T staging for esophageal carcinoma. This study established staging criteria of esophageal carcinoma using HR-T2WI and indicated that this approach could be used as a supplemental noninvasive method for the local T staging of esophageal carcinoma.

Up-Frameshift Suppressor 3 as a prognostic biomarker and correlated with immune infiltrates: A pan-cancer analysis.

BackgroundThe mRNA expression of protein Up-Frameshift Suppressor 3 Homolog B (UPF3B) differ in different tumors. However, the clinical relevance of UPF3B in cancer patients, such as with prognosis, tumor stage, and levels of tumor-infiltrating immune cells remain unclear.MethodsWe performed bioinformatics analysis of UPF3B with The Cancer Genome Atlas (TCGA) database (https://xenabrowser.net) and TIMER2.0 (Tumor Immune Estimation Resource 2.0, http://timer.comp-genomics.org/). UPF3B expression in 33 cancers versus counterpart normal tissues was analyzed using TCGA pan-cancer data. The influence of UPF3B in long-term prognosis was evaluated using Kaplan–Meier method, and the associations between UPF3B transcription levels and immune-related gene expression, immune cell infiltration, tumor microenvironment (TME) score are analyzed by spearman correlation analysis. Enrichment analysis of UPF3B was conducted using the R package “clusterProfiler.”ResultsThe transcriptional level of UPF3B was dysregulated in the human pan-cancer dataset. A significant correlation was found between the expression of UPF3B and the pathological stage of Esophageal Carcinoma (ESCA), Kidney Chromophobe (KIHC), Liver Hepatocellular Carcinoma (LIHC), and Skin Cutaneous Melanoma (SKCM). Multiple cancer types with high transcriptional levels of UPF3B were associated with a significantly worse prognosis. The functions of expressed UPF3B gene are primarily related to ubiquitin mediated proteolysis, cell cycle, and mRNA surveillance pathway. Our results also show that immune cells infiltration and immunosuppressive markers such as CTLA-4, PD-1 and PD-L1 significantly correlate with UPF3B expression.ConclusionsIn the present study, we synthetically explored the expression status and prognostic significance of UPF3B, and the relationship with clinic characters and immune microenvironment across cancers. Our results may provide novel insights for UPF3B as an immunotherapeutic target and valuable prognostic biomarker in various malignant tumor.

Role of Ct Imaging and Staging of Esophgus Carcinoma

Background and Aim: Esophageal carcinoma is the 8thmost common type of cancer worldwide and is considered a leading cause of cancer mortality. Cancer of the esophagus is one of the most lethal of all cancers. The esophagus is clearly visible on CT images. Over the last decade, computerized tomography (CT) tools have qualified the carcinoma early finding, thereby lowering mortality rates. The advent of multidetector computerized tomography (MDCT) scanners has been a boon to clinical imaging practice. The aim of the present study was to assess the role of computed tomography imaging in esophagus carcinoma staging and detection. Materials and Methods: This prospective study was conducted on 82 esophagus carcinoma patients in the department of Radiology, Sir Ganga Ram Hospital Lahore from July 2020 to June 2021. Individuals who presented with esophagus carcinoma signs and symptoms were enrolled in this study. Esophagus carcinoma was confirmed based on histopathological examination (HPE) reports and postoperative biopsy confirmed the CT findings. Data analysis was done with SPSS version 20. Results: Of the total 82 esophagus carcinoma patients, 44 (54%) were male and 38 (46%) were female. The overall mean age was 45.53±7.3 years with an age range from 18 years to 80 years. The incidence of esophagus carcinoma was more prevalent in the age group of 40 to 60 years. Male patients are more prone to esophagus carcinoma compared to females. The carcinoma in most cases affected the esophagus lower third and middle compared to the upper third. The prevalence of stage patients was as follows; T1 and T2 had 22 (26.8%) stage patients, T3 had 46 (56.1%) stage patients, and T4 had 14 (17.1%). About 52 (64%) patients had asymmetrical wall thickness while 30 (36%) had symmetrical wall thickness. Conclusion: Preoperative esophageal carcinoma staging is significantly aided by computed tomography. Imaging modality CT scans have improved esophageal carcinoma treatment and operative resection rate. As a result, CT is a non-invasive and quick imaging tool for detecting lymphadenopathies, distant metastases, and tumors. Keywords: Esophagus carcinoma; Staging; CT scan; Multidetector computerized tomography

Value of plasma SEPTIN9 methylation detection for diagnosis and predicting radiosensitivity of esophageal carcinoma

To investigate the value of plasma mSEPT9 detection in the diagnosis and prediction of radiosensitivity of esophageal carcinoma. This study was conducted in 72 patients with esophageal cancer who received radical radiotherapy in the Department of Radiotherapy of First Affiliated Hospital of Bengbu Medical College between January, 2019 and December, 2020.Plasma mSEPT9 of the patients were examined with PCR before and after radiotherapy, with 20 healthy subjects from the physical examination center as the controls.The receiver operating characteristic curve (ROC) was used to assess the value of mSEPT9 in diagnosis of esophageal cancer, and the correlation between mSEPT9 and clinicopathological characteristics of the patients was analyzed.According to their response to radiotherapy, the patients were divided into radiosensitive group and insensitive group, and their plasma mSEPT9 levels were compared before radiotherapy.All the patients were observed for dynamic changes of mSEPT9 levels after radiotherapy to analyze the association of mSEPT9 variation with radiosensitivity of the tumors. The sensitivity and specificity of mSEPT9 for the diagnosis of esophageal carcinoma were 62.5% and 100%, respectively, with an area under the ROC curve of 0.813.Plasma mSEPT9 level was correlated with lymph node metastasis and clinical stages of esophageal carcinoma (P < 0.05), but not with gender, age, invasion site, tumor length, degree of differentiation, or depth of invasion (P > 0.05).The radiosensitive patients had a significantly lower positivity rate for mSEPT9 than the insensitive patients before radiotherapy(53.06% vs 82.61%, P=0.016).In the 72 patients, the positivity rate for mSEPT9 decreased significantly after radiotherapy (30.56% vs 62.5%, P < 0.001); the positivity rate was significantly lowered after radiotherapy in the radiosensitive group (14.29% vs 53.06%, P < 0.001), but the reduction was not significant in the insensitive group (65.22% vs 82.61%, P=0.125). Detection of plasma mSEPT9 level is helpful for diagnosis and prediction of radiosensitivity of esophageal carcinoma.

Diagnostic Performance of MRI for Esophageal Carcinoma: A Systematic Review and Meta-Analysis.

Background Although CT, endoscopic US, and PET are critical in determining the appropriate management of esophageal carcinoma (squamous cell carcinoma and adenocarcinoma), previous reports show that staging accuracy remains low, particularly for nodal involvement sensitivity. Purpose To perform a systematic review and meta-analysis to determine the diagnostic performance of MRI for multiple staging thresholds in patients with biopsy-proven esophageal carcinoma (differentiation of stage T0 disease from stage T1 or higher disease, differentiation of stage T2 or lower disease from stage T3 or higher disease, and differentiation of stage N0 disease from stage N1 or higher disease [where T refers to tumor stage and N refers to nodal stage]). Materials and Methods Studies of the diagnostic performance of MRI in determining the stage of esophageal carcinoma in patients before esophagectomy and pathologic staging between 2000 and 2019 were searched in PubMed, Scopus, Web of Science, and Cochrane Library by a librarian and radiation oncologist. Pooled diagnostic performance of MRI was calculated with a bivariate random effects model. Bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2) tool. Results Twenty studies with a total of 984 patients were included in the analysis. Pooled accuracy for stage T0 versus stage T1 or higher had a sensitivity of 92% (95% CI: 82, 96) and a specificity of 67% (95% CI: 51, 81). Pooled accuracy for stage T2 or lower versus stage T3 or higher had a sensitivity of 86% (95% CI: 76, 92) and a specificity of 86% (95% CI: 75, 93). Pooled accuracy for stage N0 versus stage N1 or higher had a sensitivity of 71% (95% CI: 60, 80) and a specificity of 72% (95% CI: 64, 79). The concern for applicability was low for the patient selection, index test, and reference test domains, except for 10% of studies (two of 20) that had unclear concern for patient selection applicability. Conclusion MRI has high sensitivity but low specificity for the detection of esophageal carcinoma, which shows promise for determining neoadjuvant therapy response and for detecting locally advanced disease for potential trimodality therapy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Leeflang in this issue.

Three resected cases of esophageal carcinoma considered as being secondary solid tumors after bone marrow transplantation

BackgroundBone marrow transplantation is now an established treatment for some hematopoietic disorders and hematopoietic malignancies, and secondary solid tumors that develop after bone marrow transplantation have begun to attract attention.Case presentationHerein, we report 3 cases of esophageal carcinoma that developed after bone marrow transplantation. Case 1: 40-year-old female received cyclophosphamide and total body irradiation at 12 Gy for acute myeloid leukemia, followed by related bone marrow transplantation. She developed chronic graft-versus-host disease manifesting as pulmonary complications and was administered cyclosporine. Nine years after the transplantation, she was diagnosed as having esophageal carcinoma Stage II and underwent radical surgery. She died of the primary disease 17 months after the surgery. Case 2: A 45-year-old male patient received cyclophosphamide, VP-16 and total body irradiation at 13.2 Gy for acute lymphocytic leukemia, followed by related bone marrow transplantation. He developed chronic graft-versus-host disease manifesting as liver dysfunction. Fifteen years after the transplantation, he was diagnosed as having esophageal carcinoma Stage II and underwent radical surgery. Seven months after the surgery, he died of the primary disease. Case 3: A 30-year-old female patient received cyclophosphamide and total body irradiation at 3 Gy for Fanconi anemia, followed by unrelated bone marrow transplantation. She developed chronic graft-versus-host disease manifesting as a rash and was administered tacrolimus and methotrexate. Fifteen years after the transplantation, she was diagnosed as having esophageal carcinoma Stage III and underwent radical surgery. She died of sepsis 7 months after the surgery.ConclusionThe esophageal carcinomas developing after bone marrow transplantation had the characteristics of secondary solid tumors in all 3 patients, such as early onset, after total body irradiation, association with chronic graft-versus-host disease, and history of use of immunosuppressive drugs. Patients undergoing bone marrow transplantation require long-term follow-up after the transplantation, considering the possible development of secondary solid tumors, and in regard to secondary solid tumors developing in the gastrointestinal tract, it must be borne in mind that the risk of esophageal carcinoma is particularly high.

Identification of MTHFD2 as a novel prognosis biomarker in esophageal carcinoma patients based on transcriptomic data and methylation profiling.

DNA methylation is an important epigenetic regulatory mechanism in esophageal carcinoma (EC) and is associated with genomic instability and carcinogenesis. In the present study, we aimed to identify tumor biomarkers for predicting prognosis of EC patients.We downloaded mRNA expression profiles and DNA methylation profiles associated with EC from the Gene Expression Omnibus database. Differentially expressed and differentially methylated genes between tumor tissues and adjacent normal tissue samples were identified. Functional enrichment analyses were performed, followed by the construction of protein–protein interaction networks. Data were validated based on methylation profiles from The Cancer Genome Atlas. Candidate genes were further verified according to survival analysis and Cox regression analysis.We uncovered multiple genes with differential expression or methylation in tumor samples compared with normal samples. After taking the intersection of 3 differential gene sets, we obtained a total of 232 overlapping genes. Functional enrichment analysis revealed that these genes are related to pathways such as “glutathione metabolism,” “p53 signaling pathway,” and “focal adhesion.” Furthermore, 8 hub genes with inversed expression and methylation correlation were identified as candidate genes. The abnormal expression levels of MSN, PELI1, and MTHFD2 were correlated with overall survival times in EC patients (P < .05). Only MTHFD2 was significantly associated with a pathologic stage according to univariate analysis (P = .037) and multivariate analysis (P = .043).Our study identified several novel EC biomarkers with prognostic value by integrated analysis of transcriptomic data and methylation profiles. MTHFD2 could serve as an independent biomarker for predicting prognosis and pathological stages of EC.

Efficacy analysis of the radiotherapy and chemotherapy in patients with stage Ⅳ esophageal squamous carcinoma: a multicenter retrospective study of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG R-01F)

Objective: To evaluate the survival and prognostic factors of radiotherapy in patient with Ⅳ stage esophageal squamous carcinoma treated with radiation or chemoradiation. Methods: The medical records of 608 patients with stage Ⅳ esophageal squamous cell carcinoma who met the inclusion criteria in 10 medical centers in China from 2002 to 2016 were retrospectively analyzed. The overall survival and prognostic factors of all patients at 1, 3 and 5 years were analyzed. Results: The 1-, 3-, 5- year overall survival (OS) rates was 66.7%, 29.5% and 24.3% in stage ⅣA patients, and 58.8%, 29.0% and 23.5% in stage ⅣB patients. There was no statistical difference between the two groups (P=0.255). Univariate analysis demonstrated that the length of lesion, treatment plan, planned tumor target volume (PGTV) dose, subsequent chemotherapy, and degrees of anemia, radiation esophagitis, radiation pneumonia were related to the prognoses of patients with Ⅳ stage esophageal carcinomas after radiotherapy and chemotherapy (P<0.05). Multivariate analysis demonstrated that PGTV dose (OR=0.693, P=0.004), radiation esophagitis (OR=0.867, P=0.038), and radiation pneumonia (OR=1.181, P=0.004) were independent prognostic factors for OS. Conclusions: For patients with stage Ⅳ esophageal squamous cell carcinoma, chemoradiotherapy followed by sequential chemotherapy is recommended, which can extend the total survival and improve the prognosis of the patients. PGTV dose more than 60 Gy has better efficacy.

Efficacy of hydrocortisone sodium succinate and aluminum phosphate gel for stricture prevention after ≥3/4 circumferential endoscopic submucosal dissection.

ObjectiveEndoscopic submucosal dissection (ESD) is widely used in early-stage esophageal cancer, but the quality of life of patients with postoperative stricture is markedly reduced, requiring long-term repeat, periodic endoscopic balloon dilatation. We evaluated the combination of hydrocortisone sodium succinate and aluminum phosphate gel administered orally for stricture prevention.MethodsWe retrospectively assigned 27 patients who underwent ≥3/4 circular ESD for esophageal superficial squamous cell cancer to one of two groups according to the preventative strategy: endoscopic intralesional steroid injection and systemic steroid (IT+ST group) and oral combination of hydrocortisone sodium succinate and aluminum phosphate gel (OHA group). Stricture rate was compared between the two groups.ResultsThere were six and seven complete and ≥3/4 circular ESD cases, respectively, in the IT+ST group and four and ten cases in the OHA group. Stricture rates in the IT+ST and OHA groups were 53.8% and 7.1%, respectively. Nine patients in each group developed hypokalemia after glucocorticoid administration.ConclusionsOHA is a promising treatment strategy for stricture prevention following large-circumference ESD in patients with early stage esophageal carcinoma.

Illuminated Transhiatal Retractor for Mediastinal Dissection During Transhiatal Esophagectomy

Esophagectomy following preoperative chemoradiation provides the best outcomes in the treatment of early stage esophageal carcinoma. The exposure of the mediastinum during transhiatal esophagectomy is limited. We describe our technique of mediastinal dissection during the transhiatal esophagectomy using a newly developed transhiatal retractor.

The expression of protease-activated receptors in esophageal carcinoma cells: the relationship between changes in gene expression and cell proliferation, apoptosis in vitro and growing ability in vivo

BackgroundProtease-activated receptors (PARs) are a family of four G protein-coupled receptors expressed widely in many types of cells. PAR1, 2, and 4 have been shown to play an important role in many of the physiological activities of cells and many types of cancer cells. Esophageal carcinoma has become the fourth most common clinically diagnosed cancer and one of the top three leading causes of cancer-related deaths in China. The functions and expression patterns of PAR1, 2, and 4 in esophageal carcinoma have not published previously.MethodsHere, we systematically studied the expression of PAR1, 2, and 4 in clinical esophageal carcinoma patients and determined their role in esophageal carcinoma in vivo and in vitro through the overexpression or knockdown of PAR1, 2, and 4.ResultsWe found that the expression of PAR1 and 2 expressed higher in esophageal carcinoma than in the paracarcinoma tissues on clinical patients. PAR1 and 2 enhanced cell proliferation both in vivo and in vitro and reduced apoptosis to strengthen cancer cell vitality in TE-1 cells. In contrast, the expression of PAR4 expressed decreased in esophageal carcinoma, and its expression induced apoptosis in vivo and vitro.ConclusionIn our previous studies and the present study, we noted that the expression of PAR1, 2, and 4 was almost absent in different stages of esophageal carcinoma. PAR1 and 2 might be potential molecular markers for esophageal carcinoma, and PAR4 might be an effective treatment target for esophageal carcinoma prevention and treatment.

Application of the 8th edition of the AJCC yTNM staging system shows improved prognostication in a single center cohort of esophageal carcinomas

BackgroundThe 8th edition of the AJCC TNM staging system presents for the first time a specific classification for esophageal carcinomas treated with neoadjuvant therapy (yTNM8). In this single center study, we applied the novel staging system in a “real life” case series and compared the prognostic value of yTNM8 with the preceding 7th edition (TNM7). MethodsOut of 272 consecutive esophageal carcinomas that were treated during a 15-year period in one surgical center, all 198 cases that had undergone neoadjuvant therapy were reviewed and classified according to TNM7 and yTNM8. Results50 ypT0 cases that had no specific staging in TNM7 were included into stages I (ypT0N0M0; n = 42), IIIA (ypT0N1M0; n = 6), IVA (ypT0N3M0; n = 1) and IVB (ypT0N0M1; n = 1) in yTNM8. Both systems showed significant prognostic impact (p < 0.0001 each). yTNM8 was superior regarding prognostication with lower values for goodness-of-fit criteria (Akaike Information Criterion 1589.331 vs 1593.239; and Schwarz Bayesian Criterion 1605.487 vs.1619.088). However, in TNM7, stage IIB tumors had better prognosis than stage IIA tumors, and likewise, stage IIIA tumors better compared to stage II in yTNM8. ConclusionsyTNM8 allows accurate staging of esophageal carcinomas treated by neoadjuvant therapy, with slightly improved prognostication compared to TNM7. Additional data acquisition will be necessary for further improvement of staging for esophageal carcinomas after neoadjuvant treatment.

Survival based radiographic-grouping for esophageal squamous cell carcinoma may impact clinical T stage.

Most patients diagnosed with thoracic esophageal squamous cell carcinoma (ESCC) have progressed beyond surgical resection as a therapeutic option. Difficulties in the proper assessment of tumor invasion depth before treatment complicate determination of the type and extent of therapy. Therefore, accurate tumor clinical staging is a necessity for identifying treatment options and aiding in patient prognosis. We investigated radiographic factors as prognostic indicators for survival in ESCC. Between July 2006 - July 2010, 324 thoracic ESCC patients who underwent surgery were selected. All patients received contrast enhanced preoperative chest CT scans and esophageal barium swallow examinations. Measurement of maximal lesion cross-sectional area, the largest long diameter, largest short diameter, CT-indicated lesion length, barium-indicated lesion length and the length of pericardial fat reduction were performed. Relationships between these indicators and post-surgical survival time and the cutoff values of related factors were analyzed. Maximum long diameter, maximum lesion area and lesion length, as measured by CT imaging, were correlated with survival. Survival effects were clearly associated with group intervals, calculated by a genetic algorithm, and tumor stages. Risk-stratification intervals of esophageal lesions from radiographic imaging included: maximum long diameter < 28.7, 28.7-34.6mm, 34.6-41.4mm and >41.4mm; maximum lesion area < 355.8mm2, 355.8-568.0mm2, 568.0-907.3mm2 and >907.3mm2; and CT-indicated lesion length <30.9mm, 30.9-57.3mm, 57.3-70.6mm and > 70.6mm. The reasonable stratification of maximum esophageal lesion area, largest long diameter and lesion length measured in CT is valuable for clinical T staging of ESCC. Radiographic parameters may have prognostic clinical value in the staging of esophageal carcinoma.

Impact factor of postoperative prognosis of esophageal cancer patients with stage pT2N0~1M0

Objective: To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC). Methods: From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy. Results: The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05). Conclusion: Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.

Assessment of the radiofrequency ablation dynamics of esophageal tissue with optical coherence tomography.

.Radiofrequency ablation (RFA) is widely used for the eradication of dysplasia and the treatment of early stage esophageal carcinoma in patients with Barrett’s esophagus (BE). However, there are several factors, such as variation of BE epithelium (EP) thickness among individual patients and varying RFA catheter-tissue contact, which may compromise RFA efficacy. We used a high-speed optical coherence tomography (OCT) system to identify and monitor changes in the esophageal tissue architecture from RFA. Two different OCT imaging/RFA application protocols were performed using an ex vivo swine esophagus model: (1) post-RFA volumetric OCT imaging for quantitative analysis of the coagulum formation using RFA applications with different energy settings, and (2) M-mode OCT imaging for monitoring the dynamics of tissue architectural changes in real time during RFA application. Post-RFA volumetric OCT measurements showed an increase in the coagulum thickness with respect to the increasing RFA energies. Using a subset of the specimens, OCT measurements of coagulum and coagulum + residual EP thickness were shown to agree with histology, which accounted for specimen shrinkage during histological processing. In addition, we demonstrated the feasibility of OCT for real-time visualization of the architectural changes during RFA application with different energy settings. Results suggest feasibility of using OCT for RFA treatment planning and guidance.

Endoscopic ultrasonography for preoperative staging of esophageal carcinoma

Objective: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative staging of esophageal carcinoma (EC).Material and methods: A total of 86 surgical patients with EC who were confirmed by endoscopy and biopsy underwent preoperative TN staging with EUS examination. The EUS findings were compared with surgical pathologic results.Results: The accuracy of EUS in T and N staging of EC was 82.6% and 84.9%, respectively. While determining whether EC invades the muscularis propria or outer membrane, EUS had the favorable sensitivity, specificity, positive predictive value and negative predictive value. The short-axis diameter of lymph nodes of 5mm had high sensitivity and negative predictive value to determine malignance with low specificity and positive predictive value. The short-axis diameter of 10mm presented the satisfactory sensitivity, specificity, positive predictive value and negative predictive value.Conclusion: EUS can accurately determine the TN staging of EC and provide a reliable basis for the treatment of EC.

The importance of the concept and histological criteria of \u201cintraepithelial squamous cell carcinoma\u201d of the esophagus: in comparison between Western and Japanese criteria

BackgroundThere are differences in the histological diagnostic criteria for early stage gastrointestinal carcinoma between Western and Japanese pathologists. Western histological criteria of carcinoma are “presence of stromal invasion of neoplastic cells”, while Japanese criteria are “the degree of cytological and structural abnormality of neoplastic cells, regardless of stromal invasion”. The aim of the present study is to clarify and review the present status of the Western and Japanese histological criteria of early stage esophageal squamous cell carcinoma (SCC) and also to clarify their significance and accuracy.MethodsTwenty-nine Polish, German, and Japanese pathologists participated in this study. A total of 18 histological slides of biopsy, endoscopic submucosal dissection (ESD), and surgical resection of esophageal squamous lesions were diagnosed using a virtual slide system.ResultsMost of noninvasive (intraepithelial) carcinomas diagnosed by Japanese pathologists were diagnosed as high- or low-grade dysplasia (intraepithelial neoplasia) or reactive atypia by the majority of Polish and German pathologists. Diagnoses of not only high-grade dysplasia but also low-grade dysplasia or reactive lesion by Western criteria were given for many biopsy specimens of cases in which the corresponding ESD or surgical specimens showed definite stromal invasion.ConclusionThere still exist differences in the histological diagnostic criteria for early stage esophageal carcinoma between Western and Japanese pathologists. The Japanese diagnostic criteria could improve agreement of diagnoses between biopsy and resected specimens of esophageal SCC. Moreover, diagnostic approaches using Western criteria may cause delay in the early diagnosis and treatment of esophageal SCC.