Survival Of Esophageal Carcinoma Patients Research Articles

Fecal, duodenal, and tumor microbiota composition of esophageal carcinoma patients, a longitudinal prospective cohort.

The microbiome has been associated with chemotherapy and immune checkpoint inhibitor efficacy. How this pertains to resectable esophageal carcinoma is unknown. Our aim was to identify microbial signatures in resectable esophageal carcinoma associated with response to neoadjuvant chemoradiotherapy with or without an immune checkpoint inhibitor. From 2 prospectively collected esophageal carcinoma cohorts (n = 172 in total) treated with neoadjuvant chemoradiotherapy alone (n = 132) or a combination of neoadjuvant chemoradiotherapy and an immune checkpoint inhibitor (n = 40), fecal samples were available at baseline, during treatment, and presurgery. Additionally, in the immune checkpoint inhibitor-treated patients, tumor and duodenal snap frozen biopsies were collected over time. Fecal, tumor, and duodenal DNA were extracted for 16S ribosomal RNA sequencing. Associations were investigated between microbiome composition pathological complete response and progression-free survival (PFS). There was a statistically significant shift in the microbiota profile of the fecal, tumor, and duodenal microbiota over time. In the total cohort, patients with a pathological complete response had a stable fecal alpha diversity, while the diversity of poor responders decreased during treatment (P = .036). Presurgery, lower alpha diversity (<4.12) was related to worse PFS (log-rank P = .025). Baseline tumor biopsies of patients with short PFS had more Fusobacterium. A low baseline duodenal alpha diversity (<3.96) was associated with worse PFS (log-rank P = .012). Lower intestinal alpha diversity was associated with worse response and survival of esophageal carcinoma patients. In tumor biopsies, Fusobacterium was more abundant in patients with poor PFS. After further mechanistic validation, these findings may aid in response prediction and the design of novel microbiome modulating treatments for esophageal carcinoma patients.

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan.

To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi. We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival. Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes. Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.

Abstract 4720: Effects of removing heat and nourishing yin prescription on malignant phenotype and PI3K/AKT signaling pathway of human esophageal carcinoma cells

Abstract Introduction: Esophageal carcinoma (EC) ranks eighth in the incidence of malignant tumors and the sixth mortality worldwide. This study aims to screen out the Chinese herbs with strong inhibitory effects on the proliferation of four kinds of EC cells EC9706, EC-1, TE-1 and Eca109 from 366 Chinese herbs produced in Henan Province, and study the effect of composed Removing Heat and Nourshing Yin Prescription(RHNYP) on the proliferation, migration, invasion and PI3K/AKT signaling pathway of four EC cells. Methods: MTT and orthogonal design was applied to screen out the best effective Chinese herbs and determine the optimal dosage ratio of prescription on EC9706, EC-1, TE-1, Eca109 cells from 366 Chinese herbs alcohol extracts, the effects of this prescription on the proliferation, migration, invasion, clone formation, cell cycle and apoptosis of four EC cells were investigated by MTT, RTCA, soft agarose colony forming test, flow cytometry and western blot analysis. Then exploring the effects of RHNYP on EC related signaling pathways and key genes expression by western blot and RT-PCR assay. Results: Rhizoma Fagopyri Dibotryis(Jinqiaomai), Rhizoma Anemarrhenae(Zhimu), Asparagus Cochinchinensis(Tiandong), and Carpesium Abrolanoides Linne(Heshi) were screened out and composed Removing Heat and Nourshing Yin Prescription(RHNYP) according to their efficacy and orthogonal design. RHNYP could obviously inhibit the proliferation of EC9706, TE-1, EC-1, ECa109 cells with dose-effect and time-dependent manner. IC50 values of Jinqiaomai, Zhimu, Tiandong, Heshi in RHNYP for EC9706 cell were 27.639μg/ml, 40.015μg/ml, 9.044μg/ml, 11.208μg/ml respectively; for EC-1 cell were 24.575μg/ml, 56.991μg/ml, 9.361μg/ml, 13.584μg/ml respectively; for TE-1 cell were 23.534μg/ml, 25.862μg/ml, 6.788μg/ml, 8.911μg/ml respectively; for ECa109 cell were 33.990μg/ml, 33.604μg/ml, 19.873μg/ml, 15.227μg/ml respectively. RHNYP could effectively inhibit the proliferation, migration, invasion, cloning ability, cell cycle and reduce apoptosis of four EC cells. PI3K/AKT/mTOR pathway had closely relationship with the occurrence and development of EC and RHNYP could effectively regulate the proteins expression on the pathway. CDCK3, KIF4A and RAD51AP1 genes were negatively correlated with the overall survival of EC patients and RHNYP could significantly inhibit their expression in four EC cells. Conclusion: RHNYP can effectively inhibit EC cell proliferation, migration, invasion and cell cycle, induce apoptosis, which may be related to the regulation of PI3K/AKT/mTOR pathway. Citation Format: Fuchun Si, Wenyu Zhao, Gao Si, Xuejie Song. Effects of removing heat and nourishing yin prescription on malignant phenotype and PI3K/AKT signaling pathway of human esophageal carcinoma cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4720.

Comprehensive analysis of ZNF family genes in prognosis, immunity, and treatment of esophageal cancer

BackgroundAs a common malignant tumor, esophageal carcinoma (ESCA) has a low early diagnosis rate and poor prognosis. This study aimed to construct the prognostic features composed of ZNF family genes to effectively predict the prognosis of ESCA patients.MethodsThe mRNA expression matrix and clinical data were downloaded from TCGA and GEO database. Using univariate Cox analysis, lasso regression and multivariate Cox analysis, we screened six prognosis-related ZNF family genes to construct the prognostic model. We then used Kaplan-Meier plot, time-dependent receiver operating characteristic (ROC), multivariable Cox regression analysis of clinical information, and nomogram to evaluate the prognostic value within and across sets, separately and combined. We also validated the prognostic value of the six-gene signature using GSE53624 dataset. The different immune status was observed in the single sample Gene Set Enrichment Analysis (ssGSEA). Finally, real-time quantitative PCR was used to detect the expression of six prognostic ZNF genes in twelve pairs of ESCA and adjacent normal tissues.ResultsA six prognosis-related ZNF family genes model consisted of ZNF91, ZNF586, ZNF502, ZNF865, ZNF106 and ZNF225 was identified. Multivariable Cox regression analysis revealed that six prognosis-related ZNF family genes were independent prognostic factors for overall survival of ESCA patients in TCGA and GSE53624. Further, a prognostic nomogram including the riskScore, age, gender, T, stage was constructed, and TCGA/GSE53624-based calibration plots indicated its excellent predictive performance. Drug Sensitivity and ssGSEA analysis showed that the six genes model was closely related to immune cells infiltration and could be used as a potential predictor of chemotherapy sensitivity.ConclusionWe identified six prognosis-related ZNF family genes model of ESCA, which provide evidence for individualized prevention and treatment.

Clinicopathological correlation of aspartate aminotransferase-to-platelet ratio (APRI) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) with survival in esophageal carcinoma patients: a retrospective cohort analysis of 951 patients.

The objectives of the current study were to associate novel markers, including aspartate aminotransferase-to-platelet ratio (APRI) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) with survival in esophageal malignancy. A retrospective study in a tertiary care hospital (single-center) included 951 patients having diagnosed esophageal carcinoma of any age group. The median (interquartile range) age of study participants were 50 (38-60) years, including 43% males and 57% female patients, while the median (interquartile range) levels of AAR and APRI were 0.97 (0.81-1.25) and 0.19 (0.13-0.29), respectively. AAR was found to be higher in dysphagia for solids only and dysphagia for both liquids and solids rather than liquids only (P=0.002), while other associations included well-differentiated tumor grade (P=0.011), finding of esophageal stricture on esophagogastroduodenoscopy (P=0.015), and characteristic of mass on computerized tomography scan being both circumferential and mural (P=0.005). APRI was found to be higher in adenocarcinoma (P=0.038), and finding of circumferential±ulcerated mass on esophagogastroduodenoscopy (P<0.001). On survival analysis, adenocarcinoma (P<0.001), luminal narrowing (P=0.002), AAR greater than 1.0 (P=0.006), and APRI greater than 0.2 (P=0.007) were found to be poor survival predictors. On Cox proportional hazards regression, APRI was found to be more associated with poor survival than AAR (Hazard ratio: 1.682, 1.208-2.340, P=0.002). This study correlated clinical and pathological features of esophageal malignancy with noninvasive markers of hepatic function.

COX7B Is a New Prognostic Biomarker and Correlates with Tumor Immunity in Esophageal Carcinoma.

Esophageal carcinoma (ESCA) refers to the most common type of malignant tumor, which reveals that it occurs often all over the world. ESCA is also correlated with an advanced stage and low survival rates. Thus, the development of new prognostic biomarkers is an absolute necessity. In this study, the aim was to investigate the potential of COX7B as a brand-new predictive biomarker for ESCA patients. COX7B expression in pancancer was examined using TIMER2. The statistical significance of the predictive value of COX7B expression was explored. The relationship between COX7B expression and tumor-infiltrating immune cells in ESCA was analyzed by using ssGSEA. In this study, the result indicated that several types of cancers had an abnormally high amount of COX7B. COX7B expression in samples from patients with ESCA was considerably higher than in nontumor tissues. A more advanced clinical stage may be anticipated from higher COX7B expression. According to the findings of Kaplan-Meier survival curves, patients with low COX7B levels had a more favorable prognosis than those with high COX7B levels. The result of multivariate analysis suggested that COX7B expression was a standalone prognostic factor for the overall survival of ESCA patients. A prognostic nomogram including gender, clinical stage, and COX7B expression was constructed, and TCGA-based calibration plots indicated its excellent predictive performance. An analysis of immune infiltration revealed that COX7B expression has a negative correlation with TFH, Tcm, NK cells, and mast cells. COX7B may serve as an immunotherapy target and as a biomarker for ESCA diagnosis and prognosis.

Construction and investigation of \u03b23GNT2-associated regulatory network in esophageal carcinoma

BackgroundGlycosyltransferases play a crucial role in various cancers. β1, 3-N-acetylglucosaminyltransferase 2, a polylactosamine synthase, is an important member of the glycosyltransferase family. However, the biological function and regulatory mechanism of β3GNT2 in esophageal carcinoma (ESCA) is still poorly understood.MethodsThe Cancer Genome Atlas and Genotype-Tissue Expression databases were used for gene expression and prognosis analysis. Quantitative real-time PCR, Western blot, and immunohistochemistry were performed to detect the expression of β3GNT2 in ESCA cell lines and tissues. In vitro assays and xenograft tumor models were utilized to evaluate the impact of β3GNT2 on ESCA progression. The downstream effectors and upstream regulators of β3GNT2 were predicted by online software and verified by functional experiments.ResultsWe found that β3GNT2 was highly expressed in ESCA tissues and positively correlated with poor prognosis in ESCA patients. β3GNT2 expression was closely associated with the tumor size, TNM stage, and overall survival of ESCA patients. Functionally, β3GNT2 promoted ESCA cell growth, migration, and invasion in vitro, as well as tumorigenesis in vivo. Mechanistically, β3GNT2 knockdown decreased the expression of the polylactosamine on EGFR. Knockdown of β3GNT2 also inhibited the JAK/STAT signaling pathway. Meanwhile, the JAK/STAT inhibitor could partly reverse the biological effects caused by β3GNT2 overexpression. Moreover, β3GNT2 expression was positively regulated by CREB1 and negatively regulated by miR-133b. Both CREB1 and miR-133b was involved in the β3GNT2-mediated ESCA progression.ConclusionsOur study, for the first time, reveals the importance of β3GNT2 in ESCA progression and offers a potential therapeutic target for ESCA.

Tumor-associated macrophage polarization promotes the progression of esophageal carcinoma.

The immune response facilitated by tumor-associated macrophages is a vital determinant of tumor progression. We identified differentially expressed genes between various macrophage phenotypes in the Gene Expression Omnibus, and used Kaplan-Meier Plotter to determine which of them altered the prognosis of esophageal carcinoma patients. Fibrinogen-like protein 2 (FGL2), an immunosuppressive factor in the tumor microenvironment of various cancers, was upregulated in M2 macrophages, and higher FGL2 expression was associated with poorer survival in esophageal carcinoma patients. Using the TIMER database, we found that FGL2 expression correlated positively with the levels of immune markers of infiltrating B cells, CD8+ T cells, CD4+ T cells, macrophages, neutrophils and dendritic cells in esophageal carcinoma samples. Correlation analyses in cBioPortal revealed that the mRNA levels of FGL2 correlated strongly with those of interleukin 10, matrix metalloproteinase 9, C-C motif chemokine ligand 5, T-cell immunoglobulin mucin 3, interleukin 13, vascular cell adhesion molecule 1, macrophage colony-stimulating factor and fibroblast growth factor 7 in esophageal carcinoma tissues. The same cytokines were upregulated when esophageal squamous cell carcinoma cells were co-cultured with M2-like tumor-associated macrophages. Thus, by secreting FGL2, M2-like tumor-associated macrophages may create an immunosuppressive tumor microenvironment that induces the occurrence and progression of esophageal carcinoma.

Associations of Systemic Inflammation and Sarcopenia With Survival of Esophageal Carcinoma Patients

Although both sarcopenia and systemic inflammation reportedly affect long-term outcomes of esophageal carcinoma (EC) patients, their reciprocal associations with survival outcomes have yet to be investigated. This study aimed to evaluate the survival impact of sarcopenia combined with the neutrophil-to-lymphocyte ratio (NLR) in EC patients undergoing esophagectomy. In total, 378 EC patients were retrospectively reviewed. The cutoff value for NLR was set at the NLR median of the cohort. Sarcopenia was determined based on decreased skeletal muscle index calculated from computed tomography obtained before surgery. Univariate and multivariate Cox hazards models were applied to determine independent predictors of poor overall survival and cancer-specific survival. Sarcopenia was more common in the high-NLR group (2.57 or greater) than in the low-NLR group (less than 2.57; P= .01). In the high-NLR group, patients with sarcopenia had significantly poorer overall and cancer-specific survival than those without sarcopenia (P < .001). In contrast, there was no survival impact of sarcopenia in the low-NLR group. Patients with both high NLR and sarcopenia exhibited poor overall and cancer-specific survival (5-year overall survival= 44.4%, 5-year cancer-specific survival= 57.0%). Sarcopenia was independently associated with poor overall survival (hazard ratio= 1.95; P= .007) and poor cancer-specific survival (hazard ratio= 2.66; P= .002) as well as pathological stage III disease and noncurative resection in the high-NLR group. The survival and oncological impact of sarcopenia was noteworthy only when present with elevated NLR. The combination of 2 factors is rational for identifying EC patients likely to have poor survival outcomes.

A Novel Three-miRNA Signature Identified Using Bioinformatics Predicts Survival in Esophageal Carcinoma.

Objective We identified differentially expressed microRNAs (DEMs) between esophageal carcinoma (ESCA) tissues and normal esophageal tissues. We then constructed a novel three-miRNA signature to predict the prognosis of ESCA patients using bioinformatics analysis. Materials and Methods. We combined two microarray profiling datasets from the Gene Expression Omnibus (GEO) database and RNA-seq datasets from the Cancer Genome Atlas (TCGA) database to analyze DEMs in ESCA. The clinical data from 168 ESCA patients were selected from the TCGA database to assess the prognostic role of the DEMs. The TargetScan, miRDB, miRWalk, and DIANA websites were used to predict the miRNA target genes. Functional enrichment analysis was conducted using the Database for Annotation, Visualization, and Integrated Discovery (David), and protein-protein interaction (PPI) networks were obtained using the Search Tool for the Retrieval of Interacting Genes database (STRING). Results With cut-off criteria of P < 0.05 and |log2FC| > 1.0, 33 overlapping DEMs, including 27 upregulated and 6 downregulated miRNAs, were identified from GEO microarray datasets and TCGA RNA-seq count datasets. The Kaplan–Meier survival analysis indicated that a three-miRNA signature (miR-1301-3p, miR-431-5p, and miR-769-5p) was significantly associated with the overall survival of ESCA patients. The results of univariate and multivariate Cox regression analysis showed that the three-miRNA signature was a potential prognostic factor in ESCA. Furthermore, the gene functional enrichment analysis revealed that the target genes of the three miRNAs participate in various cancer-related pathways, including viral carcinogenesis, forkhead box O (FoxO), vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (ErbB2), and mammalian target of rapamycin (mTOR) signaling pathways. In the PPI network, three target genes (MAPK1, RB1, and CLTC) with a high degree of connectivity were selected as hub genes. Conclusions Our results revealed that a three-miRNA signature (miR-1301-3p, miR-431-5p, and miR-769-5p) is a potential novel prognostic biomarker for ESCA.

Total FDG lesion number on PET/CT predicts survival of esophageal carcinoma patients with recurrence following curative surgery.

Total lesion number is a prognostic determinant in recurrent esophageal cancer, but this requires multiple tests. Here, we investigated the prognostic value of total FDG lesion number obtained from a single PET/CT study. Subjects were 153 esophageal squamous cell carcinoma patients with loco-regional or distant recurrence following curative surgery. FDG PET/CT performed within 30 days was inspected for abnormal FDG uptake lesions using a SUVmax of 3.0 as threshold for significance. Prognostic associations were assessed by Cox proportional hazards regression and Kaplan-Meier analysis. PET/CT showed significant local FDG lesions in 49.0%, regional lesions in 78.4%, and distant lesions in 44.4% of patients. Among 73 patients with loco-regional recurrence, 54 had 0-3 and 19 had ≥4 FDG lesions. Among 80 patients with distant recurrence, 31 had 0-3 and 49 had ≥4 FDG lesions. During a median follow-up of 11.8 months, 99 deaths occurred. Univariate variables associated with poor survival included ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence. Kaplan Meier analysis showed worse survival for ≥4 than 0-3 FDG lesions in patients with loco-regional recurrence (15.6 vs. 32.1 months; P=0.009), but not in those with distant recurrence. Significant independent predictors of poor survival were ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence. Total FDG lesion number assessed by PET/CT is a significant independent prognostic factor in esophageal cancer patients with loco-regional recurrence following curative surgery.

Clinical significance of serum cathepsin B and cystatin C levels and their ratio in the prognosis of patients with esophageal cancer.

ObjectiveThe main purpose of this study was to analyze the serum cathepsin B (CTSB) and cystatin C (CysC) levels in patients with esophageal carcinoma and their correlation with the clinical indices and prognosis.MethodsThe serum levels of CTSB and CysC from 56 patients with esophageal carcinoma and 30 healthy donors were determined preoperatively by using enzyme-linked immunosor-bent assay. The correlation between CTSB and CysC was evaluated by Spearman correlation coefficient test. Kaplan–Meier survival curves were plotted, while the survival rates were compared using the log-rank test. Univariate and multivariate analyses of prognostic factors for survival were performed using the Cox proportional hazard regression model with a 95% confidence interval.ResultsCTSB (38.35±4.3 ng/mL) and CysC (703.96±23.6 ng/mL) levels were significantly higher in the sera of the patients than in controls. A significant correlation was observed between CTSB and CysC (r=0.754, P<0.001). The levels of CTSB and CysC/CTSB in the patient serum significantly correlated with the T status. CysC/CTSB ratio was also found to be significantly correlated with lymph node metastasis. None of the parameters were observed to be related to CysC, including age, gender, pathologic type, tumor differentiation and tumor invasion depth. Kaplan–Meier analysis showed that patients with higher levels of CysC/CTSB and negative lymph node metastasis experienced significantly longer overall survival time, whereas patients with higher CSTB levels tended to live shorter, although the difference was not statistically significant (P=0.081).ConclusionSerum CTSB and CysC levels are of diagnostic significance in esophageal cancer. The ratio of serum CysC/CTSB is prognostic for the survival of esophageal carcinoma patients.

Roles of squamous cell cancer antigen, cytokeratin 21-1 fragment, and carcinoembryonic antigen in the diagnosis and prognosis of postoperative locoregional recurrence in esophageal carcinoma

Background: Locoregional recurrence (LR) is the major cause for poor response after radical resection in patients with esophageal carcinoma (EC). Therefore, early diagnosis and positive treatment is crucial for the extension of overall survival in EC patients. We aim to investigate the feasibility of squamous cell cancer antigen (SCC-Ag), cytokeratin 21-1 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA) in the diagnosis of postoperative LR in patients with EC, and the correlation between their expression and the prognosis of the disease. Methods: Sixty-two EC patients with postoperative LR were included, and thirty normal individuals served as normal control. Serum SCC-Ag, CYFRA21-1and CEA were determined before and one month after treatment. SCC-Ag level was evaluated using chemiluminescent microparticle immunoassay. CYFRA21-1 was determined using the chemiluminescence assay. CEA was determined using the direct chemiluminescence assay. The patients received radiotherapy and/or chemoradiotherapy. The survival rates were measured using Kaplan-Meier method, and was tested using Logrank analysis. Multiple logic regression analysis was used for the analysis of prognostic factors. Results: Remarkable elevation was noticed in serum SCC-Ag (t=4.79, P 0.05). The SCC-Ag and CYFRA21-1 other than CEA were related to the pathological staging of EC patients with postoperative LR. The median overall survival was 12.0 months (95% CI, 8.98–15.02). The survival rates at 1, 2, 3 and 5 years were 46.1%, 19.7%, 12.3%, and 8.2%, respectively. The serum SCC-Ag and CYFRA21-1 were decreased after radiotherapy and/or chemoradiotherapy in patients with postoperative LR (t=3.24, P 0.05). Among the EC patients with postoperative LR before radiotherapy or chemoradiotherapy, the survival of patients negative for SCC-Ag and CYFRA21-1 showed significantly longer disease-free interval compared to those for these markers (χ 2 =5.92, P<0.05; χ 2 =4.92, P<0.05). Among the EC patients with postoperative LR after radiotherapy or chemoradiotherapy, the survival of patients negative for SCC-Ag showed signifcantly longer disease-free interval compared to that with positivity for this marker (χ 2 =5.30, P<0.05). Multiple logic regression analysis indicated no independent risk factors for the postoperative LR of patients with EC. Conclusions: Our results indicate that serum SCC-Ag and CYFRA21-1 contribute to the diagnosis of postoperative LR in EC patients. Besides, radiotherapy and/or chemotherapy is beneficial to the extension of survival in these patients.

Roles of squamous cell cancer antigen, cytokeratin 21-1 fragment, and carcinoembryonic antigen in the diagnosis and prognosis of postoperative locoregional recurrence in esophageal carcinoma

Background: Locoregional recurrence (LR) is the major cause for poor response after radical resection in patients with esophageal carcinoma (EC). Therefore, early diagnosis and positive treatment is crucial for the extension of overall survival in EC patients. We aim to investigate the feasibility of squamous cell cancer antigen (SCC-Ag), cytokeratin 21-1 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA) in the diagnosis of postoperative LR in patients with EC, and the correlation between their expression and the prognosis of the disease.

Inflammation-based prognostic system predicts postoperative survival of esophageal carcinoma patients with normal preoperative serum carcinoembryonic antigen and squamous cell carcinoma antigen levels.

BackgroundThe Glasgow Prognostic Score (GPS) is an established inflammation-based system that is used to predict the prognosis for several types of malignancies. In this retrospective study, we assessed the postoperative survival of 725 patients with non-metastatic esophageal squamous cell carcinoma who had normal preoperative serum tumor marker levels according to the GPS.MethodsAmong 1394 patients who underwent esophagectomy between August 2006 and December 2010, 725 with normal preoperative serum levels of carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) were enrolled. All demographic, pathologic, and survival data were analyzed retrospectively. Uni- and multivariate analyses were performed to evaluate the relationship with overall survival. The Kaplan–Meier analysis and log-rank tests were used to compare the survival curves between patients with GPS 0 (group A) and 1 or 2 (group B).ResultsPatients in group A exhibited significantly better 3- and 5-year cancer-specific survival (CSS) rates (0.780 and 0.759, respectively) than those in group B (0.624 and 0.605, respectively). Multivariate Cox regression analysis revealed that age, tumor length, pathological tumor-node-metastasis (pTNM) stage, venous invasion, lymph node metastasis, serum albumin and C-reactive protein levels, and GPS were associated with postoperative survival of these patients. Further multivariate analysis confirmed that GPS was an independent prognostic factor. The Kaplan–Meier analysis and log-rank tests demonstrated a significant difference in CSS between groups A and B (P = 0.001).ConclusionsGPS may be a valuable prognostic indicator for esophageal cancer patients with normal preoperative CEA and SCC-Ag serum levels.

Impact of comorbidities and use of common medications on cancer and non-cancer specific survival in esophageal carcinoma.

BackgroundChronic comorbidities and some of the commonly-used medications are thought to affect cancer patients’ outcomes, but their relative impact on esophageal carcinoma (EC) has not been well studied. The purpose of the study was to identify the chronic comorbidities and/or commonly-used medications that impact EC patient survival.MethodsA total of 1174 EC patients treated with chemoradiotherapy (CRT) with or without surgery in one institution from 1998 to 2012 were retrospectively included. Seven kinds of frequently occurring chronic comorbidities and 18 types of regularly-taken medications were obtained from medical records. Since it is expected prognostic factors have different effects between surgery patients and non-surgery patients, the impact value of all variables and the corresponding interactions with surgery on survival were evaluated in Cox proportional hazards regression model. Overall mortality, EC-specific mortality and non EC-specific mortality were endpoints.ResultsWe found that atrial fibrillation was the only comorbidity that showed a significant impact on non-EC specific survival for all patients (HR 1.72, P = 0.03), whereas hypothyroidism was the only comorbidity that was evaluated as an independent predictive factor for overall survival (OS) (HR 0.59, P = 0.02) and EC-specific survival (HR 0.62, P = 0.05), but this association was seen only in the non-surgical patients. No other medications were found to have a significant impact for OS, EC-specific survival or non-EC specific survival in multivariable analysis.ConclusionsOur data indicate that certain comorbidities rather than medication use affect EC-specific survival or non EC-specific survival in EC patients treated with CRT with or without surgery. Comorbidity information may better guide individual treatment in EC.

Investigation of Using Diffusion-Weighted Magnetic Resonance Imaging to Evaluate the Therapeutic Effect of Esophageal Carcinoma Treatment

Aim: To explore the associations of diffusion-weighted magnetic resonance imaging (DWI) measurements with the therapeutic effect (TE) on and survival of esophageal carcinoma patients treated with chemoradiotherapy (CRT). Methods: From March 2010 to December 2011, 77 patients were prospectively enrolled into a cohort study. DWI was performed at the beginning and 1-3 months after CRT. The immediate post-CRT TE was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). The associations between the disappearance status of hyperintense expression (HE) in DWI and the apparent diffusion coefficient (ADC) of DWI with the complete response (CR) as TE and survival were analyzed. Results: 3 patients were excluded due to the absence of HE in DWI. Analysis of the remaining 74 patients indicated that their ADC values were significantly improved from 1.64 ± 0.48 to 2.65 ± 0.58 mm²/s from pre-CRT to post-CRT (p = 0.000). Both univariate and multivariate Cox model analyses showed that high post-CRT ADC values and the disappearance status of HE associated significantly with the TE (CR rate) and survival. Conclusions: DWI examination could afford useful markers to predict the treatment response as well as the survival of patients with esophageal squamous cell carcinoma. The non-disappearance of HE in DWI and low ADC values after CRT were risk factors.

Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma (SCC) treated with three dimensional conformal radiotherapy (3D-CRT). Between January 2005 and December 2006, 153 patients (120 males, 33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis. Median age was 60 years (range: 37-84 years). The proportion of tumor location was as follows: upper thorax (including the cervical region), 73 (48%); middle thorax, 73 (48%); lower thorax, 7 (5%), respectively. The median radiation dose was 64 Gy (range: 50-74 Gy). Fifty four cases (35%) received cisplatin-based concurrent chemotherapy. Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis. The five-year overall survival rate was 26.3%, with a median follow-up of 49 mo (range: 3-66 mo) for patients who were still alive. On univariate analysis, lesion location, lesion length by barium esophagogram, computed tomography imaging characteristics including Y diameter (anterior-posterior, AP, extent of tumor), gross tumor volume of primary lesion (GTV-E), volume of positive lymph nodes (GTV-LN), and the total target volume (GTV-T = GTV-E + GTV-LN) were prognostic for overall survival. By multivariate analysis, only the Y diameter [hazard ratio (HR) 2.219, 95%CI 1.141-4.316, P = 0.019] and the GTV-T (HR 1.372, 95%CI 1.044-1.803, P = 0.023) were independent prognostic factors for survival. The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising. The best predictors for survival were GTV-T and Y diameter.

Clinical significance of combined detection of human papilloma virus infection and human telomerase RNA component gene amplification in patients with squamous cell carcinoma of the esophagus in northern China

BackgroundThe aim of the study was to test for human papilloma virus (HPV) infection and human telomerase RNA component (hTERC) gene amplification in tissues derived from esophageal cancer, in esophagus displaying atypical hyperplasia and in normal tissue, and to analyze the relationship between them and discuss whether HPV infection and hTERC gene amplification play a role in the duration of survival of esophageal cancer patients.MethodsTo test for HPV infection, surface plasma resonance was used after extracting and subjecting the DNA to PCR amplification. Measurement of hTERC gene amplification was performed by the fluorescence in situ hybridization technique.ResultsThe rates of HPV infection in the normal group, the atypical esophageal hyperplasia group and the cancer group were 0% (0/40), 10.00% (1/10) and 20.65% (19/92), respectively, with a statistically significant difference of P < 0.01. The hTERC gene amplification rate in normal tissue, grade I atypical hyperplastic tissue, grade II/III atypical hyperplastic tissue and esophageal cancer tissue were 0% (0/89), 15.38% (4/26), 47.06% (8/17) and 89.13% (82/92), respectively, with a statistically significant difference of P < 0.01. On follow-up of 92 patients, survival curves of the HPV-positive and HPV-negative groups were not significantly different (P > 0.05). Survival curves of the hTERC gene amplification-positive and hTERC gene amplification-negative groups were statistically significant (P < 0.05). A matching chi-square test showed that there was no correlation between HPV infection and hTERC gene amplification (P > 0.05).ConclusionHPV infection may be one of many factors contributing to the development of esophageal cancer, but it does not influence prognosis. Amplification of the hTERC gene appears to influence certain features associated with postoperative survival in esophageal carcinoma patients.

Comorbidity and survival of esophageal carcinoma patients at a VA medical center.

e14642 Background: This study is to analyze whether comorbidity indices predict survival in esophageal cancer patients (pts). Methods: In an IRB approved protocol, we reviewed the records of pts di...