Polypoid squamous cell carcinoma of the esophagus

Since 1971, 111 patients with esophageal carcinoma have undergone esophagectomy at the affiliated hospitals of Nippon Medical School. Of the 101 patients with ordinary squamous cell carcinoma, seven (7%) had intraluminal polypoid masses, endoscopically, and radiologically. The criteria used to select cases were as follows: (1) a size greater than 3 cm, (2) an intraluminal polypoid or pedunclated tumor, and (3) absence of wall construction and ulceration. Four of the seven polypoid cases have survived more than 5 years. One has lived more than 3 years. The 5-year survival rate of those patients with the polypoid type was 71%, but it was only 11% for the other types (P less than 0.05). Age, sex, size or location of the tumor, histologic grade, or lymph node metastasis did not affect survival. Only the incidence of adventitial involvement was significantly lower for the polypoid type. These results indicate that polypoid-type squamous cell carcinoma of the esophagus has a fairly good prognosis after surgery.     

Intramural squamous cell carcinoma of the esophagus.

A case of squamous cell carcinoma arising from an esophageal intramural squamous epithelial cyst is reported. Review of the literature reveals no previous reports of malignant transformation of esophageal cysts, although there have been reports of approximately 64 cases of benign esophageal cysts, and 35 cases of carcinoma arising in esophageal diverticula. In the present case, there was a history of increasing dysphagia for 2 months. Esophagram demonstrated a 4.5-cm concentric narrowing of the proximal esophagus just below the superior esophageal ring. Esophagoscopies revealed an esophageal stricture with intact mucosa, and bronchoscopy showed the lesion to be producing tracheal deviation. Multiple esophageal biopsies revealed mild mucosal hyperplasia with deep submucosal inflammatory changes suggesting an underlying lesion. Despite lack of histologic proof of malignancy, the patient underwent radiation therapy and bleomycin chemotherapy on the basis of the highly suggestive radiographic findings, but died with bilateral bronchopneumonia 6 months after admission. Autopsy demonstrated a 1.5-cm long intramural esophageal squamous epithelial cyst, from which arose a locally invasive squamous cell carcinoma, without mucosal involvement or metastases. There was no demonstrable evidence of any associated esophageal diverticulum.     

Choriocarcinoma arising in a squamous cell carcinoma of the esophagus

Extragonadal germ cell tumors are rare neoplasms with histologic features comparable to those of gonadal origin. Squamous cell carcinoma of the esophagus was diagnosed in a 53-year-old male patient, and was palliated for a short period by cisplatin plus 5-fluorouracil. Clinical deterioration and development of gynecomastia led to diagnosis of hormone-secreting choriocarcinoma that originated within the squamous cell tumor of the esophagus. Salvage chemotherapy affected the markers but not the tumor. Extragonadal choriocarcinoma is a chemosensitive tumor, but when arising within squamous cell carcinoma of the esophagus it may be chemoresistant, and lead to a fatal outcome.     

Radiation therapy for squamous cell carcinoma of the esophagus

Between 1965 and 1981, 119 patients with squamous cell carcinoma of the esophagus were treated with radiation therapy with curative intent. Radiation was employed in combination with surgery and delivered pre- and/or postoperatively in 20 patients (17%). The remainder received radiotherapy alone. The overall survival rate was statistically higher in patients who had surgery and radiation compared to the group receiving radiation alone. The one-, two-, and five-year survival rates of patients receiving combined treatment vs radiotherapy alone were 65% vs 35%, 25% vs 14%, and 15% vs 6%. Age, total radiation dose, and inclusion of the supraclavicular areas in the radiation portals did not impact on outcome. Other prognostic factors are discussed. Long term survivors were noted to be at substantial risk for the development of a second epidermoid malignancy in the upper aerodigestive tract. Cumulative risk at five years was approximately 25%.     

细胞周期调节蛋白在食管鳞癌组织中的表达

背景与目的:研究表明肿瘤细胞周期分析显示细胞具高增殖率的肿瘤,其临床病情发展快;细胞周期调节蛋白Ki-67、细胞周期蛋白A及p27介入到细胞的增殖,但这些因子与食管癌之间的关系的研究在我国尚未见报道。本研究观察细胞周期调节蛋白Ki-67、细胞周期蛋白A及p27在中国食管癌患者中的表达特征,以探讨这些分子标志物与临床病理因素之间的关系。方法:60例(48例男性、12例女性)食管鳞癌患者行外科手术切除肿瘤,其标本行免疫组织化学染色。Ki-67及细胞周期蛋白A表达程度以染色指数表示,p27以标记指数表示。结果:Ki-67、细胞周期蛋白A及p27免疫组化染色在瘤组织与非瘤组织中均固定于细胞核。Ki-67及细胞周期蛋白A的染色指数在低分化鳞癌(27.2±4.9;15.4±5.3)明显高于高分化鳞癌(20.6±6.3;11.3±6.4,P<0.05);p27免疫组化染色的阳性率在高分化鳞癌(36%)高于其它病理类型(29%及18%),但相互之间的差异无统计学意义(P>0.05)。结论:Ki-67、细胞周期蛋白A及p27的表达程度可反映食管鳞癌细胞的增殖状况。细胞周期调节蛋白Ki-67及细胞周期蛋白A的过度表达提示食管鳞癌细胞分化差。     

Expression of deltaNp63 in squamous cell carcinoma of the esophagus

BACKGROUND: The p63 gene is present as two isoforms, namely TAp63 and deltaNp63. The biological role of deltaNp63 in the progression of esophageal cancer is still controversial. PATIENTS AND METHODS: The expression of deltaNp63, as well as that of p63, was immunohistochemically examined in 61 resected specimens of squamous cell carcinoma of the esophagus. RESULTS: The incidences of a positive deltaNp63 expression were 32 and 64% in carcinomas with and without adventitial invasion, respectively, and 37 and 65% in those with and without lymph node metastasis, respectively (p<0.05). The prognosis was significantly better in the positive deltaNp63 group than in the negative group (p<0.01). However, a multivariate analysis revealed deltaNp63 not to be an independent prognostic factor. Regarding p63, diminished expression was more frequently observed in advanced carcinomas, however, there were no statistically significant differences. CONCLUSION: The impaired deltaNp63 reflects the progression of squamous cell carcinoma of the esophagus.     

Expression of desmoglein I in squamous cell carcinoma of the esophagus

Desmoglein I (DGI) is major component of the desmosomal membrane core that plays an important role in epithelial cell adhesion. The aim of this study was to explore the correlation between the expression of DGI and the clinicopathological findings of esophageal cancer. DGI expression was immunohistochemically examined using an anti-DGI monoclonal antibody in 139 patients with squamous cell carcinoma of the esophagus. Normal squamous epithelial cells strongly expressed DGI at their cell-cell boundaries. According to the intensity and pattern of DGI expression, the cancerous tissues were divided into three groups: DGI (++), DGI (+), and DGI (-). Of the 139 tumors, 35 (25%) were DGI (++), 65 (47%) were DGI (+), and 39 (28%) were DGI (-). A good inverse correlation between DGI expression and tumor invasion, lymph node metastasis, lymphatic invasion, and vessel invasion was observed. These results indicate that DGI expression may be a significant factor for invasion, metastasis, and prognosis of human esophageal cancer. © 1994 Wiley-Liss, Inc.     

食管鳞癌p27的表达及其临床意义

目的　p2 7可抑制细胞周期的向前推进 ,作用于细胞周期的分子更能较精确地反映肿瘤的生物学行为。即可为临床提供更为有价值的信息。本研究的目的是观察p2 7在食管癌的表达特性及阐明该分子标志物与临床病理因素之间的关系。方法　 89例 (5 6例男性、33例女性 )食管鳞癌行外科手术切除。其标本用p2 7抗体行免疫组织化学染色。p2 7表达程度以标记指数表示。结果　p2 7免疫染色在瘤与非瘤组织均固定于细胞核。p2 7的阳性免疫染色在高分化鳞癌 (4 7 3% ,14 /32 )多于其它类型 (35 5 % ,11/31;2 3 1% ,6 /2 6 ) ,有统计学意义 (P <0 0 5 )。结论　食管鳞癌细胞的增殖状况信息可由p2 7的表达程度提示 ,p2 7表达缺失提示食管鳞癌分化差     

Single-agent chemotherapy with vinorelbine for pretreated or metastatic squamous cell carcinoma of the esophagus.

AIMS AND BACKGROUND: At least half of the patients with squamous cell carcinoma of the esophagus (SCCE) present at diagnosis with metastatic disease, and most patients in a locally advanced phase will develop metastases despite potentially curative local therapy. Thus, the majority of patients with SCCE will become candidate for palliative chemotherapy. Only a few drugs have demonstrated moderate activity (>15%) against SCCE. The main purpose of this phase II trial was to assess the activity of vinorelbine, a semisynthetic vinca alkaloid with a wide spectrum of action, in advanced or relapsed SCCE. METHODS: Seventeen patients were included in the trial. Eleven of them had already received chemotherapy (cisplatin and fluorouracil) and/or radiotherapy at the time of the first diagnosis. All patients were treated with vinorelbine at the dose of 30 mg/m2 every two weeks. RESULTS: Sixteen of the 17 patients enrolled in the trial were assessable for activity: partial responses were observed in 4 of the 16 (25%), and 3 of them were pre-treated patients. A significant improvement of dysphagia was obtained in 4 of 11 symptomatic patients. Toxicity was mild, with only one episode of grade 4 neutropenia and constipation. CONCLUSIONS: In our experience, single-agent vinorelbine is active against SCCE. It was also active in patients previously treated with cisplatin and fluorouracil. The good tolerability and the possibility of relieving symptoms such as dysphagia strongly suggest the addition of vinorelbine to combination regimens with cisplatin as front-line chemotherapy for SCCE.     

A case of double neoplasms--small cell carcinoma in the mediastinum and squamous cell carcinoma of the esophagus

A 62-year-old Chinese man was admitted to our hospital because of dysphagia and hoarseness. Chest X-rays showed a superior mediastinal mass, and an operation for the removal of this mediastinal tumor was performed. The histological diagnosis indicated a small cell carcinoma, probably arising from the lung. He was readmitted to our clinic one year later with a complaint of dysphagia due to an esophageal cancer. Radical surgery for the esophageal cancer was performed, and the histological findings showed a well differentiated squamous cell carcinoma. The histogenesis of this carcinoma was considered to be independent of the earlier mediastinal tumor.     

食管基底细胞样鳞癌的诊断与治疗

目的 观察食管基底细胞样鳞癌的临床和病理组织学特征,探讨其诊断、鉴别诊断及治疗方法.方法 对23例食管基底细胞样鳞癌患者的临床和病理资料进行回顾性分析.结果 食管基底细胞样鳞癌发病年龄较大,临床表现和影像学特点与鳞癌相似,以溃疡型多见;治疗首选手术,术后应结合放化疗.本组23例食管基底细胞样鳞癌患者的1、2和3年生存率分别为60.9%、21.7%和0.结论 食管基底细胞样鳞癌具有恶性程度高、进展快、转移早和预后差等特点,临床上应采用根治性手术并结合术后放化疗的治疗方案.     

Flow cytometric DNA analysis of squamous cell carcinoma of the esophagus

Although an abnormal amount of cellular DNA content is known to occur in squamous cell carcinoma of the esophagus, the significance and clinical relevance of this finding have yet to be elucidated. Paraffin-embedded blocks from 77 patients with squamous cell carcinoma of the esophagus were dewaxed and made into a suspension by mechanical mincing and enzymatic digestion. The nuclei were stained with propidium iodide, and the DNA content evaluated with flow cytometric study. The DNA index (DI) and the coefficient of variation were determined and the results were compared with other pathologic prognostic features. DNA aneuploidy was identified in 70.1% of the specimens and found to correlate significantly with both histologic grading (P less than 0.025) and the incidence of postoperative recurrence (P less than 0.05). Although the 5-year survival was slightly better in the euploid group than in the aneuploid group (28.8% and 19.1%, respectively), this difference was not statistically significant (P greater than 0.1). There was no correlation of the DI with the extent of wall penetration by the tumor, the incidence of lymph node metastases, or the surgical staging, features previously shown to correlate with prognosis in patients with esophageal carcinoma.     

Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus

Aims

To investigate the survival benefit and preoperative risk factors for hospital mortality of salvage surgery in esophageal cancer patients who had locoregional residual/recurrent tumor after definitive chemoradiotherapy.

Methods

We retrospectively reviewed the esophageal cancer patients who presented at our hospital from 1997 to 2004. Forty-seven patients who had squamous cell cancer and developed locoregional recurrent/persistent disease after primary definitive chemoradiotherapy were elected. Twenty-seven of them received salvage esophagectomy (group 1) and the other 20 underwent non-operative treatment only (group 2). In order to assess the surgery-related mobility and mortality in group 1, 191 patients who received neoadjuvant chemoradiotherapy followed by operation during the same time period were also enrolled (group 3).

Results

The 5-year overall survival of group 1 patients was 25.4%. In contrast, all of the patients in the group 2 died within 16.7 months. The difference was statistically significant (p = 0.0029). In comparison with group 3, group 1 patients had significantly more surgery-related complications and hospital mortality. In univariate analysis for preoperative risk factors, a low albumin or hemoglobulin level was associated with high hospital mortality in group 1 (p = 0.004 and 0.003, respectively). After multivariate analysis, only the low albumin level remained borderline significance. As for disease specific survival after salvage surgery, R0 resection was the only independent prognosticator (p = 0.049).

Conclusion

Salvage surgery provides survival benefit in esophageal cancer patients with locoregional persistent or recurrent disease after primary definitive chemoradiotherapy. Preoperative albumin and hemoglobulin levels are associated with hospital mortality and may aid in selecting suitable patient for salvage surgery.     

Basaloid squamous cell carcinoma of the esophagus: a case report

Basaloid squamous cell carcinoma (BSCC) of the esophagus is an extremely rare tumor which should be differentiated from adenoid cystic and small cell undifferentiated carcinoma. We present the case of a 48-year-old male patient with esophageal BSCC. This tumor has specific histological features which may be difficult to recognize by small endoscopic biopsy examination. In our patient the surgical specimen revealed BSCC with an aggressive pattern (invasion of the whole esophageal wall thickness, lymph node metastases and intraneural spread). We proposed chemotherapy and radiotherapy after surgery, which resulted in a survival of 17 months.     

SEL1L and squamous cell carcinoma of the esophagus.

The gene SEL1L is involved both in human breast and pancreatic cancer progression. It is located on 14q24.3-31, a region known to be lost in invasive cancer of the esophagus. We aimed to assess whether SEL1L could become a useful biomarker for this cancer. We assessed SEL1L mRNA and protein expression in 35 patients and found it to be weak in low-grade and strong in high-grade dysplasia. Although the majority of cancer patients showed differential expression (mRNA and protein) of SEL1L, in five cases it was completely absent; these patients had the worst outcomes. SEL1L immunoreactivity was negative in normal tissue samples from five patients with mild esophagitis as well as in normal mucosa adjacent to the tumor. We hypothesize that SEL1L could influence those cellular changes that mediate the transition from a normal mucosa to a neoplastic lesion and may help in the identification of those patients at higher risk of developing this cancer. The specific impact of SEL1L in esophageal cancer needs further investigation.     

Concurrent chemoradiotherapy for T4 and/or M1 LYM squamous cell carcinoma of the esophagus

A phase II study was conducted to investigate the efficacy and feasibility of chemoradiotherapy for locally advanced carcinoma of the esophagus. Fifty-four patients with clinical T4 and/or M1 LYM squamous cell carcinoma of the esophagus were enrolled. Patients received protracted infusions of fluorouracil 400 mg/m2/24 hours on days 1 to 5 and 8 to 12, 2-hour infusions of cisplatin 40 mg/m2 on days 1 and 8, and concurrent radiotherapy at a dose of 30 Gy in 15 fractions over 3 weeks. Filgrastim was prophylactically administered to 35 patients. This schedule was repeated twice every 5 weeks, for a total radiation dose of 60 Gy followed by two courses of fluorouracil (800 mg/m2/24 hours for 5 days) and cisplatin (80 mg/m2 on day 1). There were 36 patients with T4 disease and 33 with M1 LYM. Forty-nine patients (91%) completed the chemoradiotherapy segment. The 18 patients (33%) who achieved a complete response included nine (25%) of the 36 with T4 disease and nine (50%) of the 18 with non-T4 disease. Major toxicities were leukopenia and esophagitis; there were four (7%) treatment-related deaths. Prophylactic filgrastim reduced the incidence of grade 3 or worse leukopenia without improving dose-intensity or response. With a median follow-up duration of 43 months, median survival time was 9 months. The 3-year survival rate was 23%. Despite its significant toxicity, this combined modality seemed to have curative potential even in cases of locally advanced carcinoma of the esophagus.     

Neoadjuvant chemoradiotherapy for advanced squamous cell carcinoma of thoracic esophagus

Advanced thoracic esophageal cancer has a poor prognosis despite advances in surgery, such as three-field lymph node dissection. Multimodal therapy is needed to improve local control, resectability and survival rate. Fifteen patients with advanced squamous cell carcinoma of the thoracic esophagus were treated with neoadjuvant chemoradiotherapy (NAC) combined with concurrent radiation (30 Gy/12 f) and 3 courses of 5-FU and CDDP (CDDP 5 mg/m2/day + 5-FU 250 mg/m2/day: day 1-5: div). In the absence of unresectable disease and surgical risk, 12 patients underwent esophagectomy (Group 1) and 3 patients underwent additional chemoradiotherapy because of high surgical risk (Group 2). Side effects consisted of nausea, vomiting and myelo-suppression in 8 patients, but all patients tolerated and completed a full course of NAC. The effective rate (CR + PR) of NAC was 58.3% in Group 1 and 66.7% in Group 2. No patients showed pathological CR. Two-year survival rate was 28.1% in Group 1 (PR: 33.3%, NC: 20.0%) and 33.5% in Group 2. This protocol had acceptable toxicities but did not show survival benefit. Further trials are necessary to improve survival rate.