T1bSM2期食管鳞状细胞癌内镜治疗的安全性和有效性分析

目的回顾性分析内镜切除术治疗T1bSM2期(黏膜下层≥200 μm)早期食管鳞状细胞癌的安全性、有效性。 方法选取2009年1月至2017年7月于解放军总医院第一医学中心接受内镜切除术治疗且术后病理提示病变累及M3层(黏膜肌层)、SM1层(黏膜下层<200 μm)和SM2层(黏膜下层≥200 μm)的79例患者为研究对象,根据浸润深度分为相对适应证组和拓展适应证组,分析比较两组患者的基本资料及术后并发症的差异,Kaplan-Meier生存分析总体生存率及无进展生存率。 结果两组患者的基本资料、术后并发症、预后、总体生存率及无进展生存率比较,差异无统计学意义。 结论对于T1bSM2期食管鳞状细胞癌,内镜切除术也是一种可以选择的治疗方式。     

人工智能在浅表食管鳞状细胞癌及癌前病变内镜诊断中的应用进展

食管癌严重威胁国民身体健康,破解这一难题的关键是早诊早治,内镜筛查为早期诊断最重要的手段。人工智能（artificial intelligence,AI）技术的快速发展使得其在消化内镜领域的应用及研究日益增加,并有望成为内镜医师早期诊断食管癌的得力助手。目前,整合多种内镜模式、具备多种诊断功能的多模态、多功能AI系统在浅表食管鳞状细胞癌及癌前病变中的应用取得不错的成果,本文将对其研究进展进行综述,并对其未来发展方向进行展望。     

关于食管鳞状细胞癌免疫治疗的几点思考

近几年免疫治疗食管鳞状细胞癌取得了很大的进展.但是对于胸外科医生而言,免疫治疗还是个新生事物,缺乏足够的经验.因此,本文试图就一些免疫治疗的热点问题进行探讨,包括免疫治疗的适应证、不良反应、疗效以及疗效的判定等,以期引起胸外科医生的重视.     

Src家族酪氨酸激酶Fyn在人食管鳞状细胞癌中的表达

目的 探讨食管鳞状细胞癌组织中Fyn的表达水平及其意义.方法 收集13例食管鳞状细胞癌组织(ESCC)和10例食管正常黏膜上皮组织(UNR),采用免疫组织化学法和免疫印迹法分析食管鳞状细胞癌组织及食管正常黏膜组织Fyn蛋白表达水平的变化.结果 免疫组织化学染色显示食管鳞状细胞癌组织中Fyn蛋白表达水平(9.68±2.31)高于食管正常黏膜组织中染色指数(3.21±1.25),差异有统计学意义(P<0.01).免疫印迹结果亦显示食管鳞癌组织中Fyn蛋白表达强于食管正常黏膜组织.结论 Fyn蛋白在食管鳞状细胞癌组织中高表达,提示Fyn基因在食管鳞状细胞癌的发生发展过程中可能起重要作用.     

食管鳞状细胞癌患者预后危险因素的分析

目的通过对食管鳞状细胞癌(鳞癌)术后长期生存和短期生存患者临床病理特征的多因素分析,探讨影响食管鳞癌患者预后的危险因素。方法随机选取临床资料和随访资料完整的食管鳞癌手术患者126例,根据随访结果,将其分为长期生存组(≥5年,48例)和短期生存组(≤1年,78例),应用二项分类logistic回归对两组患者的临床病理特征进行多因素分析。结果单因素分析结果两组在肿瘤长度、肿瘤浸润深度、肿瘤病理分级和淋巴结转移方面差别有统计学意义(P<0.01),而在患者年龄、性别、肿瘤位置和食管残端鳞癌检查结果的阴阳性方面差别无统计学意义(P>0.05)。多因素分析显示肿瘤病理分级、淋巴结转移、肿瘤浸润深度和肿瘤长度与食管鳞癌患者预后有关(P<0.05),它们的危险系数分别为2.943,2.641,2.126和1.728。相关分析发现肿瘤长度与肿瘤浸润深度呈正相关(r=0.488,P<0.001),淋巴结转移与肿瘤浸润深度和肿瘤病理分级均呈正相关(r=0.216,P=0.014;r=0.238,P=0.007)。患者年龄、性别、肿瘤部位和食管残端癌残留阴阳性与食管鳞癌患者预后无关(P>0.05)。结论食管鳞癌患者预后的主要影响因素为肿瘤病理分级、淋巴结转移、肿瘤浸润深度和肿瘤长度;肿瘤病理分级为强危险因素,肿瘤长度为低危险因素;患者年龄、性别、肿瘤位置和食管残端癌残留阴阳性为非危险因素。     

同时化疗和放疗后手术切除对T4期食管鳞状细胞癌的治疗

手术技术及围手术期处理的进步提高了食管癌的切除率和长期生存率，并降低了病死率。但单纯的手术并不能改善T4食管鳞癌的不良预后，因此为了改善属于局部进展期的食管癌的预后，尚需一种多方式治疗。近来已发展有多方式治疗，来控制食管癌局部复发和远处转移，从而延长生存期，最有希望的是手术前予以同时化疗和效疗。术前化疗放疗的理论基础为：①术前治疗可提高肿瘤切除可能。     

STAT3在食管鳞状细胞癌中的表达和意义

目的研究STAT3蛋白表达与食管鳞状细胞癌临床病理特征的关系,探讨其在食管癌变中的可能作用。方法应用免疫组织化学S-P法检测60例食管鳞状细胞癌及其癌旁组织中STAT3蛋白的表达,结合临床资料进行分析。结果STAT3蛋白阳性反应主要定位于胞质。食管鳞状细胞癌组织中STAT3蛋白表达阳性率86.7%(平均灰度值为36.05±13.74)明显高于正常组织阳性率17.6%(平均灰度值为16.92±5.43)(P<0.05)。STAT3蛋白在低分化、中分化、高分化鳞癌组的阳性表达率分别是100%、95%、73.08%,平均灰度值分别是51.22±7.09、42.18±7.21、23.16±6.94,3组间差异有统计学意义(P<0.01)。肿瘤分化程度越高STAT3蛋白表达越低。有淋巴细胞转移的食管癌组织中STAT3表达的阳性率100%(平均灰度值45.36±10.36),明显高于无淋巴细胞转移的食管癌组织阳性率78.38%(平均灰度值30.26±12.41)(P<0.05)。结论STAT3蛋白在食管鳞状细胞癌组织中的高表达可能与食管鳞癌的发生有关系。     

Study of preoperative diagnostic modalities in Chinese patients with superficial esophageal squamous cell carcinoma

BACKGROUNDEndoscopic ultrasonography (EUS) and magnifying endoscopy (ME) reliably determine indications for endoscopic resection in patients with superficial esophageal squamous cell carcinoma (SESCC). ME is widely accepted for predicting the invasion depth of superficial esophageal cancer with satisfying accuracy. However, the addition of EUS is controversial.AIMTo evaluate the diagnostic efficiency of ME vs EUS for invasion depth prediction and investigate the influencing factors in patients with SESCC to determine the best diagnostic model in China.METHODSWe retrospectively analyzed patients with suspected SESCC who completed both ME and EUS and then underwent endoscopic or surgical resection at Sun Yat-Sen University Cancer Center between January 2018 and December 2021. We evaluated and compared the diagnostic efficiency of EUS and ME according to histological results, and investigated the influencing factors.RESULTSWe included 152 lesions from 144 patients in this study. The diagnostic accuracies of ME and EUS in differentiating invasion depth were not significantly different (73.0% and 66.4%, P = 0.24); both demonstrated moderate consistency with the pathological results (ME: kappa = 0.58, 95% confidence interval [CI]: 0.48-0.68, P < 0.01; EUS: kappa = 0.46, 95%CI: 0.34-0.57, P < 0.01). ME was significantly more accurate in the diagnosis of high-grade intraepithelial (HGIN) or carcinoma in situ (odds ratio [OR] = 3.62, 95%CI: 1.43-9.16, P = 0.007) subgroups. Using a miniature probe rather than conventional EUS can improve the accuracy of lesion depth determination (82.3% vs 49.3%, P < 0.01). Less than a quarter of circumferential occupation and application of a miniature probe were independent risk factors for the accuracy of tumor invasion depth as assessed by EUS (< 1/4 circumferential occupation: OR = 3.07, 95%CI: 1.04-9.10; application of a miniature probe: OR = 5.28, 95%CI: 2.41-11.59, P < 0.01). Of the 41 lesions (41/152, 27.0%) that were misdiagnosed by ME, 24 were corrected by EUS (24/41, 58.5%). CONCLUSIONPreoperative diagnosis of SESCC should be conducted endoscopically using white light and magnification. In China, EUS can be added after obtaining patient consent. Use of a high-frequency miniature probe or miniature probe combined with conventional EUS is preferable.     

Clinical significance and prognostic value of apoptosis related proteins in superficial esophageal squamous cell carcinoma

Background: The purpose of the present study was to examine the expression of cell cycle regulators [p53, p21^WAF1/CIP1 (p21), and Rb] and apoptosis related proteins Bax and Bcl-X_L and to evaluate the relationship between their expressions and clinicopathological findings in patients with superficial squamous cell carcinomas of the esophagus.Methods: We immunohistochemically investigated the expression of p53, p21, Rb, Bax, and Bcl-X_L in 79 patients with superficial esophageal carcinoma.Results: p21 overexpression was found in mucosal carcinoma (P = 0.05) and a high Bcl-X_L score was observed for submucosal carcinoma (P = 0.03). The patients with high Bcl-X_L score had more frequent lymphatic invasion and lymph node metastasis than did those with low Bcl-X_L score (P < 0.05). Univariate analysis revealed significantly shorter survival in patients with high Bcl-X_L expression than in those with low Bcl-X_L expression, but Bcl-X_L expression was not identified as an independent prognostic factor by multivariate analysis.Conclusions: Because Bcl-Xl expression correlated well with depth of tumor invasion, lymphatic invasion, and lymph node metastasis, examination of Bcl-X_L expression will help to estimate the properties in superficial squamous cell carcinoma of the esophagus.     

Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives

Background Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique. Methods In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins. Results From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy. Conclusions Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Detection of telomerase activity in esophageal squamous cell carcinoma and normal esophageal epithelium

Background/aims: Relatively little has been reported about the telomerase activity of esophageal squamous cell carcinoma or normal esophageal epithelium. In this study, we have evaluated whether telomerase activity is a useful marker for detecting malignancies in the esophagus. Patients/methods: Esophageal carcinomas and normal esophageal tissues adjacent to carcinomas were obtained from 52 surgically treated, unselected patients, and normal esophageal epithelium from 11 non-cancerous patients were obtained by means of biopsy. The telomeric repeat amplification protocol (TRAP) assay was used for detection of telomerase activity in these samples. The incidence of detection of telomerase activity in esophageal carcinoma was compared with that of telomerase activity in normal esophageal epithelium. Moreover, the clinicopathological characteristics of telomerase-positive tumors were compared with those of telomerase-negative tumors. Results: Of the 52 carcinomas, 40 (77%) had detectable telomerase activity. However, telomerase activity was detected in 45 of 52 (87%) normal tissue samples adjacent to carcinomas and in 8 of 11 (73%) normal esophageal epithelium from non-cancerous patients. In esophageal cancer, no significant difference was detected in the clinicopathological findings between the telomerase-positive and -negative cases. Conclusion: These results indicate that not only esophageal squamous cell carcinomas but also normal esophageal epithelium show strong telomerase activity. Thus, telomerase activity may not be a good marker for the detection of carcinoma in the esophagus. Received: 16 March 1999 Accepted: 8 July 1999     

环状RNA circPRDM5在食管鳞状细胞癌中的表达和功能研究

［摘要］ 目的 探索环状RNA circPRDM5在食管鳞状细胞癌（ESCC）细胞和组织中的表达水平,及其对ESCC细胞功能的影响。方法 qRT?PCR检测circPRDM5在正常食管上皮细胞（HEEC）、ESCC细胞系、和44例ESCC组织及对应的癌旁正常组织中的相对表达水平;Transwell实验和CCK8实验分别检测siRNA沉默circPRDM5后,对细胞迁移侵袭和增殖功能的影响;构建裸鼠成瘤模型,检测circPRDM5对ESCC细胞在动物体内成瘤能力的影响。结果 与HEEC相比,circPRDM5在ESCC细胞系KYSE150、ECA109中高表达（P<0.05）,且在ESCC组织中表达（2.90±0.18）较癌旁正常组织（2.01±0.15）表达高（P<0.001）。Transwell实验和CCK8实验证明,沉默circPRDM5能明显抑制ESCC细胞的迁移侵袭和增殖能力（P<0.05）;裸鼠成瘤实验结果表明,沉默circPRDM5后,ESCC细胞的成瘤体积和重量较对照组明显下降（P<0.01）。结论 circPRDM5在ESCC的细胞和组织中高表达。在ESCC细胞中沉默circPRDM5能降低ESCC细胞的增殖、迁移侵袭、和在动物体内的成瘤能力。提示circPRDM5可能成为ESCC治疗的一个新靶点。     

Cystic squamous cell carcinoma metastasis to the neck masquerading as branchiogenic carcinoma

Primary branchiogenic carcinoma was previously a debated entity for its existence. It was a popular diagnosis for any cystic carcinoma in the neck until in 1950 Martin et al. proposed specific and strict diagnostic criteria for this condition. Only a handful of cases successfully fulfilled all the criteria were reported afterwards. We report the management of a case who was diagnosed to have cystic squamous cell metastasis from a tonsillar origin. We suggest carrying out thorough search of the upper aero digestic tract for occult primaries upon finding of a cystic metastasis in the neck. Random biopsies in the region of Waldeyer's ring are of particular importance in this situation. Bilateral tonsillectomies should be carried out in doubtful cases. Radical neck dissection and postoperative radiotherapy to the diseased side is recommended.      

58例阴茎鳞状细胞癌治疗的临床分析

目的:提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法:回顾分析58例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果:按照Jackson分期,Ⅰ期25例,Ⅱ期18例,Ⅲ期11例,Ⅳ期4例。53例行手术治疗;行阴茎肿瘤局部切除及阴茎癌部分切除43例;阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术10例(腹股沟淋巴结均阳性,髂淋巴结阳性1例)。术前新辅助治疗(热疗加化疗)联合术后化疗37例,仅术后化疗12例,单纯手术治疗4例;5例未手术治疗患者行化疗和/或放疗。48例随访2~5年,4例行阴茎部分切除者2年内复发,4例2年内死亡,7例2~5年内死亡,2年生存率为91.7%,5年生存率为77.1%,10例失访或随访期未满2~5年。结论:外科手术治疗、术前新辅助治疗联合术后化疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结的清扫根据临床分级具体处理,手术联合术前新辅助治疗及术后化、放疗是否可减少复发及提高生存率,还需进一步研究。