Do Tumor Grade and Location Affect Survival in Esophageal Squamous Cell Carcinoma? Survival Analysis of 302 Cases of pT3N0M0 Esophageal Squamous Cell Carcinoma

Background

The 7th edition of the American Joint Committee on Cancer (AJCC) cancer staging manual incorporates tumor grade and location for staging pT2–3N0M0 esophageal squamous cell carcinoma. Patients with pT3N0M0, classified as stage IIa according to the 6th edition of the AJCC cancer staging manual, can now be classified as stage Ib, IIa, or IIb. We aimed to discuss whether these changes affect survival and determine other potential prognostic factors.

Methods

We retrospectively analyzed 302 patients with postoperative pathologic stage T3N0M0 who underwent esophagectomy between 1990 and 2005 at Sun Yat-sen University Cancer Center. We performed univariate and multivariate analyses to identify prognostic factors for survival and used the Kaplan–Meier method to compare survival difference in each prognostic factor, including tumor grade and location.

Results

The 5-year overall survival rate was 46 %, with a median survival of 1,244.5 days. Gender, age, alcohol consumption, forced expiratory volume in 1 s (FEV1), and number of removed lymph nodes were independent prognostic factors in both univariate and multivariate analyses. Smoking was also a prognostic factor in survival analysis by the Kaplan–Meier method. However, histologic tumor grade and location had no significant influence on patient survival.

Conclusions

Age, gender, alcohol consumption, FEV1, number of removed lymph nodes, and cigarette smoking are independent prognostic factors in patients with pT3N0M0 esophageal squamous cell carcinoma. However, tumor grade and location may not be as strong predictors in these patients as indicated in the 7th edition of the AJCC cancer staging manual.     

The Expression of Type IV Collagen α6 Chain Is Related to the Prognosis in Patients with Esophageal Squamous Cell Carcinoma

Background The destruction of the basement membrane (BM) is the first step in cancer cell invasion and metastasis. Type IV collagen is a major component of the BM, and is composed of six genetically distinct α(IV) chains: α1(IV) to α6(IV). The loss of α5/α6(IV) chains from the epithelial BM at the early stage of cancer cell invasion has been reported in several cancers. However, the expression of α5/α6(IV) chains in esophageal squamous cell carcinoma (ESCC) remains unclear. Methods The expression of α(IV) chains in 116 resected ESCC specimens was immunohistochemically examined. The role of α6(IV) chain was assessed in ESCC cell lines by short interfering RNA (siRNA). Results In intraepithelial carcinoma, the α5/α6(IV) chains were stained in a continuous linear pattern in the BM. In some cases of ESCC with the invasion beyond the lamina propria, the α5/α6(IV) chains were lost in the BM zone surrounding the cancer cell nests, but in other cases they remained. In the former, the disease-free survival and overall survival were significantly better than in those with the latter. The down-regulation of α6(IV) chain expression by siRNA revealed a slight increase of cancer cell invasiveness. Conclusions The evaluation of α5/α6(IV) chains may be a useful marker for determining tumor cell properties, as a prognostic factor, in patients with ESCC.     

Is Ischemia-Modified Albumin a Reliable Marker in Accurate Diagnosis of Appendicitis in Children?

World Journal of Surgery - Acute appendicitis is one of the most common abdominal emergencies. Despite all improvements in diagnostic techniques, there are still ongoing problems as proper...     

Association of the Modified Albumin–Bilirubin Grade with Survival Outcomes in Esophageal Squamous Cell Carcinoma

Annals of Surgical Oncology -     

Presentation and Survival of Operable Esophageal Cancer in Patients 55 Years of Age and Below

Background  

The increased incidence of esophageal cancer, especially in the younger age group, should encourage early diagnosis. The perceived rarity and poor prognostic outcome of esophageal cancer in this group is based on retrospective studies. The goal of this study was to review the presentation and survival of young patients with esophageal cancer.     

Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?

Background

Among patients with T4 thoracic esophageal squamous cell carcinoma (TESCC), it is unclear whether the outcomes of late responders who undergo high-dose chemoradiotherapy (CRT) followed by salvage esophagectomy differs from those of early responders who undergo low-dose CRT followed by esophagectomy.

Methods

A total of 153 patients with T4 TESCC were treated with CRT. The first evaluation was performed after 40 Gy of CRT for downstaging. Of these, 28 patients could be downstaged, and underwent subsequent surgery (early responders). For the remaining patients, additional CRT was administered, and patients were re-evaluated after treatment and underwent salvage surgery. In total, 40 patients (early + late responders) were analyzed.

Results

The primary tumors exhibited a grade 3 response in six (21.4 %) of the early responders and two (16.7 %) of the late responders (p = 1.000). The rate of residual tumor in the primary tumor was 80 % (32/40 patients). The proportions of resected lymph nodes and positive metastatic nodes were similar between early and late responders (p = 0.406 and p = 0.859, respectively). The 5-year overall survival rates among the early and late responders were 25.9 and 36.5 %, respectively, and the median survival times were 24.8 and 24.3 months (p = 0.925), respectively. The 5-year cause-specific survival rates in the early and late responder groups were 61.5 and 72.9 % (p = 0.425), respectively.

Conclusion

The outcomes of both early and late responders to CRT were similar, and salvage surgery for T4 TESCC outweighs the risks in patients with T4 TESCC.     

Surgery in Esophageal and Gastric Cancer Patients: What is the Role for Nutrition Support in your Daily Practice?

Cancers of the esophagus and stomach have a major impact on patients' nutritional status by virtue of these organs' inherent digestive functions. Many patients with these cancers will require surgical intervention, which imposes further metabolic demands and compounds preexisting nutritional disorders. Patients with esophagogastric cancer are likely to have lost weight by the time the diagnosis is made. This fact alone is of clinical importance, because it is well known that patients who have lost weight will have higher operative mortality and morbidity rates than patients who maintain their weight. Initial assessment of patients with esophagogastric cancer should include a routine evaluation of nutritional status. This will allow the identification of patients who are at risk of complications, particularly in the postoperative setting. These patients should be targeted for specific nutritional support.     

Circulating Cytokeratin 18 Fragment M65—A Potential Marker of Malignancy in Colorectal Cancer Patients

Soluble cytokeratin 18 fragments (M30, M65) are released from human cancer cells during cell death and hold potential as biomarkers in colorectal cancer characterized by frequent metastatic spread. A total of 62 colorectal cancer and 27 control patients were included in the study. M65 (necrosis and apoptosis) and M30 (apoptosis) were quantified preoperatively (n = 62) and postoperatively (n = 31) using specific enzyme-linked immunosorbent assays. Presence of disseminated tumor cells (DTC) in the bone marrow was assessed by staining of A45-B/B3-positive cells in aspirates. M65 was significantly elevated in patients with International Union against Cancer stage I and IIA tumors compared to controls. A subgroup (19/31) exhibited a significant (p < 0.05) decrease of M65 after tumor surgery (503.9 ± 230.7 to 342.6 + 94.8 U/l; −32.0 ± 16.5%), in contrast to 12 patients who revealed higher M65 levels postoperatively (386.5 ± 128.5 to 519.1 ± 151 U/l; +37.4 ± 32.3%). DTC in bone marrow were found in 10% (2/19) of patients with decreasing and 50% (6/12) of the patients with increasing M65 serum concentrations after surgery (p = 0.028). In conclusion, M65 as marker is likely to be valuable to identify patients with a high incidence of systemic disease.     

STMN-1 Gene: A Predictor of Survival in Stage IIA Esophageal Squamous Cell Carcinoma After Ivor-Lewis Esophagectomy?

Background

Prognosis of esophageal squamous cell carcinoma (ESCC) is stage-specific; however, some patients with the same stage have different survival outcomes. Clinically, it is significant to explore the biological marker to predict patient’s outcome. We investigated the association between the stathmin1 gene (STMN-1) expression and the prognosis of patients who underwent Ivor-Lewis esophagectomy.

Methods

A total of 162 patients who suffered from midthoracic stage IIA ESCC and completely resected with Ivor-Lewis esophagectomy were studied for STMN-1 expression by qRT-PCR in fresh-frozen tissue and validated by immunohistochemistry in matched formalin fixed-paraffin embedded tissue samples. STMN-1 level was evaluated as a prognostic factor in ESCC. SPSS 21.0 software was used to analyze the relationship between STMN-1 expression and clinicopathological characteristics and survival probability.

Results

The overall 3- and 5-year survival was 72.20 and 42.00 % respectively. Ninety-four patients (58.02 %) experienced disease recurrence with a disease-free interval of 21.50 ± 1.20 months. qRT-PCR result showed that STMN-1 mRNA level in patients who were alive at the end of follow-up was lower compared with patients who died during the follow-up period (p < 0.05). Immunohistochemical results showed that 94 patients had STMN-1 protein overexpression (58.02 %), patient with STMN-1 overexpression had worse survival compared with patients who had low STMN-1 expression (p = 0.00). Cox regression analysis revealed that STMN-1 protein expression and T classification are independent prognostic factors.

Conclusions

Even localized ESCC are potential to relapse with poor prognosis. This study demonstrates that STMN-1 level is an independent prognostic factor after Ivor-Lewis esophagectomy. In addition, assessment of STMN-1 level could improve stratification of stage IIA ESCC patients.     

Combined Prognostic Value of Both RelA and IκB-α Expression in Human Non–Small Cell Lung Cancer

Background We sought to investigate the prognostic significance of nuclear factor (NF)-κB activity, especially nuclear RelA and IκB-α expression patterns, in non–small cell lung cancer (NSCLC). Methods A total of 116 patients with pathologically confirmed stage I to II NSCLC were included. Immunohistochemical analysis and electrophoretic mobility shift assays of NF-κB were performed to determine RelA and phosphorylated IκB-α staining, and DNA binding activity of NF-κB in human NSCLC. Downstream genes, including VEGF and IL-8, were also assessed. The prognostic significance of a single expression of RelA, phosphorylated IκB-α, and b-composite expressions was evaluated by Cox proportional hazard regression models and by Kaplan-Meier survival analyses. Correlation between RelA/IκB-α expression status and clinicopathological features of NSCLC was also analyzed. Results NF-κB DNA binding activity, VEGF, and IL-8 showed correlation with nuclear RelA and cytoplasmic pIκB-α expression. Expression of nuclear RelA/NF-κB showed an increase in NSCLC tissue compared with adjacent normal tissue and normal lung tissue. There was a positive correlation between NF-κB activation (nuclear translocation of RelA) and tumor clinicopathological features such as tumor grade, including T stages, N stages, and tumor, node, metastasis system stages, smoking status, and age. Positive correlation was observed between nuclear RelA and cytoplasmic pIκB-α. Both nuclear RelA and cytoplasmic pIκB-α were associated with poor prognosis by univariate and multivariate analyses. Conclusions Nuclear RelA and cytoplasmic pIκB-α expression are associated with a poorer prognosis in NSCLC patients. In particular, composite application of these two biomarkers might be of greater value than application of a single marker to identify patients at high risk, even at an early clinical stage. D.Z. and X.J. contributed equally to this work.     

Is Serum Albumin a Marker of Nutritional Status in Hemodialysis Patients without Evidence of Inflammation?

Hypoalbuminemia, a strong predictor of morbidity and mortality in hemodialysis patients, can be a consequence of a combination of malnutrition and inflammatory reactions. The purpose of this study was to analyze serum albumin as a marker of nutritional status in maintenance hemodialysis patients with no signs of inflammation. In a cross-sectional study, we selected 40 stable hemodialysis patients with normal levels of C-reactive protein (<0.8 mg/dL). The patients were classified as well nourished (65%) or malnourished (35%) according to the subjective global assessment. No significant differences were observed in serum albumin concentrations (immunoturbidimetric method) between well-nourished (4.3 +/- 0.3 g/dL) and malnourished (4.0 +/- 0.5 g/dL) patients, and the mean values were within the normal range in both groups. Albumin was inversely correlated with age (n=40; r=-0.32; P=0.02) and directly with energy intake (n=28; r=0.43; P=0.04). In this study, serum albumin did not discriminate well-nourished and malnourished hemodialysis patients without evidence of inflammation.     

Interleukin-2 −330T>G Genetic Polymorphism Associates with Prognosis Following Surgery for Thoracic Esophageal Squamous Cell Cancer

Background  

Key molecules in the T helper (Th)1 and Th2 pathways underlie differential responses to the progression and surgical treatment of cancer. We investigated the relationship between Th1/Th2 cytokine polymorphism and prognosis in patients with thoracic esophageal squamous cell cancer.     

The hMLH1 −93G>A Promoter Polymorphism is Associates with Outcomes in Oral Squamous Cell Carcinoma Patients

Background

The aim of this study was to investigate the impact of hMLH1 polymorphisms on treatment outcomes in patients with oral squamous cell carcinoma (OSCC).

Methods

Genotypings were performed by direct DNA sequencing in peripheral blood leukocytes from 185 male OSCC patients. Patients received primary surgery with or without adjuvant radiotherapy. Two hMLH1 tag single nucleotide polymorphisms (SNPs)—rs1800734 (?93G>A in the promoter) and rs1540354 (in the third intron)—were chosen from the HapMap project. Overall survival (OS) and disease-free survival (DFS) were compared between different genotypes.

Results

The hMLH1 rs1800734 and rs1540354 polymorphisms were in weak linkage disequilibrium (r ² = 0.456). OSCC patients with the rs1800734 AA genotype had a significantly poor prognosis in both OS and DFS. This SNP can also predict the outcomes of OSCC patients with postoperative adjuvant radiotherapy, especially in advanced stage; however, no significant differences in patient outcomes were found for the hMLH1 rs1540354 genotypes.

Conclusions

Our results demonstrate that the hMLH1 ?93G>A SNP is found to be associated with patient outcomes in OSCC. This SNP can also predict their treatment outcome of radiotherapy.     

Disseminated Tumor Cells in Biologic Subtypes of Stage I–III Breast Cancer Patients

Background  

Triple receptor-negative breast cancers (TNBC) are higher grade and more likely to metastasize. Recurrences after 5 years are rare in TNBCs. Conversely, late recurrences are seen in estrogen receptor (ER)-positive (luminal) cancers. Disseminated tumor cells (DTCs) may be responsible for late recurrences. We compared rates of DTCs in basal and luminal subtypes.     

Quality of Endoscopy Reports for Esophageal Cancer Patients: Where Do We Stand?

Backgrounds and Aims

As treatment for esophageal cancer often involves a multidisciplinary approach, the initial endoscopic report is essential for communication between providers. Several guidelines have been established to standardize endoscopic reporting. This study evaluates the compliance of esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS) reporting with the current national guidelines.

Methods

Combining the National Comprehensive Cancer Network and Society of Thoracic Surgeons guidelines, 11 quality indicators (QIs) for EGD and 8 for EUS were identified. We evaluated initial EGD and EUS reports from our institution (Memorial Sloan Kettering [MSK]) and outside hospitals (OSHs) and calculated individual and overall quality measure scores. Scores between locations were compared using the Wilcoxon signed-rank test and McNemar’s test for paired data.

Results

In total, 115 initial EGD reports and 105 EUS reports were reviewed for patients who underwent surgery for esophageal cancer between 2014 and 2016. The median number of QIs reported for the initial EGD was 4 (IQR, 3–6)—only 34% of reports qualified as “good quality” (those with ≥?6 QIs). None of the reports included all QIs. For patients who underwent EGD at both MSK and an OSH, 32% of reports from OSHs were good quality, compared with 68% from MSK (p?<?0.001). Compliance with QIs was better for EUS reports: 71% of OSH reports and 72% of MSK reports were good quality.

Conclusions

Detailed information on the initial endoscopic assessment is essential in today’s age of multidisciplinary care. Identification and adoption of QIs for endoscopic reporting is warranted to ensure the provision of appropriate treatment.