Poor prognosis in esophageal cancer patients with postoperative complications

n = 100) consisted of cases without postoperative complications. Groups B (n = 58) and C (n = 47) consisted of cases with minor and major postoperative complications. The 5-year survival rates were 41.8%, 21.3%, and 20.2% in groups A, B, and C, respectively. There was a significant difference in the prognosis between groups A and B, and also between groups A and C. Any patients who died within 5 years without a relapse their cases were excluded from the study; the 5-year survival rates were 46.7%, 32.3%, and 22.5% in groups A, B, and C, respectively, with a significant difference between groups A and B. There were no significant differences between the three groups regarding the patient characteristics. These results therefore indicate that postoperative complications might contribute to a poor prognosis in cancer patients. (Received for publication on Jan. 16, 1997; accepted on Sept. 2, 1997)     

影响食管癌术后患者预后的病理因素

探讨影响食管癌术后患者预后的病理因素.通过分析国内外食管癌患者术后的临床资料,综述影响其预后的主要相关病理因素:肿瘤侵袭程度、淋巴结转移、远处脏器转移以及由上述冈素决定的肿瘤分期早晚;与预后相关联的独立凶素:肿瘤组织学类型和分化程度、肿瘤微转移、脉管瘤栓形成和肿瘤间质淋巴细胞浸润.作者认为食管癌的术后病理分期需进一步完善.     

The clinical characteristics of patients with synchronous squamous cell carcinoma of the esopohagus and hepatocellular carcinoma

An ongoing analysis of 762 patients with esophageal cancer revealed 4 (0.52%) male patients with synchronous hepatocellular carcinoma (HCC). A long history of habitual alcohol intake and heavy cigarette smoking was recognized in all four patients and, therefore, the possibility of these two factors being independent risk factors for this double cancer was suggested. Palliative treatment was undertaken since either one or both cancers were too far advanced, or because liver function was poor even in those patients with resectable cancers. The prognosis correlated more closely to the TNM stage of esophageal cancer rather than the HCC and the causes of death were related to the esophageal cancer in all four patients. These findings suggest that, in patients with this combination of double cancer, the state of the esophageal cancer may be a more reliable prognostic factor than that of the HCC and thus, the curability of esophageal cancer is of primary importance.     

Expression of PCNA andp53 in esophageal dysplasia and esophageal carcinoma

We examined the immunohistochemical expression of proliferating-cell nuclear antigen (PCNA) andp53 proteins in dysplasia and intramucosal carcinoma of the esophagus. Immunohistochemistry was performed with monoclonal antibodies directed against PCNA andp53. We used surgically resected specimens from 29 patients who had a total of 55 lesions of severe dysplasia (n=16), intraepithelial carcinoma (n=21), and mucosal carcinoma (n=18). The mean PCNA index with immunoreactivity forp53 was 48.9±6.5 in areas of severe dysplasia (n=7), 58.2±7.3 in areas of intraepithelial carcinoma (n=10), and 71.4±9.3 in the invasive areas of mucosal carcinoma (n=10). The mean PCNA index without immunoreactivity forp53 was 41.2±5.5 in areas of severe dysplasia (n=9), 48.0±7.4 in areas of intraepithelial carcinoma (n=11), and 63.7±9.1 in invasive areas of mucosal carcinoma (n=8). The PCNA indices of the areas of severe dysplasia with immunoreactivity forp53 were significantly lower than those of intraepithelial carcinoma and mucosal carcinoma with immunoreactivity forp53. Similarly, the PCNA indices of severe dysplasia without immunoreactivity forp53 were significantly lower than those of intraepithelial carcinoma and mucosal carcinoma without immunoreactivity forp53. These results thus suggest that severe dysplasia has a lower proliferative potential than carcinoma and may therefore represent a precancerous lesion.     

术前吸烟及饮酒状态对食管鳞状细胞癌术后复发和转移的影响

目的 分析术前吸烟及饮酒状态对可手术食管鳞状细胞癌(鳞癌)患者预后的影响.方法 回顾性分析2007 ～ 2016年在陕西省人民医院接受手术治疗的483例食管鳞癌患者的临床资料.男352例、女131例,中位年龄为64(37～ 80)岁.其中吸烟者311例,饮酒者172例.分析术前饮酒及吸烟状态与食管鳞癌患者的临床病理特征...     

皮肤鳞状细胞癌中PCNA和PTEN的表达与临床病理特征的关系

目的:探讨PCNA和PTEN在皮肤鳞状细胞癌(SCC)中的表达情况,研究其表达与临床病理特征的关系。方法:采用免疫组化SP法检测52例皮肤鳞状细胞癌组织和10例正常皮肤组织石蜡标本中PCNA和PTEN蛋白的表达。结果:在SCC标本中,PCNA蛋白阳性表达率明显高于正常皮肤组织,PTEN蛋白阳性表达率明显低于正常皮肤组织(P<0.005)。PCNA蛋白的阳性表达与病理分级呈明显正相关(r=0.484),PTEN蛋白阳性表达与病理分级呈明显负相关(r=0.507),差异均有统计学意义(P<0.005);在低分化SCC标本中,PCNA蛋白的阳性表达率高于高中分化组,PTEN蛋白的阳性表达率低于高中分化组(P均<0.001);PCNA与PTEN蛋白的表达存在明显的负相关(r=0.557);两者表达均与年龄和部位无关(P>0.05)。结论:在SCC组织标本中,PCNA强表达,PTEN低表达或失表达,在SCC的发生、发展及转移过程中发挥重要作用,二者对于判断SCC的进展和预后具有重要的临床意义。     

Thrombocytosis associated with poor prognosis in patients with esophageal carcinoma

BACKGROUND: Thrombocytosis in patients with cancer has been reported to be associated with increased expression of angiogenic factors and with a poor prognosis in some types of cancer. The aim of this study is to analyze the clinicopathologic significance and prognostic value of platelet counts in patients with esophageal cancer. STUDY DESIGN: Platelet counts were measured before surgery in 374 patients diagnosed between 1987 and 1999 with primary esophageal squamous cell carcinoma. We used the cut-off level of 293 x 10(9)/L (mean of 80 healthy controls +/- standard deviation) to define thrombocytosis. We analyzed the relationship between platelet counts, TNM factors, and white blood cell counts. Among 374 patients, the levels of C-reactive protein were analyzed in 170 patients and serum thymidine phosphorylase concentration was analyzed in 91 patients. The multivariate prognostic value of platelet counts, tumor size, and TNM factors were determined using Cox's proportional hazards model. RESULTS: Platelet counts were significantly increased in patients with large tumors (p < 0.001), deep tumors, nodal involvement, and distant metastasis in univariate analysis. C-reactive protein level, white blood cell count, and serum thymidine phosphorylase concentration were also significantly increased in patients analyzed with thrombocytosis in univariate analysis. Adjusting for tumor size and TNM factors, multivariate analysis indicated that thrombocytosis as defined in this study was an independent prognostic factor (hazard ratio = 1.52, 95% CI = 1.11 to 2.08, p = 0.009). CONCLUSIONS: A high platelet count is associated with tumor progression and poor survival in patients with esophageal carcinoma.     

Decreased immunostaining for macrophage scavenger receptor is associated with poor prognosis of prostate cancer

OBJECTIVE

The aim of this study is to evaluate the expression of the macrophage scavenger receptor (MSR) in prostate needle biopsy specimens as a possible prognostic factor for prostate cancer. As MSR reportedly has a role in recognizing foreign pathogenic substances, MSR‐positive inflammatory cells are often detected in solid tumours, and there is a correlation between the relative risk of prostate cancer and polymorphism of the MSR gene.

PATIENTS AND METHODS

MSR was evaluated by immunostaining in needle biopsies of the prostate from 135 patients who were confirmed to have prostate cancer. Among these men, 70 were treated by radical prostatectomy or by radiotherapy as definitive therapy; the other 65 were treated by hormonal therapy because of advanced disease or age. Needle‐biopsy specimens were sectioned at 5 µm and immunostained with a monoclonal antibody against MSR. Six microscopic (×400) fields around the cancer foci were selected in each case for analysis.

RESULTS

The median number of MSR‐positive cells (MSR count) in each case was 24. There was an inverse correlation between the MSR count and Gleason score and clinical stage. The MSR count was lower in patients with biochemical (prostate‐specific antigen, PSA) failure than that in those with no PSA failure (P < 0.001). In all patients, the recurrence‐free survival (RFS) rate was significantly higher in those with a high MSR count (≥24) than that in those with low MSR count (<24, P < 0.001). Moreover, for patients treated by definitive or hormonal therapy, the RFS rates in those with a higher MSR count were higher than in those with a lower MSR count (P < 0.001 and 0.014, respectively). Cox multivariate analysis showed that the MSR count was a prognostic factor for prostate cancer in addition to extraprostatic extension and Gleason score (P = 0.002, 0.038 and 0.011, respectively).

CONCLUSION

The results of immunostaining of MSR in needle‐biopsy specimens is a prognostic factor for prostate cancer.     

Increased preoperative serum C-reactive protein level predicts a poor prognosis in patients with localized renal cell carcinoma

OBJECTIVE: To evaluate the value of the preoperative serum C-reactive protein (CRP) level in the prognosis of patients with localized renal cell carcinoma (RCC). PATIENTS AND METHODS: The study comprised 101 patients who had a radical nephrectomy for localized RCC (pT1-3N0M0). An elevated CRP was defined as >0.5 mg/dL before surgery. Survival rates for each variant were calculated using the Kaplan-Meier method, with the difference between survival curves evaluated using the log-rank test. Multivariate analysis was by Cox proportional hazard model; for all analyses the difference was considered significant when P < 0.05. RESULTS: The median (range) follow-up was 55 (2-187) months; 26 patients (26%) had high CRP levels, and 12 (46%) of these and three (4.0%) of the remaining 75 died from disease. The 5- and 10-year disease-specific survival rates (75% and 30%, respectively) in patients with high CRP levels were significantly worse than those in patients with normal CRP levels (both 93%, P < 0.001). In other variants, preoperative haemoglobin concentration, pathological stage, grade, histological type and microvascular tumour invasion were also related to disease-specific survival. By the Cox proportional hazards model, pathological stage and an elevated CRP were the most important prognostic factors for disease-specific survival in patients with localized RCC (P = 0.008 and 0.012, respectively). CONCLUSION: The preoperative CRP level was associated with poor survival in patients with localized RCC.     

PIK3CA mutation status in Japanese esophageal squamous cell carcinoma

BACKGROUND: A somatic mutation of the PIK3CA (phosphatidylinositol 3-kinase catalytic subunit) gene has been found in human cancer patients. However, this mutation has not yet been extensively studied in esophageal squamous cell carcinomas. MATERIALS AND METHODS: We analyzed a mutation of the PIK3CA gene in 88 Japanese cases of esophageal squamous cell carcinomas that had all undergone surgery at the Department of Surgery II, Nagoya City University Medical School, between 1996 and 2003. The TE and KYSE series of cell lines are human esophageal cancer cell lines. Two PIK3CA mutation hot spots (exon 9 and exon 20) were analyzed by a real time polymerase chain reaction (PCR)-based assay and the data were confirmed by direct sequencing. We performed a cell proliferation assay to determine the effects of a PI3K inhibitor LY294002. RESULT: In exon 9, a somatic mutation was found in two patients (2.2%) and in two cell lines. The mutations included three E545K (G1633A) mutations and one E545Q (G1633C) mutation. However, in exon 20, no mutation was observed in our esophageal cancer patients. PI3K inhibitor (LY294002) inhibited the growth of an esophageal cancer cell line with a PIK3CA mutation (E545K) in vitro. CONCLUSIONS: We found LY294002 to reduce the proliferation of the esophageal cancer cell line in vitro. Importantly, a cell line with a PIK3CA gene mutation was more susceptible to a PI3K inhibition than those without any such mutation. Further functional analyses of the PIK3CA mutations are warranted to determine whether or not they may be potentially useful targets of therapy for esophageal cancer.     

Spontaneous regression in small cell esophageal carcinoma

Spontaneous regression or remission of cancers has been defined as the disappearance of the malignancies without any treatment or with obviously inadequate treatment. Spontaneous regression is rare, while any case with a small cell carcinoma in the esophagus was not found in the literature. We experienced a 73-year-old man with small-cell carcinoma in the thoracic esophagus whom underwent esophagectomy with lymphadenectomy. A pathological examination of the resected specimens found metastasis from the small cell carcinoma in the mediastinal lymph nodes, but no malignant cells in the esophageal lesion—an ulcer scar from which the biopsy specimen was taken to be a small-cell carcinoma. This may be the first case report that spontaneous regression in a small-cell carcinoma in the esophagus was found by esophagectomy and pathological examination.