Cancer of the colon in California, 1945-1966: the California Tumor Registry experience

Appropriate data from the California Tumor Registry (1945–1966) and the Alameda County Tumor Registry were analyzed with specific reference to colon cancer (excluding rectal cancer) I.C.D.A. No. 153. The high incidence of colon cancer in the Chinese population (33.8 per 100,000) requires further epidemiologic study to ascertain its significance. The sigmoid colon is the location of the highest percentage of colonic tumors. The 5-year relative survival rate for all stages of colon cancer has increased from 24% in 1945 to 43.2% in 1966. For cases localized at the time of diagnosis, the 5-year relative survival rate was 71.3%. An inverse relationship between age and survival was noted for both sexes, except for those under 45, who had a poorer survival experience. An appreciable difference was seen in the lessened survival of patients with upper colonic versus lower colonic lesions. Part of the increase in survival over time appeared to be due to an increasing percentage of patients who received surgery in contrast to other modalities. Part of the female's better survival experience was due to the fact that more women in proportion to men with colon cancer underwent surgery. The physician should take these characteristics, among others, into account when advising his patient on his chances of survival (and when considering treatment modality), and be alert to the high risk of this entity in certain racial, sex, and age groups as noted.     

食管腺鳞癌22例临床分析

目的 总结食管腺鳞癌的临床特点、诊断、治疗和预后.方法 回顾性分析经病理确诊和治疗的22例食管腺鳞癌患者临床资料,应用Kaplan-Meier法进行生存分析.结果 22例食管腺鳞癌患者的临床症状、影像学表现和内窥镜下所见与食管鳞状细胞癌(鳞癌)相似.19例患者术前内窥镜活检误诊为鳞癌.单纯手术治疗16例,手术+术后放疗3例,单纯放疗、序贯化放疗和同期化放疗各1例.本组总的1、3、5年生存率分别为67.6%、33.8%和18.1%,中位生存时间为24.5个月.结论 食管腺鳞癌少见,易误诊,宜采用以手术为主的综合治疗,预后评价不一.     

2020年ASCO会议食管及食管胃交界癌放疗与综合治疗进展

食管癌是我国最常见的恶性肿瘤之一,早期发现率较低,大多数患者确诊时已属于中晚期,预后较差,5年生存率很低。放疗在食管癌治疗中发挥着重要作用,尽管目前放疗技术有了较大的改进,但也无法大幅度地提高生存率,总体疗效不够满意。放疗照射剂量方面的研究已处于瓶颈期,目前研究主要集中在化疗药物、靶向药物和免疫药物与放疗联合的综合治疗领域,本文就2020年ASCO会议上多项食管及食管胃交界癌放疗与综合治疗的研究成果予以汇总,并结合近年来该领域的相关研究进行综述。     

Late Stage and Grave Prognosis of Esophageal Cancer in Thailand

Background: Esophageal cancer is one of the major health concerns in Southeast Asian countries, includingThailand. However, only a limited number of studies have been reported from this region. This study wasdesigned to evaluate the prevalence, clinical characteristics and survival rate of esophageal cancer in Thailand.Materials and Methods: Clinical information, histological features and endoscopic findings were collected froma tertiary care center in central region of Thailand between September 2011- November 2014 and reviewed.Results: A total of 64 esophageal cancer patients including 58 men and 6 women with mean age of 62.6 yearswere enrolled. Common presenting symptoms were dysphagia (74%), dyspepsia (10%) and hematemesis (8%).Mean duration of symptoms prior to diagnosis was 72 days. Esophageal stenosis with contact bleeding was themost common endoscopic finding (55.6%). The location of cancer was found in proximal (16%), middle (50%)and distal (34%) esophagus. Squamous cell carcinoma was far more common histology than adenocarcinoma(84.2% vs 10.5%). However, esophageal adenocarcinoma was significantly more common than squamous cellcarcinoma in distal area of esophagus (100% vs 22.9%; p=0.0001, OR=1.6, 95%CI=1.1-2.2). Esophageal cancerstages 3 and 4 accounted for 35.2% and 59.3% respectively. Overall 2-year survival rate was 20% and only 16%in metastatic patients. Conclusions: Most esophageal cancer patients in Thailand have squamous cell carcinomaand nearly all present at advanced stage with a grave prognosis. Screening of high risk individuals and earlydetection might be important keys to improve the survival rate and treatment outcome in Thailand.     

Combined modality therapy of esophageal cancer

Esophageal cancer is a deadly disease. Only one third of patients with localized disease experience long-term survival. Over the past 20 years, investigators have evaluated neoadjuvant strategies to improve the outcomes of surgical management. Chemotherapy and radiation have been evaluated individually and in combination for preoperative management of patients with localized esophageal cancer. This article provides a critical review of the data on multimodality approaches to the management of esophageal cancer.     

86例早期食管癌临床诊治探讨

目的: 探讨提高早期食管癌的诊断率和远期生存率的体会。 方法: 对福建医科大学附属第二医院自1998年1月至2004年12月手术治疗的86例早期食管癌进行回顾性分析。 结果: 本组病例部分早期食管癌症状大多轻微,自觉不适病程长短不一,X线检出率为84.9%(73/86),电子胃镜检查确诊率为100%(86/86)(其中尚有1例经过3次镜检获得病理诊断)。手术切除率为100%(86/86),并发症发生率为14.0%(12/86)。术后均未再行辅助治疗,定期随访,5年生存率为94.2%(81/86)。 结论: 早期食管癌的病程进展比较缓慢,症状轻微,呈非特异性,容易忽视,应高度重视早期食管癌的症状,采用内镜结合碘染色等检查方法多次检查(必要时采用多项检查方法和定期复查),结合临床症状综合分析,将有助于提高早期食管癌的诊断率。一些分子生物学指标被用于食管癌的实验室诊断,亦将有助于提高早期食管癌的诊断。早期食管癌的手术治疗远期疗效佳,手术治疗(食管次全切除并常规区域淋巴结清扫)是治疗早期食管癌的有效方法。术后复发与转移是早期食管癌患者术后死亡的主要原因。早期食管癌手术治疗不能完全达到治愈目的,且术后患者生存期较长,应定期密切随访,以便尽早对食管复发癌或转移癌进行有效的治疗,提高患者的生存质量和远期生存率。     

Ovarian carcinoma in California: The California tumor registry data

Appropriate data from the California and Alameda County Tumor Registries were analyzed with specific reference to ovarian cancer (I.C.D. No. 175). The median age for ovarian cancer cases (1942–1969) was 56.7 years. There was a direct association of the age-adjusted death rate and average annual incidence rate of ovarian cancer patients and the presence of a high socioeconomic ranking (r = + 0.37) (p < 0.05). There was a positive association of ovarian cancer incidence with the census tract index of crowding per household. An excess of ovarian cancer deaths was noted in the Spanish surname population (p < 0.05). Further follow-up studies are suggested for this disease which has a five-year relative survival rate for all stages in California of 33%.     

Epidemiology and pathogenesis of esophageal cancer: management and its controversial results (review)

Esophageal cancer including squamous cell and adenocarcinoma is considered to be a serious malignancy with respect to prognosis and a fatal outcome in the great majority of cases. Epidemiological data define a certain geographical distribution and relate pathogenesis and aetiology to several chemical substances as well as to Barrett's esophagus and reflux. Surgery remains the standard treatment for localized disease and offers approximately a 10% 5-year survival. Radiation therapy and chemotherapy have been exploited during the last decades not only in advanced cases but also in addition to surgery in a combined modality, in order to increase the cure rate. The controversial results of trials dealing with the management of esophageal cancer are critically reviewed.     

胃镜检查在下咽癌共病食管癌中的重要性评价及其临床特点分析

背景与目的：食管癌是常见的消化道恶性肿瘤,而当作为头颈部鳞癌中最常见的下咽癌与食管癌共病存在时预后很差,因此早期诊断对该病生存率的提高至关重要。探讨胃镜检查在下咽癌共病食管癌早期诊断中的重要性及其临床特点。方法：在2013年2月—2019年9月广西医科大学附属肿瘤医院收治的226例下咽癌患者中,回顾性分析40例进行了胃镜检查患者的临床资料及确诊为下咽癌共病食管癌患者的临床特点,比较分析进行或未进行胃镜检查下咽癌患者的生存率。结果：226例下咽癌患者中,有40例（17.7%）进行了胃镜检查,其中检出下咽癌共病食管癌36例（90.0%）,其中同时性癌29例（80.6%）,异时性癌7例（19.4%）。36例下咽癌共病食管癌患者中位年龄56.5（47.3~62.5）岁,男性32例（88.9%）,有吸烟史25例（69.4%）,有饮酒史24例（66.7%）,下咽癌生长的主体部位在梨状窝区的23例（63.9%）,呈结节样肿块型25例（69.4%）,食管癌呈隆起型病变31例（86.1%）,非隆起型病变5例,其中3例为食管鳞癌,2例为原位癌。156例未进行胃镜检查及32例进行胃镜检查的下咽癌患者生存曲线比较差异无统计学意义（P＞0.05）。186例未进行胃镜检查及40例进行胃镜检查的下咽癌患者下咽癌病理学分化程度比较差异无统计学意义（P＞0.05）。结论：胃镜检查在下咽癌共病食管癌的早期诊断中具有重要意义,建议对下咽癌患者常规开展胃镜检查并作为定期随访项目;中年、男性、吸烟、饮酒是下咽癌共病食管癌患者的重要临床特点。     

Determining Overall Survival and Risk Factors in Esophageal Cancer Using Censored Quantile Regression

Background: Esophageal cancer is one of the leading causes of death worldwide. The global increasing rate of thistype of cancer requires more attention. The purpose of this study was to determine the overall survival probability ofesophageal cancer after diagnosis and to assess the potential risk factors in a population of Iranian patients. Materialsand Methods: This retrospective cohort study was conducted on 127 cases with esophageal cancer in the Azarbaijanprovince, East of Iran. Participants in the study were diagnosed during 2009-2010 and were followed up for 5 years. Theevent was considered death due to esophageal cancer and those who survived until the end of the study were assumed asright censored. Censored quntile regression was fitted to find the overall survival of the patients using adjusted effects ofvariables and was compared with Cox regression model. Results: Patients’ mean and median survival time were 16.99and 10.06 months respectively and 89% off cases died by the end of the study. The 1, 3, 6, 12 and 36-month survivalprobabilities were 0.95, 0.76, 0.60, 0.43, and 0.18. The median survival time for females and males without surgerywere 21.79 and 14.76 month respectively. The accuracy of predictions were 0.99 and 0.74 for the censored quantileregression and Cox, respectively. Conclusion: We concluded that being male, not having surgery, longer wait timebetween having symptoms and being diagnosed, low socioeconomic status and old age to be significant risk factors inreducing the probability of survival from esophageal cancer.     

Targeted therapies for esophageal cancer

Esophageal cancer is a highly aggressive neoplasm. In 2005, 14,520 Americans will be diagnosed with esophageal cancer, and more than 90% will die of their disease. On a global basis, cancer of the esophagus is the sixth leading cause of cancer death worldwide. In fact, gastric and esophageal cancers together accounted for nearly 1.3 million new cases and 980,000 deaths worldwide in 2000-more than lung, breast, or colorectal cancer. Although esophageal squamous cell carcinoma cases have steadily declined, the incidence of gastroesophageal junction adenocarcinoma has increased 4%-10% per year among U.S. men since 1976, more rapidly than for any other cancer type, and parallels rises in population trends in obesity and reflux disease.With advances in surgical techniques and treatment, the prognosis of esophageal cancer has slowly improved over the past three decades. However, the 5-year overall survival rate (14%) remains poor, even in comparison with the dismal survival rates (4%) from the 1970s. The underlying reasons for this disappointingly low survival rate are multifold: (a) ineffective screening tools and guidelines; (b) cancer detection at an advanced stage, with over 50% of patients with unresectable disease or distant metastasis at presentation; (c) high risk for recurrent disease after esophagectomy or definitive chemoradiotherapy; (d) unreliable noninvasive tools to measure complete response to chemoradiotherapy; and (e) limited survival achieved with palliative chemotherapy alone for patients with metastatic or unresectable disease. Clearly, additional strategies are needed to detect esophageal cancer earlier and to improve our systemic treatment options. Over the past decade, the field of drug development has been transformed with the identification of and ability to direct treatment at specific molecular targets. This review focuses on novel targeted treatments in development for esophageal squamous cell carcinoma and distal esophageal and gastroesophageal junction adenocarcinoma.     

Breast cancer in Norway 1970-1993: a population-based study on incidence, mortality and survival.

The incidence, mortality and survival of breast cancer patients from 1970 to 1993 were studied using data from the Cancer Registry of Norway. The age-adjusted incidence rate increased from 62.0 to 76.9 per 100,000 person-years during the period, and more than 2000 cases are now registered annually. The increase tends to be highest in the age group below 40 years. The increase is mainly found in cases with localized tumours at the time of diagnosis. The mortality rate has been almost unchanged in the period; the age adjusted mortality rate is 27.0 per 100,000 person-years at the end of the study period. The 5-year overall survival has increased among cases with axillary lymph node metastases at the time of diagnosis; the other stages show only little improvement.     

Prostate cancer: trends in mortality and stage-specific incidence rates by racial/ethnic group in Los Angeles County,California (United States)

Between 1976 and 1988 in the United States, the secular trends in age-adjusted incidence rates of prostate cancer were significantly different by racial/ethnic group (P<0.001), and increased significantly only among non-Hispanic Whites at a rate of 2.7 percent (95 percent confidence interval [CI]=2.3–3.1%) annually. While incidence rates of regional disease increased significantly (7.7 percent to 11.3 percent annually) among all racial/ethnic groups during this period, localized disease increased significantly only among non-Hispanic Whites, by 1.8 percent (CI=1.4–2.3%) annually. Prostate cancer mortality in Los Angeles County (California) remained constant among Hispanics, non-Hispanic Whites, and Asians, but increased 1.6 percent (CI=0–3.2%) annually among Blacks. While the increase in localized disease rates of non-Hispanic Whites may be due to increased detection of asymptomatic disease, this apparently has not occurred among other racial/ethnic groups in Los Angeles County. The secular increase in regional disease rates among all racial/ethnic groups without a concurrent increase in mortality (except Blacks), suggests increased accuracy of staging rather than a true increase in incidence may account for these trends. Adjusted for socioeconomic status, year and age at diagnosis, Black and Hispanic men were at significantly higher risk of being diagnosed with non-localized disease (odds ratio = 1.39 and 1.24, respectively) than were non-Hispanic Whites.Drs Ross and Bernstein are also with the Cancer Surveillance ProgramThis work was supported in part by grant CA17054 from the US National Institutes of Health, and grant SIG#20 from the American Cancer Society. Cancer incidence data were collected under Subcontract 050H-8709 with the California Public Health Foundation. The subcontract is supported by the California Department of Health Services as part of its statewide cancer reporting program, mandated by Health and Safety Code Section 210 and 2113.     

食管贲门癌术后内镜检查的价值

 我院子1984年7月至1992年3月，因食管贲门癌术后行内镜检查73例。镜检结果：返流性食管炎21例（28.77%）.其中包括6例金属打外露。食管复发癌16例（21.95%）,吻合口狭窄8例（10.95%）,声带麻痹7例（9.58%）,食管异物6例（8.20%）,正常6例（8.20%）.为了早期发现食管复发癌，建议术后2年以内每3-6个月行内镜检查-次，2年以后每年-次。     

Survival data and prognostic factors seen in Pakistani patients with esophageal cancer.

BACKGROUND: Esophageal cancer is common in Pakistan. An attempt has been made for the first time to look at the survival data and prognostic factors associated with esophageal cancer in this region. PATIENTS AND METHODS: We did a retrospective review of 263 cases seen at the Aga Khan University Hospital in Karachi. Data analysis was done using the Kaplan-Meier method and the Cox proportional hazard model. RESULTS: Squamous cell carcinoma was noted in 81% of the cases, whereas adenocarcinoma was the second most common. At the time of diagnosis, early-stage disease was found in 25%, locally advanced in 41% and metastatic in 34% of all cases. Mean age at diagnosis was 56 years, with 59% males and 41% females. Survival data were available in 89 cases. Median survival was 7 months. On univariate analysis, the following factors were of prognostic significance: obstruction, histology, albumin level at diagnosis, age and platelet count. On multivariate analysis, three factors were found prognostic: presence or absence of obstruction, squamous cell carcinoma versus adenocarcinoma and platelet count. CONCLUSIONS: We found that patients with squamous cell carcinoma and absence of thrombocytopenia and obstruction had a better overall survival. However, this is a limited retrospective analysis; we therefore recommend that these prognostic factors be evaluated in larger studies.     

食管癌诊断中代谢组学应用进展

目的 食管癌在我国具有高发病率和高死亡率,找到早期筛查和诊断的方法是提高生存率的关键.代谢组学在肿瘤标志物的早期筛查中具有较为显著的优势.本研究总结代谢组学在食管癌早期诊断中的应用,探讨其发展方向和最新动态.方法 以"代谢组学、肿瘤、食管癌和诊断"为关键词,检索PubMed以及CNKI期刊全文数据库截至2016-10发表的相关文献,共检索到英文文献108篇,中文文献46篇.纳入标准:(1)代谢组学相关研究;(2)食管癌的诊断.根据纳入标准分析文献23篇.结果食管癌患者和健康个体之间确实存在代谢轮廓差异.目前研究人员已经证明了血清代谢组学和尿液代谢组学应用于食管癌的诊断和分期的可行性,并筛选出一部分异常的小分子代谢物,包括胆碱磷酸、谷氨酸盐、肌醇、腺苷、缬氨酸和γ氨基丁酸等.结论食管癌代谢组学研究已取得可喜的进展,但因为代谢组学技术和检测仪器的局限,得到的食管癌发病相关代谢物还不全面,还需进一步提高检测手段,改进研究方法,使代谢组学发挥更大的作用.     

Gamma knife radiosurgery for management of cerebral metastases from esophageal carcinoma

Esophageal carcinoma rarely results in intracranial metastases but when it does, the patient prognosis is grim. Because of its rarity outcomes after stereotactic radiosurgery (SRS) are not known. We sought to evaluate the outcomes of SRS in the management of esophageal cancer that has spread to the brain. This single institution retrospective analysis reviewed our experience with esophageal metastasis from 1987 to 2013. Thirty patients (36 SRS procedures) with a median age of 59 (37–86 years) underwent Gamma knife^® SRS. The esophageal origin was adenocarcinoma in 26 patients (87 %), squamous cell carcinoma in 3 patients (10 %), and mixed neuroendocrine carcinoma in 1 patient (3 %). Fifteen patients were treated for a single metastasis and 15 patients were treated for multiple metastases for a total of 87 tumors. The median tumor volume was 5.7 cm³ (0.5–44 cm³) with a median marginal dose of 17 Gy (12–20 Gy). The median survival time from the diagnosis of brain metastasis was 8 months and the median survival from SRS was 4.2 months. This corresponded to a 6-month survival of 45 % and a 12-month survival of 19 % after SRS. A higher KPS at the time of procedure was associated with an increase in survival (p = 0.023). The local tumor control rate in this group was 92 %. Four patients had repeat SRS for new metastatic deposits. One patient developed a new neurological deficit after SRS. SRS proved an effective means of providing local control for esophageal metastases to the brain. Concomitant systemic disease progression at the time of brain metastasis resulted in poor long-term survival.     

哈萨克族食管癌组织中microRNA-21的表达及其意义

目的：探讨哈萨克族食管癌组织中microRNA-21（miRNA-21）的表达及其意义。方法收集72例哈萨克族食管癌患者临床样本,采用实时定量PCR检测食管癌组织、周围正常食管组织miRNA-21表达水平;以患者性别、年龄、临床分期、肿瘤部位、分化程度、淋巴结转移、病情是否恶化等作为观察指标,分析miRNA-21与临床资料的关系。再以肿瘤中位生存期作为观察指标,筛选出影响哈萨克族食管癌患者预后的危险因素。结果食管癌组织miRNA-21相对表达量为（7.57±0.14）,周围正常食管组织相对表达量为（1.37±0.08）,食管癌组织相对表达量高于正常组织（P﹤0.05）。72例食管癌患者分为miRNA-21高表达组42例和低表达组30例,miRNA-21表达与临床分期、淋巴结转移、肿瘤进展有关,即淋巴结转移、肿瘤进展及肿瘤临床分期越晚,肿瘤miRNA-21表达也越高（P﹤0.05）;miRNA-21高表达组5年生存率为20.7%,低表达组5年生存率为38.6%,两组5年生存率比较差异具有统计学意义（χ2=4.715,P=0.005）;多因素分析显示,临床分期、肿瘤进展、miRNA-21表达水平是影响哈萨克族食管癌患者预后的独立危险因素（P﹤0.05）。结论 miRNA-21在食管癌组织表达水平高于正常组织,且miRNA-21表达越高,患者预后越差,miRNA-21可以作为哈萨克族食管癌诊断及预后评价的指标之一。     

食管癌穿孔后治疗的研究进展

食管癌是中国常见的肿瘤之一,穿孔是食管癌常见的并发症。目前对于食管癌穿孔的治疗,不管是中国还是国际上缺乏统一的专家共识。本文应用PubMed、中国知网、万方数据库等检索平台系统,检索1996-2017年12月相关文献,筛选出27篇相关文献,并通过27篇文献对食管癌穿孔的发生机制、临床特点进行分析。可手术患者可延长生存,但同时围手术期并发症风险提高,而营养支持下同步放化疗也可明显延长生存。