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.     

The expression of murine double minute 2 is a favorable prognostic marker in esophageal squamous cell carcinoma without p53 protein accumulation

Background Murie double minute 2 (MDM2) is an oncoprotein that inhibits the function of p53 tumor-suppressor protein. Although there have been a few reports onMDM2 gene abnormalities, there has been no investigation into expression of the product of this gene in esophageal squamous cell carcinoma. Thus, the clinicopathological and prognostic significance of the product of theMDM2 gene is as yet unknown. Methods MDM2 protein expression status was analyzed in surgically resected materials by immunohistochemical procedures. Results The expression of MDM2 significantly correlated inversely with tumor size, depth of invasion, lymph node metastasis, lymphatic vessel invasion, and stage of disease. However, the expression of MDM2 correlated with neither p53 protein accumulation status nor Ki-67 labeling index. The prognosis with MDM2-positive status was significantly better than that with MDM2-negative status for patients with p53-negative tumors, but not in those with p53-positive tumors. Moreover, multivariate analysis showed that the expression of MDM2 was an independent prognostic factor in patients with p53-negative tumors. Conclusions These findings indicate that MDM2 immunohistochemical analysis may provide useful information concerning the prognosis in esophageal squamous cell carcinoma patients with p53-negative tumors.     

The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection

Objective

To evaluate factors in penile squamous cell carcinoma predictive of pelvic lymph node metastasis and survival.

Materials and methods

Data were collected and analyzed retrospectively in 146 patients with squamous cell carcinoma of penis who underwent bilateral inguinal lymph node dissection in our center between January 1998 and April 2011. Variables recorded included serum squamous cell carcinoma antigen, primary tumor p53 immunoreactivity, histological grade, pathological tumor stage, lymphatic or vascular invasion, absent/unilateral or bilateral inguinal lymph node involvement, number of metastatic inguinal lymph nodes, presence of extracapsular growth and lymph node density.

Results

Seventy patients had inguinal lymph node metastasis (LNM). Of these, 33 (47.1 %) had pelvic LNM. Primary tumor strong p53 expression, lymphatic or vascular invasion, involvement of more than two inguinal lymph nodes and 30 % or greater lymph node density were significant predictors of pelvic LNM. Primary tumor strong p53 expression (odds ratio [OR] 5.997, 95 % confidence intervals [CI] 1.615–22.275), presence of extracapsular growth (OR 2.209, 95 % CI 1.166–4.184), involvement of more than two inguinal lymph nodes (OR 2.494, 95 % CI 1.086–5.728) and pelvic lymph node involvement (OR 18.206, 95 % CI 6.807–48.696) were independent prognostic factors for overall survival.

Conclusions

Primary tumor expression of p53, lymphatic or vascular invasion, number of metastatic inguinal lymph nodes and lymph node density were all predictors of pathologic pelvic lymph node involvement. Patients with pelvic LNM had an adverse prognosis, with a 3-year overall survival rate of approximately 12.1 %. Pelvic lymph node dissection should be considered in these cases.     

PTEN和p53在食管鳞癌中的表达及意义

目的探讨抑癌基因PTEN、p53在食管鳞癌中的表达及意义。方法应用免疫组化S-P法检测食管鳞癌组织、癌旁正常食管组织中PTEN和p53的蛋白表达情况,分析其在食管鳞癌发生发展过程中的作用以及两者之间的作用关系。结果PTEN、p53在食管鳞癌组织中的阳性表达率分别是53.33%(32/60)、61.67%(37/60),对照组阳性表达率分别是91.67%(55/60)、3.33%(2/60)。PTEN阳性表达与食管鳞癌的分化程度、淋巴结转移、浸润深度、TNM分期有关(P<0.05),与年龄、性别无关(P>0.05)。p53阳性表达与食管鳞癌的分化程度、淋巴结转移、浸润深度有关(P<0.05),与TNM分期、年龄、性别无关(P>0.05)。PTEN与p53在食管鳞癌中的表达呈负相关关系(P<0.05)。结论PTEN低表达p、53高表达在食管鳞癌的发生发展中起重要的作用,二者相互作用,诱导食管鳞癌的发生发展。联合检测PTEN、p53对食管鳞癌的诊断、治疗有指导意义。     

长链非编码RNA HOTAIR 在食管鳞状细胞癌中的表达及其临床意义

【摘要】 目的 探讨长链非编码RNA HOTAIR在食管鳞状细胞癌组织中的表达情况及其临床意义。方法 采用原位杂交技术检测93例食管鳞癌组织及20例癌旁组织中HOTAIR的表达情况。运用SPSS16.0进行统计分析了解HOTAIR表达与临床病理特征之间的关系。结果 HOTAIR在食管鳞癌组织中比癌旁组织中表达阳性率高,且差异有统计学意义(P<0.001)。HOTAIR表达与食管鳞状细胞癌的浸润深度、临床分期、有无淋巴结转移、分化程度有关(P＜0.05),与年龄、性别无关(P＞0.05)。结论 HOTAIR与食管鳞癌的发生发展相关。     

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.     

胃癌淋巴管生成与淋巴结转移的关系

目的:研究胃癌淋巴管生成与淋巴结转移的关系。方法:应用逆转录-聚合酶链反应(RT-PCR)和免疫细胞化学方法检测血管内皮生长因子-C(VEGF-C)和血管内皮生长因子受体-3(VEGFR-3)mRNA及其蛋白在5株胃癌细胞株和3对伴有淋巴结转移的胃癌组织及相应的正常黏膜中的表达。此外,还应用免疫组织化学方法检测86例胃癌标本的淋巴管密度(LVD)和VEGF-C蛋白的表达。结果:VEGF-C mRNA和蛋白高表达于3株胃癌细胞,而VEGFR-3 mRNA和蛋白在上述3个细胞株中均呈弱表达。VEGF-C和VEGFR-3 mRNA均表达于3对伴有淋巴结转移的胃癌和相应的正常黏膜组织中,但在正常组织中的表达水平低于肿瘤组织。VEGF-C蛋白在66.3%(57/86)的病例中呈阳性表达。在伴淋巴结转移的胃癌中,VEGF-C表达较无淋巴结转移者更显著(P<0.001),其表达与淋巴管浸润(P<0.001)和TNM分期(P<0.01)均密切相关,但与病人的年龄和性别、肿瘤大小、位置、组织学类型、浸润深度及远处转移均无明显相关。LVD则与VEGF-C蛋白表达(P<0.001)、淋巴结转移(P<0.01)、淋巴管浸润(P<0.01)、TNM分期(P<0.05)及组织学类型(P<0.05)密切相关,但与病人的年龄和性别、肿瘤大小、位置、浸润深度及远处转移无明显相关。结论:在胃癌中,VEGF-C可能通过VEGFR-3信号通道促进淋巴管生成,从而增加胃癌淋巴结转移率。因此,肿瘤淋巴管生成可能成为治疗胃癌的一个新靶点。     

子宫内膜癌热休克蛋白70、90的表达及其临床意义

目的 :探讨子宫内膜癌中热休克蛋白 ( HSP) 70、90的表达及意义。方法 :用免疫组化 Envision法及图象分析仪检测了 3 0例正常子宫内膜、3 0例增生过长子宫内膜和 53例子宫内膜癌中 HSP70、90的表达情况。结果 :子宫内膜癌中 HSP70的表达为( 2 0 9.0 6± 5.3 6 ) ,明显高于正常内膜 ( 1 45.2 1± 4.0 9)和增生过长内膜 ( 1 48.59± 4.2 3 ) ,P均 <0 .0 1 ;子宫内膜癌中 HSP90的表达为 ( 1 6 6 .98± 5.71 ) ,明显低于正常子宫内膜( 2 0 8.57± 3 1 .1 4)和增生过长子宫内膜 ( 2 49.73± 4.94) ,分别为 P<0 .0 5、P<0 .0 1。子宫内膜癌中 HSP70表达随肿瘤病理分级升高而增强 ( P<0 .0 1 ) ,非内膜样癌较内膜样癌表达增强 ( P<0 .0 1 ) ;子宫内膜癌中 HSP90表达随肿瘤病理分级升高而表达减弱 ( P<0 .0 1 ) ,非内膜样癌较内膜样癌表达减弱 ( P<0 .0 1 )。但子宫内膜癌中 HSP70、90表达与肌层浸润深度、术后病理分期、淋巴结转移未见显著相关性 ( P>0 .0 5)。结论 :HSP70、90可能与子宫内膜癌发生及预后有关     

Overexpression of vascular endothelial growth factor-C correlates with lymph node micrometastasis in submucosal esophageal cancer

Lymph node metastasis, including lymph node micrometastasis (LMM), is one of the most important prognostic factors in esophageal squamous cell carcinoma (ESCC). Vascular endothelial growth factor C (VEGF-C) plays a key role in the process of lymphangiogenesis. We examined VEGF-C expression and tumor microvessel density of the primary tumors in ESCC and analyzed relationships between VEGF-C expression and clinicopathologic findings including LMM in submucosal ESCC. The subjects were 87 patients with submucosal ESCC. Immunohistochemical staining of VEGF-C and CD34 was performed with primary tumors, and staining of cytokeratin was performed with dissected lymph nodes. Microvessel density was calculated from CD34 expression, and LMM was detected by cytokeratin staining. VEGF-C overexpression significantly correlated with depth of tumor invasion, lymphatic invasion, and lymph node metastasis (P<0.05, P<0.0001, and P<0.0001, respectively). High microvessel density also correlated with lymphatic invasion and lymph node metastasis (P<0.005 and P<0.05, respectively). LMM was detected in 8 cases and 14 lymph nodes by cytokeratin staining. VEGF-C overexpression and high microvessel density were found in tumors with lymph node metastasis and/or LMM, compared with tumors without nodal metastasis or LMM (P<0.0001 and P<0.01, respectively). The present findings indicate that in ESCC with submucosal invasion, VEGF-C overexpression of the primary tumor is a strong high risk factor for lymph node metastasis, including LMM. Supported in Grant No. 17390373 part by grants-in-aid for scientific research from the Ministry of Education, Science, Sports and Culture, Japan. (Shoji Natsugoe, M.D., Ph.D.)     

Expression of p53 and RB Proteins in Squamous Cell Carcinoma of the Esophagus: Their Relationship With Clinicopathologic Characteristics

Background: Cancer of the esophagus is one of the most malignant tumors and has a poor prognosis. The p53 and retinoblastoma (RB) genes are involved in the regulation of cell population by suppressing cell proliferative activity. Our goal was to clarify whether expression of p53 and RB genes could be prognostic factors in squamous cell carcinoma of the esophagus.Methods: Tumor samples taken from 73 patients undergoing subtotal esophagectomy were immunohistochemically stained for the p53 and RB genes. An image analyzer was used for quantitative assessment of the staining, and clinicopathologic characteristics of those patients were investigated.Results: Patients in whom p53 expression was high had greater tumor diameter, deeper tumor invasion, and worse prognosis compared with patients in whom p53 expression was low. Patients in whom RB expression was low had a higher incidence of lymph node metastasis and more advanced disease than did those in whom RB expression was high. The combination of p53 and RB expression revealed that the cases with high p53 and low RB expression had significantly worse survival rates and deeper tumor invasion compared with other groups. In various clinicopathologic parameters, (e.g., age, sex, tumor-diameter, tumor type, location, differentiation, TNM classification,TNM stage) tumor type, tumor size, depth of invasion, lymph node involvement, distant metastasis, and combined p53 and RB expression showed significant differences in survival by univariate analysis. Among those six variables, only lymph node involvement showed an independent prognostic factor for survival (P = .0055) by multivariate analysis.Conclusions: The combination of p53 and RB expression is not a prognostic indicator in the surgical treatment of esophageal cancer.     

Clinical Significance of P53 Protein Expression in Papillary Thyroid Carcinoma

BACKGROUND: Although mutations in the p53 suppressor gene in thyroid carcinoma have usually been detected in anaplastic carcinoma, P53 protein expression has been detected immunohistochemically in papillary thyroid carcinoma (PTC). In the present study, we examined the immunohistochemical expression of P53 protein in PTC to investigate the relations between its expression and the clinicopathologic features. METHODS: The study was performed on 68 patients in whom thyroidectomy with lymph node dissection had been performed to treat PTC at Teikyo University Hospital. Expression of P53 protein was evaluated immunohistochemically in sections of paraffin-embedded tissue in 68 primary tumors and 196 lymph node metastases. RESULTS: Overexpression of P53 protein in the primary tumor was observed in 29 cases (43%). Statistical analysis revealed significant correlation between P53 protein expression in the primary tumor and large tumor size (unpaired t-test: p < 0.01), the presence of lymph node metastasis (unpaired t-test: p < 0.05), and the mean number of lymph node metastases (unpaired t-test: p < 0.05). Although 29 (43%) of the primary tumors overexpressed P53 protein, 143 (73%) of the metastatic lymph nodes overexpressed P53 protein irrespective of whether there was P53 overexpression by the primary tumor. CONCLUSIONS: The results of this study suggest that immunohistochemistry for P53 in the primary tumor could be useful in the clinical evaluation of patients with PTC. Moreover, P53 protein overexpression in lymph node metastasis may be useful as a treatment guide or target for lymph node recurrences.     

Evaluation of malignancy and the prognosis of esophageal cancer based on an immunohistochemical study (p53, E-cadherin, epidermal growth factor receptor)

The subjects in this study consisted of 40 preoperative untreated esophageal squamous cell carcinoma patients. While p53 did not significantly correlate with the clinicopathological factors, E-cadherin significantly correlated with lymphatic invasion, vascular invasion, the depth of invasion, the degree of lymph node metastasis, the histological stage, and the number of lymph node metastases. Epidermal growth factor receptor (EGFR) significantly correlated with age, the depth of invasion, and the number of lymph node metastases. The 5-year cumulative survival rate was 45.7% in the p53-positive cases and 61.9% in the p53-negative cases, with no significant difference, and 87.8% in the E-cadherinpositive cases and 19.1% in the-negative cases, and the difference was significnat. The prognosis was significantly poor in EGFR-positive subjects: the 5-year survival rate was 38.6% in EGFR-positive cases and 68% in-negative cases. The 5-year survival rate in E-cadherin-negative, EGFR-positive cases was 0%, while it was 91.7% in the reverse pattern, and this difference was significant. These findings suggest that both E-cadherin and EGFR are important prognostic factors, and a more precise prognosis can thus be obtained by combining them. Such a combined technique may be very useful as an indicator for grading the biological malignancy of esophageal cancer.     

联合评估survivin和p53在胃癌组织中表达的临床意义及对预后的影响

目的 研究胃癌原发灶中survivin和p53的表达与临床病理特征,恶性潜能及预后的影响。方法 免疫组化法检测125例行根治切除胃癌组织中survivin和p53表达情况,采用单因素和多因素分析比较survivin和p53表达及其共同表达与临床病理特征和预后关系。结果 survivin和p53表达阳性率各自为57．6％（72例／125例）和59．2％（74例／125例）。survivin阳性表达率在弥漫型和组织分化差（均P〈0．01）、肿瘤浸润更深、有淋巴结转移、淋巴管浸润及进展期（P〈0．05）胃癌组织中显著增高。p53表达与淋巴结转移和淋巴管浸润（P〈0．037）相关。单因素分析显示,survivin和p53表达阳性分别与5年生存率有关（P=0．0050和P=0．0025）。多因素分析显示,survivin和p53共同表达患者预后更差（P=0．001）。结论 survivin和p53在胃癌组织中均有较高的表达率,survivin阳性表达和p53阳性表达分别提示预后不良,survivin和p53共同表达为胃癌根治术后独立的预后因子。     

The prognostic value of p53, Ki-67 and matrix metalloproteinases MMP-2 and MMP-9 in transitional cell carcinoma of the renal pelvis and ureter

AIM: To investigate the prognostic and predictive relevance of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 in patients with transitional cell carcinoma (TCC) of the upper urinary tract. METHODS: The expression of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 was examined by immunohistochemistry in 69 patients with TCC of the upper urinary tract. Correlation of p53, Ki-67, MMP-2 and MMP-9 over-expression with conventional pathological parameters and patient survival was examined. RESULTS: p53 over-expression was significantly correlated with histological grade (P < 0.05), but not with pathological stage, vascular invasion, lymphatic invasion or lymph node metastasis. Ki-67 over-expression was significantly correlated with stage, grade, lymphatic invasion and vascular invasion (P < 0.05). In survival analyses, Ki-67 over-expression was a significant prognostic factor in the univariate analysis (P < 0.05), but it did not have a significant impact on survival in the multivariate analysis. Ki-67 labeling index was a significant prognostic factor in patients with a low p53 labeling index, but not in patients with a high p53 labeling index. CONCLUSION: Ki-67 over-expression is of prognostic value in TCC of the upper urinary tract, while p53, MMP-2 and MMP-9 are of limited value.     

VEGF-C和MMP-7的表达与胃癌侵袭转移的关系

目的 探讨胃癌中血管内皮生长因子C（VEGF-C）和基质金属蛋白酶7（MMP-7）的表达及两者与胃癌侵袭和淋巴结转移的关系。方法 采用SP免疫组化技术，分别检测60例胃癌组织、癌旁组织及30例癌周区域淋巴结中VEGF-C及MMP-7的表达水平。结果 VEGF-C和MMP-7在胃癌组织中的阳性表达率明显高于正常胃黏膜及癌旁组织；在区域淋巴结癌转移组中的阳性表达率明显高于无癌转移组（P〈0．01）；伴有淋巴结转移的胃癌组织中VEGF-C，MMP-7的阳性表达率明显高于无淋巴结转移组（P〈0．05）；VEGF-C，MMP-7表达与淋巴结转移、淋巴管侵犯、浸润深度、TNM分期有密切关系（P〈0．05）。结论 VEGF-C和MMP-7在胃癌中的高表达与胃癌浸润侵袭程度、淋巴结转移有密切关系。     

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

Clinicopathologic characteristics of peripheral squamous cell carcinoma of the lung

Squamous cell carcinoma of the lung can be divided into two types according to the location of the primary site: the central type and the peripheral type. The clinicopathologic factors in the peripheral type of lung squamous cell carcinoma have not yet been fully evaluated. A total of 204 surgically resected lung squamous cell carcinomas were reviewed with special reference to their location, histologic characteristics based on tumor growth patterns, and clinicopathologic factors. The central type and the peripheral type accounted for 95 and 109 cases, respectively. Although the patient population of the peripheral type was older, with a lower pathologic stage, lower lymphatic vessel involvement, and lymph node metastasis, the Kaplan-Meier survival proportions did not differ significantly between these two groups. Based on the histologic growth pattern, the peripheral type was classified under three subgroups as follows: 1). the alveolar space-filling type, 2). the expanding type, and 3). the combined type. Among these three types, the alveolar space-filling type showed neither lymphatic vessel invasion nor lymph node metastasis and had the most favorable prognosis. The central and peripheral types of lung squamous cell carcinoma have different clinicopathologic characteristics and should be classified under respectively different categories.     

p21Waf1/Cip1 Expression Is a Prognostic Marker in Curatively Resected Esophageal Squamous Cell Carcinoma, but Not p27Kip1, p53, or Rb

Background: p21Waf1/Cip1 (p21), p27Kip1 (p27), p53, and Rb play critical roles in cell cycle regulation and may influence the clinical behavior of tumors. We examined whether their expression is useful to predict survival of patients with esophageal squamous cell carcinoma (ESC).Methods: Expression of p21, p27, p53, and Rb was studied by the immunohistochemical method in specimens from 62 patients with curatively resected ESC tumors and scored by a computerized image analysis system.Results: The median expression scores of p21, p27, p53, and Rb (14, 12, 27, and 50, respectively) were used as cut-off points to define low and high expression groups for each protein. The 5-year survival rate for the high p21 expression group was 68%; that for the low expression group was 31% (P = .0062). p27, p53, and Rb were not correlated with overall survival. When patients were categorized into four groups based on p21 expression level and lymph node involvement (pN), the survival curves were significantly different (P = .0017). Thus, patients without lymph node involvement but with low p21 expression had survival similar to that of patients with lymph node involvement and high p21 expression. Multivariate analysis showed that age (P = .0102), lymph node involvement (P = .0076), and p21 (P = .0276) were independent prognostic factors.Conclusions: Expression of p21 is an independent prognostic factor in curatively resected ESC. Definition of new subgroups of patients based on p21 expression may help to enhance the stratification of stage.     

Clinicopathologic Characteristics and Clinical Outcomes of Esophageal Basaloid Squamous Carcinoma: Experience at a Single Institution

This retrospective study investigated the clinicopathologic characteristics and clinical outcomes of esophageal basaloid squamous carcinoma (BSC). Among 190 patients with esophageal carcinoma treated surgically between 1998 and 2011, we identified 9 (4.7%) with BSC. All of the patients were male, with a median age of 65 years. The frequencies of venous invasion, lymphatic invasion, and lymph node metastasis were 56%, 89%, and 67%, respectively. A total of 2 patients were pathologic stage 1, 5 were stage 2, and 2 were stage 3. Tumor recurrence was observed in 56% of the patients. The 5-year survival rate for patients with esophageal BSC was 40%, which was compatible with the figure of 53.8% for control patients (n = 18) with typical squamous cell carcinoma matched for sex, age, tumor location, and pathologic stage (P = 0.45). Although esophageal BSC shows aggressive lymph-vascular invasion and has a high likelihood of recurrence, its prognosis seems identical to that of typical squamous cell carcinoma.     

Preoperative mapping of lymphatic drainage from the tumor using ferumoxide-enhanced magnetic resonance imaging in clinical submucosal thoracic squamous cell esophageal cancer

BACKGROUND: In thoracic esophageal cancer, lymph node metastases distribute widely from the neck to the abdominal area as a result of a complex periesophageal lymphatic network. The aim of the present study was to evaluate the potential clinical utility of a new method of mapping lymphatic drainage from tumors using ferumoxide-enhanced magnetic resonance imaging (MRI). METHODS: Twenty-three patients with clinical submucosal thoracic squamous cell esophageal cancer were examined. Ferumoxides were injected endoscopically into the peritumoral submucosal layer, after which their appearance in the lymph nodes in the neck, superior mediastinum, and abdomen was evaluated using MRI. RESULTS: Flux of ferumoxides from tumors was detected in all 23 patients. Among the 20 patients with middle and lower thoracic esophageal cancers, there was no lymphatic drainage to the neck in 5 (25%) patients, none to the neck and superior mediastinum in 4 (20%), and none to the abdomen in 2 (10%), which could enable the extent of lymph node dissection to be reduced. We diagnosed clinical negative lymph node metastasis (N0) in 17 patients; the remaining 6 patients were diagnosed with clinical lymph node metastasis. Two patients (12%) diagnosed clinical N0, showed pathologic lymph node metastasis. Ferumoxide-enhanced MRI detected an influx of contrast agent into the metastatic node in both patients. CONCLUSIONS: Ferumoxide-enhanced MRI lymphatic mapping enables detection of the direction and area of lymphatic flux. It thus has the potential to improve our ability to gauge the appropriate extent of treatment in clinical submucosal squamous cell esophageal cancer.