食管鳞癌患者癌性贫血的危险因素分析

目的：探讨食管鳞癌患者癌性贫血的危险因素。方法：回顾性分析180例食管鳞癌患者的临床资料,分为贫血组与非贫血组。分析贫血与食管鳞癌患者临床病理特征之间的相关性。分析2组贫血相关指标的差异及食管鳞癌的贫血类型。用Logistic回归方法分析影响贫血的因素。结果：180例食管鳞癌患者中,78例存在不同程度的贫血。贫血的发生与血清白蛋白水平、TNM分期、分化程度及有无淋巴结转移具有相关性（均P＜0.05）,与年龄、性别、肿瘤部位无相关性（均P>0.05）。78例贫血患者中,大细胞性贫血占26.92%,正常细胞性贫血占17.95%,小细胞性贫血占55.13%。血清白蛋白水平、TNM分期、淋巴结转移情况与贫血的发生密切相关（均P＜0.05）,是贫血发生的独立预后因素。结论：食管鳞癌患者癌性贫血是由多种因素共同作用的结果,在治疗中要注意预防贫血的发生,提高患者的生活质量。     

胸段食管鳞癌隆突下淋巴结转移的诊断

目的探讨CT对胸段食管鳞癌隆突下淋巴结转移的诊断价值及其相关影响因素。方法回顾性分析2011年1月至2015年6月该外科收治的290例胸段食管鳞癌患者术前的CT影像资料,记录每位患者隆突下淋巴结的长径、短径及平均CT值,并与术后病理结果对照。结果通过ROC曲线分析,CT下隆突下淋巴结长径≥10.8 mm时考虑转移,曲线下面积为0.860,敏感性为93.0%,特异性为67.5%;隆突下淋巴结短径/长径≥0.61时考虑转移,曲线下面积为0.776,敏感性为83.7%,特异性为69.5%;隆突下淋巴结平均CT值≥37.30 HU时考虑转移,曲线下面积为0.781,敏感性为90.7%,特异性为65.9%。隆突下淋巴结是否转移与肿瘤位置、肿瘤长度、浸润深度(肿瘤T分期)和其他站淋巴结是否转移有明显相关性(P<0.05),与患者年龄、性别、肿瘤分化程度无明显相关性(P>0.05)。结论当CT显示,隆突下淋巴结长径≥10.8 mm,短径/长径比值≥0.61或平均CT值≥37.30 HU时,应考虑隆突下淋巴结转移,此时应行经右胸、颈、腹三切口的三野清扫;胸部中段食管肿瘤长度≥5 cm、肿瘤浸润超过黏膜层或其他站淋巴结有转移为隆突下淋巴结转移的危险因素。     

食管鳞癌中TGF-β1与临床病理因素关系意义的研究

目的　研究食管鳞癌中TGF β1的表达 ,及它在食管鳞癌细胞的增殖、侵袭、转移中的作用。方法　运用免疫组织化学方法研究TGF β1蛋白表达情况 ,显微镜下计数阳性细胞指数 (LI) ,并进行统计分析。结果　①正常食管黏膜阳性率为 2 0 % (2 / 10 ) ,食管鳞癌组织为 62 % (3 1/ 50 ) ,两者差异有显著性 (χ2 =5.93 94,P =0 .0 15) ;LI后者高于前者 (t=2 .717,P =0 .0 0 9) ,正常食管黏膜阳性 2例 ,均为弱阳性 (LI <2 5% )。②TGF β1在食管鳞癌组织中的表达与年龄、性别无明显关系 (P >0 .0 5) ,不同分化级别中两者表达亦无差异 (P >0 .0 5)。有淋巴结转移组TGF β1水平高于无淋巴结转移组 ,差异有显著性 ,P =0 .0 0 3。食管外膜浸润组TGF β1显著高于未受浸润组 ,P =0 .0 0 1,临床分期Ⅰ Ⅱ与Ⅲ Ⅳ期TGF β1表达水平差异有显著性 ,P =0 .0 0 0。结论　①食管鳞癌中存在TGF β1的高表达 ,表达水平与淋巴结转移、浸润侵袭、临床分期等有关 ,其检测有辅助诊断作用 ,且有利于判断肿瘤转移、浸润和后继治疗 ;②表达水平与组织分级无关 ,提示TGF β1在促进肿瘤局部侵袭转移中的重大作用 ,有助于理解临床上一些肿瘤生物学行为与组织分级不符的现象     

炎性指标预测食管鳞癌根治性同步放化疗患者生存预后的价值研究

［摘要］　目的　探讨炎性指标对食管鳞癌根治性同步放化疗患者预后的预测价值。方法　回顾性分析2016年1月至2017年12月于徐州医科大学附属宿迁医院肿瘤科行根治性同步放化疗的154例食管癌患者的临床资料。采用受试者工作特征（ROC）曲线分析治疗前系统免疫炎症指数（SII）、预后营养指数(PNI)、中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)和淋巴细胞-单核细胞比值(LMR)对患者总生存期的预测效能。采用Kaplan-Meier法绘制生存曲线,比较不同组别的生存期。采用Cox回归分析影响患者生存预后的因素,并将筛得指标通过R语言软件建立列线图预测模型。结果　ROC曲线分析结果显示,治疗前SII、NLR、PLR、LMR及PNI水平均能有效预测患者的生存预后情况（P<0.05）。Kaplan-Meier生存曲线分析结果显示,SII≤794.8组的生存预后优于SII>794.8组（P<0.05）,NLR≤3.25组的生存预后优于NLR>3.25组（P<0.05）,PLR≤125.65组的生存预后优于PLR>125.65组,差异均有统计学意义（P<0.05）。多因素Cox回归分析结果显示,美国东部肿瘤协作组（ECOG）评分（HR=1.774）、T分期（HR=1.749）、淋巴结转移（HR=2.147）、SII（HR=2.513）是影响患者生存预后的独立因素（P<0.05）。由此建立的列线图预测模型的C-index为0.796（95%CI：0.757～0.871）,具有良好的精准度。结论　SII是影响食管鳞癌根治性放化疗患者生存预后的独立因素。基于SII等指标建立的预测模型具有良好的精准度,可供临床参考、使用。     

胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨

目的探讨胸段食管鳞癌淋巴结转移规律及术中淋巴结清扫方式。方法 480例行根治术的胸段食管鳞癌患者,标记各部位清扫淋巴结分别送检,进行临床病理资料分析。结果本组386例患者有淋巴结转移。全组清扫淋巴结5 424枚,平均每例清扫11.3枚,689枚淋巴结有转移。22例患者出现跳跃性淋巴结转移,其中胸上段3例、中段9例、下段1例。胸上段食管鳞癌颈部淋巴结转移率47.6%,高于胸中段（10.5%）和胸下段（1.3%）,P均〈0.05。胸下段食管鳞癌向腹腔淋巴结转移率为33.1%,高于胸中段（19.4%）和胸上段（3.8%）,P均〈0.05。胸中段食管鳞癌有上纵隔淋巴结（23.5%）及下纵隔淋巴结（29%）和腹腔淋巴结（19.4%）的双向转移趋势,隆突下淋巴结转移多见,转移率54.2%。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见,胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点,胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。胸上段食管癌行颈、胸、腹三野淋巴结清扫,重点清扫颈段食管旁及锁骨上、下界包括隆突下淋巴结;胸下段食管癌可行胸、腹两野淋巴结清扫,重点清扫隆突下、下胸段食管旁、胃左动脉旁淋巴结;胸中段食管癌淋巴结清扫方式应根据具体情况设定。     

食管鳞癌组织CD44V6蛋白的表达及意义

CD44 V6 基因蛋白的特异性表达与恶性肿瘤的发生发展、侵袭转移和预后密切相关。我们用流式细胞仪检测了食管鳞癌组织中 CD44 V6 蛋白的表达 ,分析其与食管鳞癌各种临床病理指标的关系 ,探讨 CD44 V6 蛋白检测在食管鳞癌患者预后判断中的价值。临床资料 :食管癌组织取自 5 2例患者 ,男 3 6例 ,女 16例 ;年龄 3 7～ 68岁 ,中位年龄 5 2岁。术前未接受放疗和化疗。术后病理检查确诊均为鳞癌。癌肿位于食管上段 5例 ,中段 3 3例 ,下段 14例 ;大体病理分型为溃疡型 3 5例 ,髓质型 9例 ,蕈伞型 8例 ;病理分级 级 18例 , 级 2 4例 , 级 10例 …     

缺氧诱导因子与食管鳞癌血管生成

食管癌是我国常见的恶性肿瘤，且以鳞癌最为多见。食管鳞癌的发生、发展与肿瘤血管生成密切相关。缺氧诱导因子是近期肿瘤血管生成研究的热点因子，此文就该因子与食管鳞癌血管生成的研究现状作一综述。     

pN0胸段食管鳞癌术后复发 转移的危险因素探讨

目的探讨p N0胸段食管鳞癌术后复发、转移的高危因素,为术后采取合理辅助治疗提供临床依据,提高患者远期生存率。方法回顾性分析福建省泉州市光前医院肿瘤外科2003-01~2010-12收治的76例p N0胸段食管鳞癌患者的临床资料,应用Cox比例风险回归模型分析术后3年内肿瘤复发、转移的危险因素。结果术后3年内复发转移率为34.2%。单因素分析结果显示,肿瘤部位、p T分期、有无脉管癌栓与术后复发、转移相关(P0.05)。多因素分析结果显示,食管中上段癌、p T3-4a、脉管癌栓是影响p N0胸段食管鳞癌术后复发、转移的独立风险因素。结论胸中上段癌、p T3-4a、脉管癌栓是p N0胸段食管鳞癌术后复发、转移的独立风险因素,术后应给予积极辅助治疗。     

Risk factors of lymph node metastasis in T1 esophageal squamous cell carcinoma

Background and Aim: To perform endoscopic mucosal resection (EMR) for T1 esophageal cancer, it is essential to estimate the lymph node status exactly. In order to evaluate the feasibility of EMR for esophageal cancers, we evaluated the clinicopathological features of T1 esophageal squamous carcinomas with an emphasis on the risk factors and distribution patterns of lymph node metastasis. Methods: From 1994 to 2006, a total of 200 patients with T1 esophageal carcinoma were treated surgically in our institution. Among them, clinicopathological features were evaluated for 197 consecutive patients with T1 squamous cell carcinoma. Results: The frequency of lymph node involvement was 6.25% (4/64) in mucosal cancers and 29.3% (39/133) in submucosal cancers (P < 0.001). In patients with M1 (n = 32) and M2 (n = 14) cancers, no lymph node metastasis was found. In multivariate analysis, size larger than 20 mm, endoscopically non‐flat type, and endo‐lymphatic invasion were significant independent risk factors for lymph node metastasis. The differentiation of tumor cell was not a risk factor for lymph node metastasis. Conclusions: We suggest that EMR may be attempted for flat superficial squamous esophageal cancers smaller than 20 mm. After EMR, careful histological examination is mandatory.     

Clinicopathologic factors predicting lymph node metastasis in superficial esophageal squamous cell carcinoma

Abstract

Objective. Surgical resection is the treatment of choice for superficial esophageal squamous cell carcinoma (SESCC), but it is associated with high mortality and morbidity rates. Recently, endoscopic resection for SESCC has been indicated for patients with a low risk of lymph node metastasis (LNM). Therefore, to successfully treat SESCC with endoscopic resection, it is very important to identify patients with a low risk for LNM. The objective of this study was to investigate clinicopathologic factors that predict LNM in patients who underwent esophagectomy for SESCC. Methods. The study included 104 patients with SESCC from three university hospitals in Pusan, Korea. Clinicopathologic factors were evaluated to identify independent factors predicting LNM by univariate and multivariate analyses. Results. In univariate analysis, the depth of tumor invasion and lymphovascular invasion had significant influences on LNM (p = 0.001 and p < 0.001, respectively). Gross type, tumor size, and tumor differentiation were not predictive for LNM. In multivariate analysis, the depth of tumor invasion and lymphovascular invasion were signi?cantly associated with LNM in patients with SESCC (OR 9.04, p = 0.049; OR 11.61, p = 0.002, respectively). Conclusions. The depth of tumor invasion and lymphovascular invasion were independent predictors of LNM in patients with SESCC. Therefore, endoscopic resection could be performed in patients with SESCC that is limited to the mucosa, without lymphovascular invasion.     

Neoadjuvant chemoradiotherapy followed by esophagectomy for initially resectable squamous cell carcinoma of the esophagus with multiple lymph node metastasis

Neoadjuvant chemoradiotherapy (CRT) was expected to improve surgical curability and prognosis for advanced esophageal cancer. However, the clinical efficacy of neoadjuvant CRT followed by esophagectomy with three-field lymphadenectomy (3FL) for initially resectable esophageal squamous cell carcinoma (SCC) remains unclear. Since 1998, we have defined the status of metastases to five or more nodes, or nodal metastases present in all three fields as multiple lymph node metastasis, which was previously shown to be associated with poor prognosis. Between 1998 and 2002, 83 patients with initially resectable esophageal SCC were prospectively allocated into two groups, according to the clinical status of nodal metastasis. Nineteen patients clinically accompanied by multiple lymph node metastasis initially underwent neoadjuvant CRT followed by curative esophagectomy with 3FL (CRT group). The other 64 patients clinically without multiple lymph node metastasis immediately received curative esophagectomy with 3FL (control group). Although the overall morbidity rate was significantly higher in the CRT group, no in-hospital death occurred in either group. Patients without pathologic multiple lymph node metastasis in the CRT group showed a significantly better disease-free survival rate than either patients pathologically with multiple lymph node metastasis in the control group or those in the CRT group. However, the differences in the overall survival rate among the groups were not significant. Thus, the significant survival benefit by neoadjuvant CRT in addition to esophagectomy with 3FL was not confirmed, although it may have been advantageous, without increase in mortality, to at least some patients who responded well to neoadjuvant CRT. Therefore, neoadjuvant CRT can be an initial treatment of choice for resectable esophageal SCC clinically with multiple lymph node metastasis. The prediction of response to CRT and the development of alternative treatment for hematogenous recurrence could achieve a further survival benefit of this trimodality treatment.     

Tumor cell dissociation score highly correlates with lymph node metastasis in superficial esophageal carcinoma

BACKGROUND: It is still not clear which parameters are important for predicting the metastatic potential of superficial esophageal squamous cell carcinoma (SESCC). The purpose of the present paper was thus to investigate tumor cell dissociation (TCD) in SESCC as a predictive factor of lymph node metastasis. METHODS: Thirty-three SESCC were classified into four groups based on the depth of tumor invasion. Carcinomas not invading as far as the muscularis mucosa were classified as group A; carcinomas invading to the muscularis mucosa or less than one-third of the upper submucosa were classified as group B; those invading to the middle layer of the submucosa were classified as group C; and those invading one-third of the lower submucosa were classified as group D. The TCD score was calculated by dividing the length of the TCD region by the maximal longitudinal length of the area of invasion into or beyond the lamina propria, and multiplying by 100. E-cadherin expression of the carcinomas was investigated in the TCD area and the successive area of mucosal invasive carcinoma (SAM). RESULTS: The incidence of lymph node metastasis was 0% in group A, 10% in group B, 36.4% in group C and 57.1% in group D. The mean TCD scores (+/-SEM) of SESCC with lymph node metastasis were higher than that without (85.3 +/- 5.7, 16.3 +/- 3.9, respectively; P < 0.001). In group C, the TCD score of cases with lymph node metastases was higher than in those without lymph node metastasis (P < 0.001). E-cadherin expression was significantly reduced in the area of TCD compared with the SAM located over the TCD area (P < 0.001). CONCLUSIONS: The TCD score is an important predictive marker for lymph node metastasis in SESCC. Clinical evaluation of TCD scores in endoscopic mucosal resection (EMR) specimens would enable accurate prediction of lymph node metastasis and extend the indication of EMR treatment for SESCC.     

Tumor budding as a useful prognostic marker in esophageal squamous cell carcinoma

We examined the prognostic significance of tumor budding in patients with esophageal squamous cell carcinoma, particularly in comparison to other routine pathological findings. Fifty-six cases who underwent an esophagectomy were reviewed. We defined tumor budding as an isolated single cancer cell or a cluster composed of fewer than five cancer cells and divided these into two grades; low-grade (< 5 budding foci) and high-grade (> or = 5 budding foci) within a microscopic field of x 200. There were 22 (39.3%) and 34 (60.7%) cases with low- and high-grade budding, respectively. There were significant differences in the patients with low- and high-grade budding in relation to tumor size, pT stage, lymphovascular invasion, perineural invasion, circumferential resection margin involvement, and AJCC stage (P < 0.05). The 3-year survival rates of the patients with low- and high-grade budding were 72.3% and 30.7%, respectively (P = 0.04). We propose that tumor budding may be a pathological marker suggesting high malignancy potential and decreased postoperative survival in patients with esophageal squamous cell carcinoma.     

Development and validation of a nomogram for preoperative prediction of lymph node metastasis in pathological T1 esophageal squamous cell carcinoma

Endoscopic resection is increasingly used to treat patients with pathological T1 (pT1) esophageal squamous cell carcinoma (ESCC) because of its small surgical trauma. However, reports of the risk factors for lymph node metastasis (LNM) have been controversial. Therefore, we aim to build a nomogram to individually predict the risk of LNM in pT1 ESCC patients, to make an optimal balance between surgical trauma and surgical income.One hundred seventy patients with pT1 esophageal cancer in our hospital were analyzed retrospectively. Logistic proportional hazards models were conducted to find out the risk factor associated with LNM independently, and those were imported into R library “RMS” for analysis. A nomogram is generated based on the contribution weights of variables. Finally, decision analysis and clinical impact curve were used to determine the optimal decision point.Twenty-five (14.7%) of the 170 patients with pT1 ESCC exhibited LNM. Multivariable logistic regression analysis showed that smoking, carcinoembryonic antigen, vascular tumor thromboembolus, and tumor differentiation degree were independent risk factors for LNM. The nomogram had relatively high accuracy (C index of 0.869, 95% confidence interval: 0.794–0.914, P < .0001). The decision curve analysis provided the most significant clinical benefit for the entire included population, with scores falling just above the total score of 85 in the nomogram.Smoking, carcinoembryonic antigen, vascular tumor thromboembolus, and tumor differentiation degree may predict the risk of LNM in tumor 1 ESCC. The risk of LNM can be predicted by the nomogram.     

Study of abnormal chromosome regions in esophageal squamous cell carcinoma by comparative genomic hybridization: relationship of lymph node metastasis and distant metastasis to selected abnormal regions

Squamous cell carcinoma of the esophagus (ESCC) has a poor prognosis among digestive tract cancers. Lymph node metastasis and distant metastasis are the major factors determining its prognosis. We used comparative genomic hybridization (CGH) to evaluate primary tumor lymph nodes and metastatic areas from ESCC patients in order to determine the relationship between abnormal chromosome regions and outcome. Tumor tissues and lymph nodes were collected from 51 patients with ESCC, and abnormal chromosome regions were detected by CGH. We searched for regions that were significantly more common in patients with lymph nodes metastases (n≥ 6) or distant metastases, and correlated those chromosomal changes with survival. Regions showing amplification in more than 65% of esophageal squamous cell cancers were as follows: 17q12 (90.2%), 17q21 (86.3%), 3q29 (82.4%), 3q28 (78.4%), 8q24.2 (76.5%), 22q12 (76.5%), 3q27 (74.5%), 8q24.3 (74.5%), 1q22 (70.6%), 5p15.3 (70.6%), 22q13 (70.6%), 3q26.3, 8q23, 8q24.1, 9q34, 11q13, 17p12, 17q25, 20q12, 20q13.1 (68.6%), 1q32, 1q42, and 20q13.2 (66.7%). Regions showing deletion in more than 50% of the tumors were as follows: Yp11.3 (62.7%), 3p26 (56.9%), Yq12 (54.9%), 13q21 (52.9%), 4q32 (51.0%), and 13q22 (51.0%). When Fisher's test was used to assess associations of these regions with metastases to lymph nodes, amplification at 2q12–14 (P= 0.012), 3q24–26 (P= 0.005), and 7q21–31 (P= 0.026) were significant. Survival was worse for patients with amplification at all 3 regions. In patients with distant organ metastases, amplification at 7p13–21 was significant (P= 0.008), and survival was worse. Chromosomal amplifications in ESCC at 2q12–14, 3q24–26, and 7q21–31 were associated with lymph node metastasis, while amplification at 7p13–21 was related to distant metastasis. Amplification at these regions correlated with worse survival. Genes involved in the phenotype of ESCC may exist in these regions. Identification of these genes is a theme for future investigation.