The therapeutic effects of rehmannia oral liquid for the syndrome of heat accumulation with Yin consumption in esophagus cancer patients undergoing radiotherapy--a report of 60 cases

OBJECTIVE

To observe the clinical therapeutic effects of Rehmannia Oral Liquid on the syndrome of heat accumulation with Yin consumption in intermediate or late esophagus cancer patients undergoing radiotherapy.

METHODS

The IFN-alpha, TNF-alpha, IL-1beta and TGF-beta1 levels in sera were determined by the method of ABC-WLISA before and after the treatment with Rehmannia Oral Liquid. At the same time, the observation was carried out on the patient's general condition, symptoms and signs, barium meal or CT examinations, and biopsy. Another 30 cases of esophagus cancer were treated singly with radiotherapy as the control group.

RESULTS

Rehmannia Oral Liquid could obviously improve the patient's general condition, and the symptoms and signs after radiotherapy. Based on the X-ray examination and biopsy, the short-term local control rate of the treatment group and the control group was 70.0% and 40.0% respectively, showing a significant difference (P<0.05). Before the treatment, the level of serum IFN-alpha of both cancer groups was lower and the levels of TNF-alpha, IL-1beta and TGF-beta1 were higher than that of normal group. After treatment, the level of IFN-alpha in both treatment group and control group increased significantly (P<0.01), and the treatment group improved more obviously than the control group (P<0.05). The level of TNF-alpha of both groups decreased significantly (P<0.01) after treatment, and the level of IL-1beta decreased in treatment group and increased in control group without the significant difference as compared with that before treatment The level of TGF-beta1 was significantly increased in control group (P<0.05) and decreased in treatment group (P>0.05) after treatment. The difference between groups was significant (P<0.05).

CONCLUSION

Rehmannia Oral Liquid can obviously reduce the radiotherapy reaction, improve the quality of life, and raise the therapeutic effects. The action mechanism of the Liquid may lie in balancing the cytokine network and regulating the disordered signal transmission.

[Study on changes of vitamin nutrition status of population in a high-risk area of esophageal cancer]

OBJECTIVE

To study the changes of vitamin nutritional status of residents in a high-risk area of esophageal cancer.

METHODS

8 towns where nutrition survey had been done were selected, 2 villages were randomly selected from each town and 30 families were randomly selected per village. The blood and 4h burden urine samples were collected from subjects. The serum vitamin A, blood total ascorbic acid and glutathione reductase activition coefficient (AC) in red blood cell were determinde by using of trifluoroacetic acid colorimetry, 2, 4-dinitrophenylhydrazine colorimetric method and Sauberlich method respectively. The contents of vitamin B2 , reduction ascorbic acid and total ascorbic acid in 4h burden urine were measured by using of fluorescent pectrophotometry,2,6-Dichloro-N-(4-hydroxyphenyl)-1,4-benzoquinoneimine titrimetric method and 2,4-dinitrophenylhydrazine colorimetric method respectively. The results were analyzed and compared with those of in 1980, 1983 and 1984. The t-test or chi2-test was carried out.

RESULTS

The level of serum retinal in residents living in Ren cun, Dongyao and Hejian is significantly higher than that of in 1982 (P < 0.01). The level of vitamin B2 in 4h burden urine in residents living in Yaocun, Rencun and Heshun are significantly higher than that of in 1982 or 1984 (P < 0.01). The number of ribflavin deficiency of population living in Dongyao, Hejian, Yaocun and Rencun are significantly lower than that of in 1982 or 1983 (P < 0.01) according to the content of 4h burden urine and glutathione reductase activation coefficient (AC) in red blood cell; the number of vitamin C deficiency of population living in Dongyao, Hejian,Yao cun, Ren cun and Heshun are significantly lower than that of in 1982 or 1983 (P < 0.01) according to blood total ascorbic acid and the ascorbic acid content of 4h-burden urine and.

CONCLUSION

Vitamin nutritional status of residents in a high-risk area of esophageal cancer have been improved.

Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy

AIM: To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.

METHODS: Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.

RESULTS: Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P < 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1, 3 and 5 years was 48.28% (42/87), 19.54% (17/87) and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis. In patients whose serum TGFβ1 level decreased after RT, the survival rate at 1, 3 and 5 years was 61.02% (36/59), 28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P < 0.01).

CONCLUSION: Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.

Temporal change in brain natriuretic Peptide after radiotherapy for thoracic esophageal cancer

PURPOSE

To investigate the relationships of plasma levels of brain natriuretic peptide (BNP) with abnormal (18)F-fluorodeoxyglucose (FDG) accumulation in the myocardium corresponding to irradiated fields and temporal changes in BNP, which is used as an index of heart remodeling, after radiotherapy for the mediastinum.

MATERIALS AND METHODS

Brain natriuretic peptide concentrations were measured before and after radiotherapy for thoracic esophageal cancer, and the change in BNP concentration after radiotherapy was investigated. Moreover, FDG accumulation in the myocardium was investigated in patients who had undergone FDG positron emission tomography less than 14 days before or after measurement of BNP concentration, and the Mann-Whitney U test was used to detect significant difference between BNP concentrations in patients with and without abnormal FDG accumulation corresponding to the irradiated field.

RESULTS

There was significant difference between the levels of BNP in patients without abnormal FDG accumulation in the irradiated myocardium and in patients with abnormal FDG accumulation (p < 0.001). The levels of BNP in the 9-24 months after radiotherapy group and in the >24 months after radiotherapy group were significantly higher than the levels in the before radiotherapy group, immediately after radiotherapy group, 1-2 months after radiotherapy group, and control group.

CONCLUSIONS

The level of BNP was significantly increased more than 9 months after the start of radiotherapy and was significantly higher in patients who had high FDG accumulation corresponding to the irradiated field. The results of this study indicate that BNP concentration might be an early indicator of radiation-induced myocardial damage.

[The effects of blood motilin and gastrin on electrical activity and emptying of the intrathoracic stomach after esophagectomy for cancer]

OBJECTIVE

To observe the effects of blood motilin and gastrin on the electrical activity and emptying of the intrathoracic stomach after esophagectomy for cancer.

METHODS

Electrogastrography and determination of blood motilin and gastrin were carried out in 52 subjects, including 20 normal volunteers and 32 esophageal cancer patients before and 1, 3, 6, 12 months after operation. Gastric emptying of radiopaque granula was studied in 35 of the 52 subjects, including 5 normal volunteers, 7 preoperative patients and 23 postoperative patients.

RESULTS

The preoperative gastric emptying of radiopaque granula was 28.0 +/- 8.0 pieces 120 second after eating the test meal, significantly less than that of the normal controls [(38.0 +/- 2.0) pieces, t = 3.515, P = 0.006], and decreased to (16.0 +/- 4.8) pieces one month after esophagectomy (t = 6.987, P = 0.000), and then recovered to 16.8 +/- 4.8 one year after surgery but still could not reach normal (t = 9.387, P = 0.0000). Compared with the normal controls, the amplitude of electrogastrogram (EGG) of the preoperative patients was (229 +/- 118) microv, not significantly different from that of the controls [(226 +/- 62) microv, t = 0.085, P = 0.933], and the frequency of EGG of the preoperative patients was (3.1 +/- 0.2) times per minute, not significantly different from that of the controls too [(3.2 +/- 0.1) times per minute, t = 0.872, P = 0.387]. But the frequency and amplitude of EGG of the patients one month after operation were (2.9 +/- 0.3) times per minute and (172 +/- 46) microv respectively, both significantly decreased in comparison with those of the normal controls (t = 2.336, P = 0.024; and t = 3.118, P = 0.003). The amplitude reached normal [(223 +/- 60) microv, t = 0.145, P = 0.885] 1 year after surgery, but the frequency still remained at a low level [(3.0 +/- 0.1) times per minute, t = 2.208, P = 0.033). The level of blood motilin of the preoperative patients was (488 +/- 197) ng/L, significantly higher than that of the controls [(248 +/- 98) ng/L, t = 5.030, P = 0.000], and the blood gastrin level of the preoperative patients was (26 +/- 15) ng/L, significantly higher than that of the controls [(20 +/- 12) ng/L, t = 2.741, P = 0.043]. One year after operation the blood motilin level maintained at a high level [(443 +/- 129) ng/L, t = 3.725, P = 0.001], and the gastrin level remained at a high level too [(48 +/- 23) ng/L, t = 3.703, P = 0.001].

CONCLUSION

Physiologically important, persistent elevation of blood gastrin and motilin in the patients who underwent esophagectomy for cancer facilitates the recovery of electrical activity and emptying of the intrathoracic stomach.

Sensitization against anticancer drugs by transfection with UBE2I variant gene into ras-NIH3H3 mouse fibroblasts

We previously performed SEREX (serological identification of antigens by recombinant expression cloning) using the sera of patients with esophageal squamous cell carcinoma (SCC), and isolated a variant clone (AK093616) of ubiquitin-conjugating enzyme E21 (UBE2I). This clone was tentatively designated as UBE2I-v5 and analyzed for biological function by transient transfection of the cDNA into activated Ha-ras-transformed NIH3T3 (ras-NIH) mouse fibroblasts. Chemosensitivity to 92 cytotoxic drugs was compared between UBE2I-v5-transfected cells and the parental ras-NIH cells. The UBE2I-v5-transfected cells were more sensitive than the parental cells to anticancer drugs such as vincristine (VCR), mitoxantrone (MIT) and etoposide (VP16). The regression analysis of the total chemosensitivity pattern of UBE2I-vS-transfected cells revealed that the function of UBE2I-v5 was positively related to RPA2 (replication protein A2), Rho-GDI (Rho guanine nucleotide dissociation inhibitor a), FUS (putative tumor suppressor) and TKT (transketolase) but negatively related to Per-1 (period-I), Ran (nuclear Ras-related protein), PTEN (phosphatase and tensin homolog), C/EBPalpha (CCAAT/enhancer binding protein a) and the tumor suppressor p53. Thus, it is possible that UBE21-v5 plays a role in carcinogenesis by suppressing the function of CIEBPa and/or p53 via RPA2-like activity.

Oxidative DNA damage and total antioxidant status in serum of patients with esophageal squamous cell carcinoma

BACKGROUND/AIMS

Oxidative stress is connected with activation of somatic mutations and rates of cell proliferation existing in cancer tissue. High level of reactive oxygen species is a mutagenic factor for DNA damage. Antioxidants are the components of the cellular defense mechanism against reactive oxygen molecules. The aim of our study was to analyze DNA peroxidation products' concentration and total antioxidant level in serum of the patients with esophageal squamous cell carcinoma before and after esophagectomy. We examined these parameters as markers of cancer development.

METHODOLOGY

We tested 18 patients (2 woman and 16 men, mean age 59.4 years) with esophageal squamous cell cancer before and after esophagectomy and 12 healthy people as a control group. Concentrations of 8-OHdG and enzymatic antioxidants level were analyzed in serum. Data were statistically analyzed by Mann-Whitney test.

RESULTS

We observed statistically significant higher concentrations of 8-OHdG and significant lower levels of enzymatic antioxidants in the patients with cancer in comparison to the control group. After esophagectomy we observed normalization of these parameters. In four patients the level of total antioxidants was low and 8-OHdG concentration was high during the whole time of treatment. These patients had disease progression.

CONCLUSIONS

Estimation of serum 8-OHdG concentration and total antioxidant status may be helpful for monitoring cancer therapy in patients with esophageal squamous cell cancer.

Usefulness of serum protein profiling for prediction of preoperative chemoradiosensitivity of esophageal cancer

We examined whether serum protein profiling is a reliable index for prediction of therapeutic efficacy of preoperative chemoradiotherapy (PCRT) in advanced esophageal cancer compared with evaluation of the efficacy of conventional clinical examination. We entered 42 patients who received PCRT and surgery between 1998 and 2002 into this study. Serum protein profiling was performed using the preoperative serum of the patient to select the marker set that enabled the efficacy of PCRT to be evaluated accurately. The efficacy of PCRT was predicted with the marker set, and the sensitivity, specificity and accuracy of the method were calculated based on evaluation of the efficacy by pathological examination. Similarly, therapeutic efficacy was also predicted based on evaluation of the efficacy of conventional clinical examination, and the results were compared with those of prediction by serum protein profiling. The correlation between each predictive examination and outcome was evaluated. The sensitivity, specificity and accuracy of prediction of therapeutic efficacy of PCRT by serum protein profiling were 90.9, 100 and 93.3%, respectively. In clinical examination, prediction of the efficacy of PCRT by three methods was as follows: by esophagography, sensitivity 76.0%, specificity 17.6%, accuracy 52.4%; by endoscopy, sensitivity 80.0%, specificity 11.8%, accuracy 52.4%; by computed tomography, sensitivity 60.0%, specificity 47.1%, accuracy 54.8%, respectively. These results demonstrated the superiority of serum protein profiling in predicting the therapeutic efficacy of PCRT compared with conventional clinical examination. Moreover, serum protein profiling was the only significant prognostic factor as regards the correlation with outcome by multivariate analysis.

Serum midkine depends on lymph node involvement and correlates with circulating VEGF-C in oesophageal squamous cell carcinoma

Lymph node metastasis (LNM) is a key factor for selection of treatment method and patients' prognosis in oesophageal squamous cell carcinoma (ESCC). However, no biomarkers able to support the clinical detection of LNM have been reported. Recently, vascular endothelial growth factor C (VEGF-C) was found to be a more accurate marker of LNM in lung cancer than computed tomography. Midkine is a multifunctional cytokine involved in cancer development. We investigated circulating midkine levels in ESCC patients (n=73) compared with those in healthy subjects (n=42) with double-antibody-sandwich indirect enzyme-linked immunosorbent assay (DASI-ELISA). We found that midkine was elevated in ESCC and involved in metastatic disease. Serum midkine (sMK) was a good marker of LNM, evaluated both clinically and pathologically, as revealed by ROC analysis. It also correlated with serum levels of VEGF-C. The increase of sMK was related to cancer cells, although a weak correlation was observed between sMK and platelet and leucocyte counts.

Clinical prognostic scoring system to aid decision-making in gastro-oesophageal cancer

Background

Accurate prediction of prognosis in gastro-oesophageal cancer remains challenging. The aim of this study was to develop a robust model for outcome prediction.

Methods

The study included 220 patients with gastric or oesophageal cancer newly diagnosed over a 2-year period. Patients were staged and underwent treatment following discussion at a multidisciplinary team (MDT) meeting. Clinical and investigative variables were collected, including performance and nutritional status, and serum C-reactive protein (CRP) level. Primary endpoints were death within 12 and 24 months.

Results

Overall median survival was 13 months. Advanced clinical stage (P &lt; 0·001), reduced performance score (P &lt; 0·001), weight loss exceeding 2·75 per cent per month (P = 0·026) and serum CRP concentration above 5 mg/l (P = 0·031) were identified as independent prognostic indicators in multivariable analysis. A prognostic score was constructed using these four variables to estimate a probability of death. Applying the model gave an area under the receiver–operator characteristic curve of 0·84 and 0·85 for prediction of death at 12 and 24 months respectively (both P &lt; 0·001).

Conclusion

This model accurately estimated the probability of death within 12 and 24 months. This may aid the MDT decision-making process.

Circulating tumor cells in perioperative esophageal cancer patients: quantitative assay system and potential clinical utility

PURPOSE

To establish a quantitative system for evaluating the role of circulating tumor cells (CTC) in peripheral blood samples in patients who undergo surgery for treatment of esophageal cancer.

EXPERIMENTAL DESIGN

One hundred fifty-five peripheral blood samples from 53 esophageal cancer patients were collected before surgery (B-1), immediately after surgery (B0), and on the 3rd day postoperatively (B+3). Eighty-nine samples from 22 benign patients who underwent thoracotomy and 30 healthy volunteers were obtained as controls. A real-time reverse transcription-PCR quantitative analysis system based on carcinoembryonic antigen (CEA) mRNA gene expression was designed for detection of CTC.

RESULTS

This developed system can detect CEA mRNA-positive cells down to 3 cells per milliliter of peripheral blood. The cells in negative control groups were lower than the detection limit. The medians of 188 [95% confidence interval (95% CI), 155-498], 1513 (95% CI, 660-7,974) and 707 (95% CI, 737-3,005) CEA mRNA-positive cells per mL with the CEA-positive rates of 28.3%, 60.4%, and 42.9% in B-1, B0, and B+3 peripheral blood samples were obtained, respectively. There was statistically significant difference between B-1 and B0 (P=0.0001) and between B-1 and B+3 (P=0.0209). Fifty percent of patients with R>0.4 showed metastasis in 1 year after surgery, whereas the probability was only 14.3% for patients with R<0.4 (where R is CTC ratio of B+3 to B0, P=0.043).

CONCLUSIONS

Esophageal cancer operation results in tumor cells dissemination and significant increase of CTC in peripheral blood, which is related to the developed metastasis. CTC are helpful for evaluating micrometastasis and have the potential for predicting recurrence in esophageal cancer.

Helicobacter pylori and CagA seropositivity and its association with gastric and oesophageal carcinoma

OBJECTIVE

Helicobacter pylori infection is an established risk factor for non-cardia gastric adenocarcinoma. Infection with H. pylori strains harbouring the cagA pathology island may augment this association. H. pylori infection may at the same time reduce the risk for oesophageal carcinoma. However, prospective data on the association between CagA seropositivity and gastric or oesophageal carcinomas are limited. The purpose of this study was to investigate whether CagA seropositivity among H. pylori seropositive subjects is associated with gastric or oesophageal carcinomas.

MATERIAL AND METHODS

A nested case-control study was performed in the Malmö Preventive Medicine cohort consisting of 32,906 middle-aged subjects. Tumour cases were identified by the Swedish National Cancer Registry. The Western blot method Helicoblot 2.1 was used to detect H. pylori and CagA seropositivity.

RESULTS

Non-cardia gastric adenocarcinoma was associated with H. pylori seropositivity, odds ratio 17.8 (95% CI: 4.2-74.8; 67 cases). The odds ratio for CagA seropositivity among H. pylori seropositive subjects was 9.7 (95% CI: 1.5-infinity). No significant associations were found between cardia gastric adenocarcinoma and H. pylori or CagA seropositivity among H. pylori seropositive subjects; odds ratios were 1.5 (95% CI: 0.51-4.8) and 2.7 (95% CI: 0.38-infinity), respectively (24 cases). Oesophageal adenocarcinoma and oesophageal squamous cell carcinoma were not significantly associated with H. pylori seropositivity or with CagA seropositivity among H. pylori seropositive subjects; the odds ratios associated with oesophageal adenocarcinoma were 0.46 (95% CI: 0.07-2.6) and 0.38 (95% CI: 0.02-24), respectively. Corresponding odds ratios for oesophageal squamous cell carcinoma were 0.44 (95% CI: 0.15-1.2; 37 cases) and 2.0 (95% CI: 0.24-infinity), respectively.

CONCLUSIONS

CagA seropositivity among H. pylori seropositive subjects is a risk factor for non-cardia gastric adenocarcinoma.

Plasma DNA as a molecular marker for completeness of resection and recurrent disease in patients with esophageal cancer

OBJECTIVE

To identify a marker for completeness of resection and recurrent disease in patients with esophageal cancer.

DESIGN

Case series.

SETTING

Department of Surgery of the University of Southern California.

PATIENTS

Forty-four healthy subjects and 45 patients with esophageal cancer prior to esophagectomy. Six patients were unresectable and 39 had a complete resection.

MAIN OUTCOME MEASURES

Plasma DNA levels were measured using polymerase chain reaction. Twenty resected patients had follow-up plasma DNA levels measured.

RESULTS

Preoperatively, plasma DNA levels exceeded the normal level in 38 (84%) of 45 patients. Preoperatively, 12 patients received neoadjuvant therapy and 11 had plasma DNA levels higher than normal. All 6 unresectable patients had DNA levels higher than normal. At initial follow-up, the plasma DNA levels remained higher than normal in 2 (10%) of 20 patients, and systemic disease was subsequently detected in each. Plasma DNA levels dropped lower than or remained normal in 18 (90%) of 20. In 14 of 18 patients, there was no evidence of recurrent disease at a median of 12 months (range, 3-20 months); in 4 patients, the plasma DNA level rose higher than normal on follow-up and all developed subsequent systemic disease on computed tomographic or positron emission tomographic scan. Six of the 20 patients developed systemic disease during the follow-up (2 had persistently elevated plasma DNA levels, and 4 developed elevated plasma DNA levels at subsequent follow-ups). In 4 of these 6 patients, elevated plasma DNA levels were detected prior to imaging evidence of disease.

CONCLUSIONS

Plasma DNA levels are significantly elevated in patients with esophageal cancer and following complete resection should return to normal. Persistently elevated plasma DNA levels after resection or levels that rise on follow-up indicate residual or recurrent disease.

Role of serum angiopoietin-2 level in screening for esophageal squamous cell cancer and its precursors

BACKGROUND

Angiopoietin-2 (Ang-2) is one of the critical regulators of tumor angiogenesis. Studies have shown a significant correlation of Ang-2 expression to tumor invasion and metastasis in various human cancers, but little is known about the serum Ang-2 (sAng-2) levels in esophageal squamous cell cancer (ESCC) and its precursors. In this study, we aimed to investigate its role in screening for ESCC and its precursors.

METHODS

We carried out a free endoscopic screening in Feicheng City, a high ESCC incidence area in Shandong Province of China. Serum samples were collected as follows: 91 from normal subjects, 44 from patients with esophagitis, 85 from patients with hyperplasia, and 13 from patients with early ESCC. In addition, 28 serum samples were obtained from patients with invasive ESCC undergoing surgery in People's Hospital of Feicheng City. All the subjects of the five groups were diagnosed by histopathology. The sAng-2 levels were tested and compared, and the diagnostic power in early or/and invasive ESCC was calculated in terms of sensitivity and other parameters.

RESULTS

The sAng-2 levels were (22.0 +/- 5.5), (21.3 +/- 3.2), (20.5 +/- 3.3), (24.0+/- 5.0), and (29.8 +/- 5.0) U/ml in normal, esophagitis, hyperplasia, early ESCC, and invasive ESCC groups respectively. It was significantly higher in early ESCC than inhyperplasia group (P = 0.009). The invasive ESCC group showed the highest Ang-2 level among all groups (all P = 0.000). The sensitivities of sAng-2 to early and invasive ESCC were 23.1% and 78.6% respectively.

CONCLUSION

sAng-2 level is related to carcinogenesis and progression of ESCC, but it can not be used to screen for early ESCC.

Pre-operative nutritional status does not alter the metabolic response to major gastrointestinal surgery in patients with oesophageal cancer

Malnutrition is associated with an increased incidence of perioperative morbidity and mortality. To evaluate the effect of malnutrition on the metabolic and inflammatory response to surgery in patients with oesophageal cancer, we studied the effects of oesophagectomy in six patients with major (13·9 (se 1·3) %) weight loss and five patients with minor (0·7 (se 0·6) %) weight loss in the 6 months before to surgery. Rates of appearance (Ra) of glucose, glycerol, leucine and urea were determined by stable isotopically labelled tracer infusion before and after surgery. C-reactive protein was measured as an inflammation marker. BMI was lower in the patients with major weight loss than those with minor weight loss (20·3 (se 0·7) and 24·9 (se 1·5) kg/m2, P = 0·02). With the exception of greater glucose Ra in the major weight loss than minor weight loss subjects (11·1 (se 0·3) v. 9·5 (se 0·3) μmol/kg per min, P = 0·01), there were no differences in substrate kinetics before surgery between groups. Surgery increased glucose Ra, leucine Ra and urea Ra by 41, 24 and 58 %, respectively, in the total group. Changes in substrate kinetics in response to surgery were not different between patients with major and minor weight loss. Surgery increased C-reactive protein concentrations to a comparable extent in both groups. In conclusion, major upper gastrointestinal tract surgery in patients with oesophageal cancer elicits a catabolic response, characterized by increased inflammation, glucose production and protein breakdown. However, this catabolic response does not seem to be influenced by pre-operative nutritional status.

Quantification of circulating plasma DNA fragments as tumor markers in patients with esophageal cancer

The quantity and quality of circulating DNA fragments was analyzed by quantitative real-time polymerase chain reactions (qPCR) in plasma from patients with esophageal carcinomas, in order to assess their diagnostic value.

PATIENTS AND METHODS

Plasma was collected preoperatively from 24 patients with esophageal cancer and 21 healthy controls. qPCR was performed using two primer sets for the beta-actin gene, amplifying short and long segments.

RESULTS

The DNA concentrations in both the short and long assays of esophageal cancer patients were significantly higher than the controls (p<0.001). The area under the receiver-operating characteristic curve was 0.83 (short) and 0.91 (long) for esophageal cancer patients versus the controls. There was also a significant difference in DNA integrity (short/long) between esophageal cancer patients and the control group (p= 0.001).

CONCLUSION

qPCR assays for plasma DNA concentrations and their integrity can serve as new diagnostic markers for screening and monitoring patients with esophageal cancer.

Prospective study of serum 25(OH)-vitamin D concentration and risk of oesophageal and gastric cancers

We prospectively examined the relation between pretrial serum vitamin D status and risk of oesophageal and gastric cancers among subjects who developed cancer over 5.25 years of follow-up, including 545 oesophageal squamous cell carcinomas (ESCC), 353 gastric cardia adenocarcinomas, 81 gastric noncardia adenocarcinomas, and an age- and sex-stratified random sample of 1105 subjects. The distribution of serum 25(OH)D was calculated using the known sampling weights. For the cohort as a whole, the 25th, 50th, and 75th percentile concentrations of 25(OH)-vitamin D were 19.6, 31.9, and 48.7 nmol l(-1), respectively, and we found that higher serum 25(OH)D concentrations were associated with monotonically increasing risk of ESCC in men, but not in women. Comparing men in the fourth quartile of serum 25(OH)D concentrations to those in the first, we found a hazard ratio (HR) (95% confidence interval (CI)) of 1.77 (1.16-2.70), P trend=0.0033. The same comparison in women had a HR (95% CI) of 1.06 (0.71-1.59), P trend=0.70. We found no associations for gastric cardia or noncardia adenocarcinoma. Among subjects with low vitamin D status, higher serum 25(OH)D concentrations were associated with significantly increased risk of ESCC in men, but not in women. Further refinements of the analysis did not suggest any factors, which could explain this unexpected result.

[Establishment of a diagnostic model of serum protein fingerprint pattern for esophageal cancer screening in high incidence area and its clinical value]

OBJECTIVE

To analyze the alterations of serum proteomic pattern in esophageal squamous cell carcinoma (ESCC) by SELDI-TOF-MS, to establish a diagnostic model of ESCC screening in high incidence area and investigate its clinical value.

METHODS

SELDI-TOF-MS and CM10 proteinChip were used to detect the serum proteomic patterns of 36 cases of ESCC and 38 healthy control subjects in high incidence area. The data were analyzed and a diagnostic model was established by using support vector machine (SVM). The diagnostic model was evaluated by leave-one-out cross validation.

RESULTS

At the molecular weight range of 2000 to 20,000, 31 protein peaks were significantly different between ESCC and controls (P < 0.01). A diagnostic model consisting of 4 protein peaks could do the best in diagnosis of ESCC and controls. The accuracy was 85.1%, sensitivity was 86.1%, specificity was 84.2%, and positive value was 83.8%.

CONCLUSION

The diagnostic model formed by 4 protein peaks, established in this study, can well distinguish ESCC from healthy subjects. It provides a new approach for ESCC screening in high incidence area.

[A dynamic observation on serum cytokine and immunoglobulin (IgG, IgA, IgM) in patients with esophageal cancer]

OBJECTIVE

To study the changes of serum interleukin-2 (IL-2), interleukin-8 (IL-8) and immunoglobulin (IgG, IgA, IgM) in patients with esophageal cancer, and to probe the relationship between the levels of IL-2, IL-8, IgG, IgA and IgM and the progress of cancer.

METHODS

The serum levels of IL-2 and IL-8 were detected by enzyme-linked immunosorbent assay for 72 case of primary esophageal cancer, 68 advanced esophageal cancer and 120 healthy controls, and the level of immunoglobulin (IgG, IgA, IgM) in patients with esophageal cancer was dynamically observed.

RESULTS

The IL-2 level in patients with early esophageal cancer [(1.69 +/- 0.53) ng/ml] or late esophageal cancer [(1.11 +/- 0.60) ng/ml] was lower than the control group [(2.78 +/- 0.51) ng/ml] (P < 0.01), the late esophageal cancer group was lower than early esophageal cancer group (P < 0.05). The level of IL-8 in patients with early esophageal cancer [(85.48 +/- 6.14) ng/L] or late esophageal cancer [(121.41 +/- 6.22) ng/L] was much higher than the control group [(54.48 +/- 12.20) ng/L] (P < 0.01), the late esophageal cancer group was much higher than early esophageal cancer group (P < 0.01); There was correlation between the levels of IL-2 and IL-8 and the worsen-extent of the tumour in patients with early esophageal cancer or late esophageal cancer. But the level of IgG [(12.23 +/- 2.50) g/L], IgM [(1.60 +/- 0.80) g/L] in the patients with esophageal cancer compared with the level of IgG [(11.65 +/- 3.70) g/L], IgM [(1.46 +/- 0.71) g/L] in the health control group have no significant difference (P > 0.05), the level of IgA [(3.50 +/- 1.10) g/L] in patients with esophageal cancer Compared with the control group [(1.88 +/- 1.08) g/L] has significant difference (P < 0.01), and along with the worsen-extent of the tumor in patients the level of IgA has the increased tendency.

CONCLUSION

The IL-8 might accelerate the pathogenesis of esophageal cancer, and the IL-2 might restrain. The positive correlation between the level of IgA and the patients with esophageal cancer is observed in this study; the immune maladjustment of IL-2, IL-8 and IgA might be correlative to esophageal cancer, and the IL-2, IL-8 and IgA levels might be an available index for the severity of esophageal cancer, Which may be of some help for clinic practitioners to judge the progress, curative effect and prognosis of the cancer.

Reduced expression of human DNA repair genes in esophageal squamous-cell carcinoma in china

Epidemiological studies indicated that the incidence of esophageal squamous-cell carcinoma (ESCC) is associated with exposure to a variety of environmental factors. To determine whether the baseline expression of genes involved in DNA damage and repair induced by these carcinogens is associated with higher risk for ESCC, a case-control study was undertaken and the relative expression levels of six DNA repair genes (MGMT, hOGG1, XRCC1, XPD, hMLH1, and hMSH2) were determined in peripheral blood mononuclear cells (PBMC). One hundred patients with newly diagnosed, untreated ESCC and 117 healthy controls matched for age, gender, and residence were recruited. Expression levels of six genes were measured by quantitative real-time reverse-transcription polymerase chain reaction (RT-PCR). Compared with controls, the relative expression levels of hMLH1, hMSH2, XRCC1, XPD, and MGMT, were significantly altered in ESCC patients. Using the median of relative expression level in controls as the cutoff point, results also demonstrated an increased risk for ESCC associated with reduced expression of hMSH2, XRCC, XPD, and MGMT. The expression levels of four genes (hMSH2, XRCC1, XPD, MGMT) present in PBMC were significantly correlated with increased risk for ESCC, in which there was reduced expression of MGMT, suggesting an important etiology role for MGMT expression in the initiation of ESCC in Huaian of China.

Serum ghrelin levels and risk of subsequent adenocarcinoma of the esophagus

OBJECTIVE

Several large studies have shown a negative association between Helicobacter pylori (H. pylori) infection and esophageal adenocarcinoma. Diminution of gastric ghrelin secretion by H. pylori could protect against esophageal malignancy by decreasing appetite, food intake, and acid production, thereby decreasing weight and gastroesophageal reflux.

METHODS

We evaluated the association of ghrelin with esophageal adenocarcinoma using a population from a previous nested case-control study. Among 128,992 enrolled in a multiphasic health checkup (MHC) between 1964 and 1969, 52 patients developed esophageal adenocarcinoma by the year 2000. Three random controls from the MHC cohort were matched to each case by age, sex, race, and the date and site of their MHC. Serum samples collected at the MHC had been previously tested for IgG antibodies against H. pylori and the CagA protein. Serum ghrelin concentrations were determined by a commercial EIA on 52% of the initial subjects (31 cases and 79 controls).

RESULTS

A concentration of ghrelin greater than 3,200 pg/mL at MHC (fourth quartile) was associated with a lower risk of esophageal cancer (H. pylori and body mass index [BMI] adjusted OR=0.18 [CI 0.04-0.78]). This inverse association was seen only in overweight subjects (BMI>or=25, P value for interaction=0.09). The effects of H. pylori and ghrelin were independent.

CONCLUSION

Contrary to the original hypothesis, high rather than low serum ghrelin was associated with protection against esophageal adenocarcinoma but only among overweight subjects.

Clinical usefulness of CYFRA 21-1 for esophageal squamous cell carcinoma in radiation therapy

AIM

The aim of this study was to examine the clinical usefulness of cytokeratin 19 fragments (CYFRA 21-1) compared with squamous cell carcinoma (SCC) antigen in patients with esophageal cancer treated with radiation therapy.

METHODS

Fifty-one patients with stage I-IV esophageal cancer were evaluated. CYFRA 21-1 and SCC antigen serum levels were measured at the start and the end of radiation therapy.

RESULTS

CYFRA 21-1 (> 3.5 ng/mL) and SCC antigen (> 1.5 ng/mL) before radiation therapy were elevated in 63% and 53% of the patients, respectively. The CYFRA 21-1 levels were significantly correlated with TNM stages, tumor depth and lymph node metastasis (P = 0.0003, P = 0.019 and P = 0.019, respectively), whereas no correlation was observed between SCC antigen and these factors. The values of CYFRA 21-1 in all patients who survived without recurrence were under the cutoff level at the end of treatment, but the values in all patients with locoregional recurrence were above the level. However, there was no significant correlation between SCC antigen level at the end of treatment and any clinical outcome.

CONCLUSIONS

The results suggest that the evaluation of CYFRA 21-1 would be useful not only for assessment before radiation therapy but also for monitoring after radiation therapy in the treatment for esophageal cancer.

[Serum level and genotype of interleukin-6 in patients with esophageal cancer]

OBJECTIVE

To investigate the polymorphism of the interleukin-6 (IL-6) gene promoter-572C/G and -634C/G in patients with esophageal cancer, and to study the relation between the serum level and genotype of interleukin-6 and esophageal cancer.

METHODS

Peripheral blood samples were collected from 118 patients with esophageal cancer and 130 healthy persons as controls. The polymorphism of IL-6 was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The serum level of IL-6 was determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The frequency of the genotype GG of the IL-6 (-634) site in the cancer group was 12.7%, significantly higher that that of the control group (3.8%, P<0.05). The risk of esophageal cancer of the G allele carriers was 1.759 times that of the C allele carriers (OR=1.759, 95% CI=1.150-2.691). The serum level of IL-6 of the esophageal cancer group was (16.9+/-5.3) ng/L, significantly higher than that of the control group [(4.6+/-2.6) ng/L, P<0.01]. The serum level of IL-6 of the esophageal cancer with the G allele carriers was (18.8+/-6.1) ng/L, significantly higher than that of the esophageal cancer without the G allele carriers [(13.2+/-6.0) ng/L, P<0.01]. There was no significant difference in the distribution of the IL-6 gene-572C/G polymorphism between the 2 groups (P>0.05).

CONCLUSION

IL-6 gene-634C/G polymorphism is associated with the esophageal cancer. The IL-6 allele G carriers may be at increased risk of the esophageal cancer because of the increase of the IL-6 expression.

Dikkopf-1 as a novel serologic and prognostic biomarker for lung and esophageal carcinomas

Gene expression profile analysis of lung and esophageal carcinomas revealed that Dikkopf-1 (DKK1) was highly transactivated in the great majority of lung cancers and esophageal squamous cell carcinomas (ESCC). Immunohistochemical staining using tumor tissue microarrays consisting of 279 archived non-small cell lung cancers (NSCLC) and 280 ESCC specimens showed that a high level of DKK1 expression was associated with poor prognosis of patients with NSCLC as well as ESCC, and multivariate analysis confirmed its independent prognostic value for NSCLC. In addition, we identified that exogenous expression of DKK1 increased the migratory activity of mammalian cells, suggesting that DKK1 may play a significant role in progression of human cancer. We established an ELISA system to measure serum levels of DKK1 and found that serum DKK1 levels were significantly higher in lung and esophageal cancer patients than in healthy controls. The proportion of the DKK1-positive cases was 126 of 180 (70.0%) NSCLC, 59 of 85 (69.4%) SCLC, and 51 of 81 (63.0%) ESCC patients, whereas only 10 of 207 (4.8%) healthy volunteers were falsely diagnosed as positive. A combined ELISA assays for both DKK1 and carcinoembryonic antigen increased sensitivity and classified 82.2% of the NSCLC patients as positive whereas only 7.7% of healthy volunteers were falsely diagnosed to be positive. The use of both DKK1 and ProGRP increased sensitivity to detect SCLCs up to 89.4%, whereas false-positive rate in healthy donors was only 6.3%. Our data imply that DKK1 should be useful as a novel diagnostic/prognostic biomarker in clinic and probably as a therapeutic target for lung and esophageal cancer.