Carcinogenic potential of the noncancerous epithelium in patients with oesophageal cancer

Prognostic significance of the MIB-1 proliferation index for patients with squamous cell carcinoma of the esophagus

BACKGROUND

A number of studies have indicated that the ki-67 proliferation index is of important prognostic significance for a variety of neoplasias. It was the aim of this study to investigate whether any correlation exits between the MIB-1 proliferation index and various clinicopathologic parameters in squamous cell carcinomas of the esophagus from 72 patients (20 women: median age, 64 years; range, 45-79 years; and 52 men: median age, 61 years; range, 43-77 years).

METHODS

Proliferative activity was determined using an immunohistochemical method with monoclonal antibody MIB-1 (ABC method), for tumor samples obtained from individuals who underwent esophagectomy in the period from 1983 to 1991. The percentage proliferation index (PI) was calculated as the number of positive cells divided by the total number of cells examined. Thirty-nine patients (54%) died of recurrence of esophageal cancer, with a median survival span of 15 months (range, 1-58 months). Thirty-three patients (46%) were still alive at the time of this study; their median follow up was 57 months (range, 40-98 months).

RESULTS

Significant differences between proliferative index values were recorded for the following parameters: survival rate, P < 0.0001; presence of lymph node metastasis, P < 0.05; size of the primary esophageal lesion, P < 0.01; proliferation pattern of the tumor, P < 0.01; and age of the patients, P < 0.05. No correlation was found regarding histologic differentiation, clinical stage, location of the lesion, intraepithelial cancerous spread, lymphatic and blood vessel invasion, and sex of the patients.

CONCLUSION

The MIB-1 proliferation index may be a powerful prognostic marker for patients with squamous cell carcinomas of the esophagus.

Prevalence and clinicopathologic features of multiple squamous cell carcinoma of the esophagus

BACKGROUND

The occurrence of independent synchronous esophageal carcinoma in patients with grossly invasive esophageal cancer (GEC) is well known. Although multiple primary carcinoma of the esophagus is not uncommon, the exact prevalence is controversial, and its clinicopathologic features remain relatively unknown.

METHODS

Fifty-four patients with squamous cell GEC who underwent transthoracic esophagectomy with systematic lymphadenectomy between 1987 and 1991 at the Institute for Digestive Diseases, Belgrade University Clinical Center, were included in the study.

RESULTS

Detailed histopathologic examination of the esophagus resected for squamous cell carcinoma was performed in 54 patients and revealed 17 patients (31%) with associated cancer independent of the main tumor. The second lesion was significantly less invasive than the main tumor. There was no significant difference (P = 0.06) in sex, age, main tumor site, tumor differentiation, tumor diameter, lymph node involvement, or tumor stage between patients with multiple cancer and patients with solitary cancer, but there was a significant difference in the depth of invasion (P < 0.01). The tumor stage in patients with multiple cancer was determined by the main tumor stage and was not influenced by the associated lesion. The prevalence of multiple primary cancer of the esophagus is lower in other reports than in this series.

CONCLUSIONS

The patients in this study had significantly more invasive main tumors. It seems likely that a higher prevalence of multiple cancer may be expected in patients with advanced main tumor penetration. These results support the concept that the entire esophagus may be considered as one entity of field cancerogenesis.

Esophageal cancer associated with multiple cancerous lesions: clinicopathologic comparisons between multiple primary and intramural metastatic lesions

Detailed histopathological examination of serial blocks and subserial sections of the entire resected esophagus in 111 patients who underwent esophagectomy for esophageal squamous cell carcinoma revealed 38 associated cancerous lesions apart from the main tumors, in 33 patients (29.7%). These associated lesions were divided into multiple primary lesions (MPLs; 27 lesions in 23 patients) and intramural metastatic lesions (IMLs; 11 lesions in 10 patients). Thirteen and fourteen MPLs were distributed on the proximal and distal sides, respectively, of the main tumor with the same mean distance of 2.6 cm. Three and 8 IMLs were located on the proximal and distal sides, respectively, with mean distances of 3.4 cm and 4.6 cm. With respect to the histological depth of cancer invasion, MPLs were all confined within the submucosal layer (superficial cancer) while IMLs varied from the submucosa to the adventitia. Histological findings indicate that MPLs may be associated with a possible increased multicentric carcinogenic potential in the non-cancerous epithelium of the esophagus of patients who have had an antecedent esophageal cancer, and that IMLs are developed by intramural lymphatic spread from the primary esophageal cancer. These results emphasize the need for careful attention to the choice of margins during the surgical resection of the esophagus.

Possible association between gastrectomy and subsequent development of esophageal cancer

To clarify the possible association between gastrectomy and the subsequent development of esophageal cancer, we studied the incidence of subjective gastroesophageal reflux in 287 patients and analyzed the nutritional status and results of endoscopic examination of the esophagus in 62 patients who had survived for a long period after gastrectomy for nonmalignant diseases. The incidence of postoperative reflux was 22.6%. None of the patients had severe deterioration of blood parameters or nutritional status. Endoscopic observation revealed esophagitis in 24.2% of patients, mainly in the lower esophagus. Histologically, there was a high incidence of infiltration of neutrophils and lymphocytes, enlarged papillae, and basal cell hyperplasia. Epithelial dysplasia was detected in 41.9% of patients, and of these there were more patients in whom the degree of dysplasia was more severe in the lower esophagus than in other areas. These data suggest that postgastrectomy gastroesophageal reflux is more likely than postgastrectomy changes in nutritional status to be a possible contributory factor to the development of subsequent esophageal cancer.

Resection of carcinoma in the cervical esophagus following prior removal of a thoracic esophageal carcinoma--a case report

We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking another lesion, especially in the cervical portion of the esophagus is imperative.