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Liu H, Li K, Xia J, Zhu J, Cheng Y, Zhang X, Ye H, Wang P. Prediction of esophageal cancer risk based on genetic variants and environmental risk factors in Chinese population. BMC Cancer 2024; 24:598. [PMID: 38755535 PMCID: PMC11100074 DOI: 10.1186/s12885-024-12370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Results regarding whether it is essential to incorporate genetic variants into risk prediction models for esophageal cancer (EC) are inconsistent due to the different genetic backgrounds of the populations studied. We aimed to identify single-nucleotide polymorphisms (SNPs) associated with EC among the Chinese population and to evaluate the performance of genetic and non-genetic factors in a risk model for developing EC. METHODS A meta-analysis was performed to systematically identify potential SNPs, which were further verified by a case-control study. Three risk models were developed: a genetic model with weighted genetic risk score (wGRS) based on promising SNPs, a non-genetic model with environmental risk factors, and a combined model including both genetic and non-genetic factors. The discrimination ability of the models was compared using the area under the receiver operating characteristic curve (AUC) and the net reclassification index (NRI). The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to assess the goodness-of-fit of the models. RESULTS Five promising SNPs were ultimately utilized to calculate the wGRS. Individuals in the highest quartile of the wGRS had a 4.93-fold (95% confidence interval [CI]: 2.59 to 9.38) increased risk of EC compared with those in the lowest quartile. The genetic or non-genetic model identified EC patients with AUCs ranging from 0.618 to 0.650. The combined model had an AUC of 0.707 (95% CI: 0.669 to 0.743) and was the best-fitting model (AIC = 750.55, BIC = 759.34). The NRI improved when the wGRS was added to the risk model with non-genetic factors only (NRI = 0.082, P = 0.037). CONCLUSIONS Among the three risk models for EC, the combined model showed optimal predictive performance and can help to identify individuals at risk of EC for tailored preventive measures.
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Affiliation(s)
- Haiyan Liu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou City, 450001, Henan Province, China
- Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Keming Li
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou City, 450042, Henan Province, China
| | - Junfen Xia
- Office of Health Care, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Jicun Zhu
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Yifan Cheng
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou City, 450001, Henan Province, China
- Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Xiaoyue Zhang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou City, 450001, Henan Province, China
- Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Hua Ye
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou City, 450001, Henan Province, China
- Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou City, 450052, Henan Province, China
| | - Peng Wang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou City, 450001, Henan Province, China.
- Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou City, 450052, Henan Province, China.
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Ke RT, Hsiao YH, Tai WC, Li SH, Yao CC, Chuang KH, Lai HH, Chen Y, Chen LC, Lu HI, Chen YH, Lo CM. Similar survival after endoscopic submucosal dissection and esophagectomy in early esophageal cancer and synchronous or metachronous head and neck cancer. J Cardiothorac Surg 2024; 19:52. [PMID: 38311758 PMCID: PMC10840295 DOI: 10.1186/s13019-024-02514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Early-stage esophageal cancer is treated using endoscopic submucosal dissection and esophagectomy. Field cancerization in patients with early-stage esophageal cancer affects treatment outcomes and causes synchronous or metachronous head and neck cancers. We hypothesized that esophagectomy could provide better overall and relapse-free survivals in patients with esophageal cancer and synchronous or metachronous head and neck cancer. METHODS We retrospectively identified patients with early esophageal squamous cell carcinoma and synchronous or metachronous head and neck cancers. We separated the patients into endoscopic submucosal dissection and esophagectomy groups to compare overall and relapse-free survivals. RESULTS The study included 106 patients, 25 of whom underwent endoscopic submucosal dissection and 81 underwent esophagectomy. Overall and relapse-free survivals did not show significant differences between the two groups for both synchronous and metachronous head and neck cancers. CONCLUSIONS Endoscopic submucosal dissection could provide similar overall and relapse-free survivals in patients with esophageal cancer and synchronous or metachronous head and neck cancer.
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Affiliation(s)
- Ruei-Ti Ke
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Yu-Hsin Hsiao
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Department of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Department of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kai-Hao Chuang
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Hsing-Hua Lai
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Yu Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Li-Chun Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan.
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Stawinski PM, Dziadkowiec KN, Kuo LA, Echavarria J, Saligram S. Barrett's Esophagus: An Updated Review. Diagnostics (Basel) 2023; 13:diagnostics13020321. [PMID: 36673131 PMCID: PMC9858189 DOI: 10.3390/diagnostics13020321] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
Barrett’s esophagus (BE) is a change in the distal esophageal mucosal lining, whereby metaplastic columnar epithelium replaces squamous epithelium of the esophagus. This change represents a pre-malignant mucosal transformation which has a known association with the development of esophageal adenocarcinoma. Gastroesophageal reflux disease is a risk factor for BE, other risk factors include patients who are Caucasian, age > 50 years, central obesity, tobacco use, history of peptic stricture and erosive gastritis. Screening for BE remains selective based on risk factors, a screening program in the general population is not routinely recommended. Diagnosis of BE is established with a combination of endoscopic recognition, targeted biopsies, and histologic confirmation of columnar metaplasia. We aim to provide a comprehensive review of the epidemiology, pathogenesis, screening and advanced techniques of detecting and eradicating Barrett’s esophagus.
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Ren LH, Zhu Y, Chen R, Shrestha Sachin M, Lu Q, Xie WH, Lu T, Wei XY, Shi RH. Endoscopic debulking resection with additive chemoradiotherapy: Optimal management of advanced inoperable esophageal squamous cell carcinoma. World J Gastrointest Oncol 2022; 14:1758-1770. [PMID: 36187386 PMCID: PMC9516645 DOI: 10.4251/wjgo.v14.i9.1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/22/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is no remedial strategy other than definitive chemoradiotherapy for patients with advanced esophageal squamous cell carcinoma (ESCC) who are not eligible to undergo surgical treatment.
AIM To introduce a novel therapy called endoscopic debulking resection (EdR) followed by additive chemoradiotherapy (CRT) and evaluate its efficacy and safety.
METHODS Advanced, inoperable ESCC patients between 1 January 2015 and 30 December 2019 were investigated retrospectively. Patients who received EdR followed by CRT were deemed the EdR + CRT group and those without CRT were deemed the EdR group. Overall survival (OS), progression-free survival (PFS), and adverse events were evaluated.
RESULTS A total of 41 patients were enrolled. At a median follow-up of 36 mo (range: 1-83), the estimated 1-, 2-, and 3-year cumulative OS rates of patients who underwent EdR plus additive CRT were 92.6%, 85.2%, and 79.5%, respectively, which were higher than those of patients who underwent EdR alone (1-year OS, 83.3%; 2-year OS, 58.3%; 3-year OS, 50%; P = 0.05). The estimated 2-year cumulative PFS rate after EdR + CRT was 85.7%, while it was 61.5% after EdR (P = 0.043). According to the univariate and multivariate Cox regression analyses, early clinical stage (stage ≤ IIB) and additive CRT were potential protective factors for cumulative OS. No severe adverse events were observed during the EdR procedure, and only mild to moderate myelosuppression and radiation pneumonia were observed in patients who underwent additive CRT after EdR.
CONCLUSION EdR plus CRT is an alternative strategy for selective advanced inoperable ESCC patients.
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Affiliation(s)
- Li-Hua Ren
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ye Zhu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Rong Chen
- Department of Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Mulmi Shrestha Sachin
- Department of Gastroenterology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Qin Lu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Wei-Hua Xie
- Quality Management, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Tong Lu
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Xiao-Ying Wei
- Department of Pathology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Rui-Hua Shi
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
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Abula G, Song WX, Liu H, Ren XF, Chen X. Prediction model for selection of adjuvant therapy population after endoscopic submucosal dissection for early esophageal lesions. Shijie Huaren Xiaohua Zazhi 2022; 30:587-598. [DOI: 10.11569/wcjd.v30.i13.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic treatment is the first choice for early esophageal lesions without obvious metastasis or infiltration, especially endoscopic submucosal dissection (ESD). However, the occurrence of non-curative resection, recurrence, or metastasis after ESD is inevitable, which may require adjuvant therapy such as additional surgery or chemora-diotherapy.
AIM To analyze the risk factors for additional surgery or chemora-diotherapy after ESD for early esophageal lesions, and explore the effect of curative resection on additional adjuvant therapy.
METHODS Patients who underwent ESD for stage T1 esophageal cancer (EC) and precancerous lesions were analyzed retrospectively. Postoperative recurrence, metastasis, and adjuvant treatment were followed, and a prediction model for adjuvant treatment population selection was established.
RESULTS Non-curative resection was correlated with patient age, proportion of lesions, and microscopic size(P < 0.05), among which the proportion of lesions > 2/3 (odds ratio [OR] = 7.958, P = 0.007) was an independent risk factor. Two of curative and ten of non-curative resection cases received additional treatment, indicating that further treatment after ESD might be required regardless of whether curative resection was performed. Patient age, proportion of lesions, lesion lifting, differentiation, vascular invasion, and tumor invasion depth were correlated with the need for further treatment (P < 0.05). Age ≥ 70 years (OR = 4.210, P = 0.049), poor lifting (OR = 18.171, P = 0.047), and depth of tumor up to SM2 (OR = 38.781, P = 0.012) were independent risk factors. The AUC of the nomogram model was 0.864 (95%CI: 0.766-0.962); the specificity and sensitivity were 95.8% and 75.0%, respectively. Calibration curve analysis, decision curve analysis, and Hosmer and Lemeshow test (χ2 = 1.5954, P = 0.991) showed that the predictive value of the model was acceptable.
CONCLUSION For patients with stage T1 EC and precancerous lesions, whether further surgery or chemoradiotherapy is needed after ESD should be comprehensively considered.
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Affiliation(s)
- Gulisitan Abula
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen-Xuan Song
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hang Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiang-Feng Ren
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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