Prevention and management of early esophageal cancer

The Importance of Concurrent Chemotherapy for T1 Esophageal Cancer: Role of FDG-PET/CT for Local Control

AIM

To evaluate whether patients with T1 esophageal squamous cell carcinoma receiving definitive radiotherapy can be managed without concurrent chemotherapy, and the role of 18F-fluorodeoxyglucose positron-emission tomography with computed tomography (FDG-PET/CT) in demonstrating local control (LC).

PATIENTS AND METHODS

Twenty-four out of 37 patients with newly-diagnosed T1 EC treated with definitive radiotherapy between July 2009 and July 2016 were retrospectively analyzed. FDG-PET/CT was performed before treatment. Eleven patients were assigned to a concurrent chemoradiotherapy (CRT) group. Thirteen were placed in a no-CRT group. The two groups were compared and univariate analysis of clinical factors influencing the prognosis in each group was conducted.

RESULTS

Mean radiotherapy doses were 59.2 Gy in the no-CRT group and 55.5 Gy in the CRT group (p=0.025). Overall survival, disease-free survival, and LC rates at 2 years were lower in the no-CRT group compared to the CRT group. Disease-free survival and LC rates at 2 years were significantly lower in the patients with FDG-avid primary tumor in the no-CRT group (p=0.002 and p=0.002, respectively). All patients with FDG-avid primary tumors in the no-CRT group developed local recurrence.

CONCLUSION

It is important to note that all patients with FDG-avid primary tumor in the no-CRT group developed local recurrence. This would suggest that concurrent chemotherapy is an integral part of disease management in patients with T1 esophageal squamous cell carcinoma.

Marsdenia tenacissima extract induces G0/G1 cell cycle arrest in human esophageal carcinoma cells by inhibiting mitogen-activated protein kinase (MAPK) signaling pathway

Marsdenia tenacissima extract (MTE, trade name: Xiao-Ai-Ping injection) is an extract of a single Chinese plant medicine. It has been used for the treatment of cancer in China for decades, especially for esophageal cancer and other cancers in the digestive tract. In the present study, the potential mechanism for MTE's activity in esophageal cancer was explored. The effects of MTE on the proliferation of human esophageal cancer cells (KYSE150 and Eca-109) were investigated by the MTT assay, the BrdU (bromodeoxyuridine) incorporation immunofluorescence assay, and flow cytometric analysis. MTE inhibited cell proliferation through inducing G0/G1 cell cycle arrest in KYSE150 and Eca-109. Western blot analysis was employed to determine protein levels in the MTE treated cells. Compared with the control cells, the expression levels of the cell cycle regulatory proteins cyclin D1/D2/D3, cyclin E1, CDK2/4/6 (CDK: cyclin dependent kinase), and p-Rb were decreased significantly in the cells treated with MTE at 40 mg·mL(-1). In addition, MTE had an inhibitory effect on the MAPK (mitogen-activated protein kinase) signal transduction pathway, including ERK (extracellular signal-regulated kinase), JNK (c-Jun N-terminal kinase), and p38MAPK. Moreover, MTE showed little additional effects on the regulation of cyclin D1/D3, CDK4/6, and p-Rb when the ERK pathway was already inhibited by the specific ERK inhibitor U0126. In conclusion, these data suggest that MTE inhibits human esophageal cancer cell proliferation through regulation of cell cycle regulatory proteins and the MAPK signaling pathways, which is probably mediated by the inhibition of ERK activation.

MicroRNA-17, microRNA-18a, and microRNA-19a are prognostic indicators in esophageal squamous cell carcinoma

BACKGROUND

The members of the microRNA (miR)-17-92 cluster have been reported to be highly expressed in several cancers. However, whether their expression is associated with clinicopathologic factors, the prognosis of patients in esophageal squamous cell carcinoma (ESCC) remains unknown.

METHODS

Using SYBR green real-time quantitative reverse transcription polymerase chain reaction, we detected the expression of members of the miR-17-92 cluster, including miR-17, miR-18a, miR-19a, miR-20a, miR-19b, and miR-92a, in 105 surgical specimens from ESCC patients. We then investigated their impact on clinicopathologic factors and survival.

RESULTS

All six members of the miR-17-92 cluster had a significantly higher level of expression in the 105 ESCC tissue specimens than in normal esophageal mucosa (p < 0.05). The miR-18a expression positively correlated with tumor stage (p = 0.025). Meanwhile, miR-92a expression positively correlated with clinical stage (p = 0.022), and miR-19b expression positively correlated with tumor size (p = 0.005), lymph node metastasis (p = 0.040), and clinical stage (p = 0.011). The overexpression of miR-17a was correlated positively with lymph node metastasis (p = 0.035) and clinical stage (p = 0.022). MiR-18a, miR-17, and miR-19a were prognostic indicators for progression-free survival and overall survival. both in univariate analysis and in multivariate analysis.

CONCLUSIONS

This study suggests that miR-17, miR-18a, and miR-19a can serve as potential unfavorable prognostic biomarkers in ESCC which are associated with some clinicopathologic factors. However, the regulatory pathway associated with potential candidate miRNAs remains to be explored.

Surgical treatment for early esophageal squamous cell carcinoma

More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC, evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affecting lymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwent transthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed. The χ(2) test or Fisher's exact test were used to detect factors related to lymph node metastasis. Univariate and multivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females with a median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining 20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computed tomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients with carcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumours and 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph node metastases in the follow-up. The 5- and 10-year overall survival rates were 81.4% and 70.1%, respectively. Only histologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph node metastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independent prognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade and pT category affected the presence of lymph node metastases and were independent prognostic factors for early ESCC.

Clinical effective analysis of chemo-radiotherapy for esophageal carcinoma patients with dietary and lifestyle factors of high and low risk

AIM: To study the clinical effects of chemo-radiotherapy for esophageal carcinoma patients with dietary and lifestyle factors of high risk.

METHODS: In a nested case-control study, data for esophageal carcinoma potential determinants from a survey that conducted on 496 patients in Wanzhou district of Chongqing municipality was analyzed. The classification tree model was constructed using exhaustice chi-square automatic interactiong detection method. The clinical effects of chemo-radiotherapy for esophageal carcinoma patients were observed.

RESULTS: In 7 out of the 15 risk factors selected, water pollution and fast eating were the most important factors. Furthermore, esophageal carcinoma was more frequent among smokers and fast eaters in alcohol drinkers. There were more survival benefits for esophageal carcinoma patients with high risk dietary and lifestyle factors (the median survival time, 21 month) relative to low risk patients (14 month) followed by chemo-radiotherapy. Significant difference was found between two groups (t = 15.87, P < 0.01).

CONCLUSION: It is possible that water pollution, and poor dietary and lifestyle factors such as hot-temperature food items and fast eating, smoking and alcohol drinking were the main risk factors for esophageal carcinoma of Wanzhou region. Chemo-radiotherapy has more clinical benefits for esophageal carcinoma patients with diet habits and lifestyle factors of high risk.