Modern surgery for esophageal cancer

Cytokine-induced killer cells/dendritic cells and cytokine-induced killer cells immunotherapy for the treatment of esophageal cancer: A meta-analysis

OBJECTIVES

This meta-analysis was designed to systematically evaluate whether autologous cytokine-induced killer cells (CIK) or dendritic cells and cytokine-induced killer cells (DC-CIK) immunotherapy combined with chemotherapy can improve the therapeutic effect and safety of chemotherapy in esophageal cancer (EC).

MATERIALS AND METHODS

Randomized controlled trials (RCTs) were electronically searched databases including CNKI, WanFang, WeiPu, CBMDisc, PubMed, Web of Science, EMbase, the Cochrane Library, and Clinical Trials. The databases were searched for articles published until June 2019. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included literature. Meta-analysis was performed using RevMan5.3.

RESULTS

Seventeen studies (1416 participants) were included. The differences between CIK/DC-CIK combination chemotherapy and chemotherapy alone were significant. The results displayed that the number of CD3+, CD4+, CD4+/CD8+, and NK cells was significantly increased after 1 to 2 weeks of treatment with CIK/DC-CIK cells in the treatment group (all P < .05). In addition, the results shown that 1-year overall survival was significantly prolonged (P < .0001) and quality of life was improved (P = .001) in EC chemotherapy combined with immunotherapy groups compared with conventional treatment. Furthermore, cytokine expression levels of interleukin 2 (IL-2), tumor necrosis factor α (TNF-α), and interleukin 12 (IL-12) were significantly increased (P = .0003) as well as the levels of immunoglobulins were elevated (P < .00001). Serum levels of tumor marker molecules, carcinoembryonic antigen (CEA), carbohydrate antigen (CA)-199, and CA-125 were lower in treatment groups than that of control groups (P < .00001). No fatal adverse reactions were noted (P = .04).

CONCLUSIONS

It is safe and effective for patients to use chemotherapy combined with CIK/DC-CIK immunotherapy. Immunotherapy can simultaneously improve the antitumor immune response. Specifically, DC-CIK cells can increase T lymphocyte subsets, CIK cells, NK cells, and immunoglobulins in peripheral blood to enhance antitumor immunity. Therefore, combination therapy enhances the immune function and improves the therapeutic efficacy of patients with EC.

Defining cure for esophageal cancer: analysis of actual 5-year survivors following esophagectomy

BACKGROUND

Esophagectomy is the mainstay of curative treatment for localized esophageal cancer. However, what constitutes cure is not well defined. This study was undertaken to characterize actual 5-year survivors following esophagectomy and to determine prognostic factors for disease-specific survival (DSS) from 60 months.

MATERIALS AND METHODS

Between 1987 and 2004, 398 consecutive patients underwent esophagectomy and had potential for 5 years follow-up. Clinicopathological factors associated with DSS from 5 years onward were analyzed.

RESULTS

Median DSS was 25 months. Neoadjuvant therapy was administered to 159 of 398 (40%). There were 114 of 398 (29%) actual 5-year survivors. On multivariate analysis, 5-year survivors were significantly more likely to have lower T classification, N classification, and R0 resections compared with patients who died less than 5 years after surgery. There were 66 of 398 patients (17%) with positive margins, and 6 of these were 5-year survivors. Of the 114 5-year survivors, 17 (15%) subsequently died of esophageal cancer. Prognostic factors for DSS after surviving 5 years were age and T classification for patients treated with neoadjuvant therapy and surgery alone, respectively. Powerful prognostic factors from time of treatment, including nodal status, were no longer prognostic factors after surviving to 5 years.

CONCLUSIONS

No single clinicopathological variable negated survival to 5 years. Prognostication once surviving 5 years is difficult. The majority of 5-year survivors can be considered cured of esophageal cancer.

A cost and benefit study of esophagectomy for patients with esophageal cancer

INTRODUCTION

The incidence of esophageal cancer is increasing all over the world but the cost-and-benefit of esophagectomy for esophageal cancer patients was rarely studied. The aim of this study is to compare the cost-and-benefit of esophagectomy in different stages of esophageal cancer.

MATERIALS AND METHODS

Clinical and utilization data, including medical expenses and reason for treatment, of esophageal cancer patients were collected, summed and followed up for 5 years. The patients were divided into two groups according to their treatments, with or without esophagectomy. The monthly medical expense and relative expense performance index (REPI) were then calculated. Factors influenced total and monthly medical expense and survival time were further analyzed.

RESULTS

A total of 310 esophageal cancer patients, 281 male and mean age of 64.3, were included in this study. One hundred forty-nine patients had undergone esophagectomy. The 5-year survival rate, total and monthly medical expense for two groups was 36.0% and 10.2% (p<0.001), USD $22,532.8 vs. 12,256.4 (p<0.001) and USD $2,101.65 vs. 2,033.94 (p=0.831), respectively. The REPIs in four different stages were 7.573, 2.422, 2.446 and 0.705. Both esophagectomy and tumor stage were the sole factors that could influence total and monthly medical expense respectively. Both esophagectomy and tumor stage could influence a patient's survival time.

CONCLUSIONS

Esophagectomy has better performance than non-esophagectomy for patients with stages I to III esophageal cancer. Therefore, adding economical considerations, esophagectomy is recommended for patients, at least earlier than stage III.