Future Directions in Improving Outcomes for Patients with Gastric and Esophageal Cancer

Tumor budding is associated with poor prognosis and clinicopathologic factors in esophageal carcinoma: A meta-analysis

BACKGROUND AND OBJECTIVE

Tumor budding is associated with the prognosis of several solid cancers, but further evidence is needed to identify its relation with esophageal cancer. Our study aims to assess the relationship between tumor budding and overall survival, disease-free survival, and clinicopathologic variables in EC.

METHODS

Multiple electronic databases were searched and 20 relevant studies containing 3370 patients were identified. The fixed effects and a random-effects model were used to perform a meta-analysis.

RESULT

Tumor budding was associated with poor overall survival in EC in both univariate analyses (HR:2.63; 95 % CI 2.06-3.38; p < 0.001) and multivariate analysis (HR: 2.00; 95 % CI 1.68 to 2.39; P < 0.001). Tumor budding was also associated with poor overall survival in subtypes of EC in subgroup analyses i.e. ESCC (HR:3.26; 95 % CI 2.48 to 4.29; P < 0.001), and EAC (HR:2.00; 95 % CI 1.36 to 2.95; P < 0.001) in univariate analysis and ESCC (HR: 2.95; 95 % CI 2.18 to 3.99; P < 0.001) and EAC (HR: 1.65; 95 % CI 1.33 to 2.04; P < 0.001) in multivariate analyses. In addition, tumor budding was also associated with poor DFS (HR: 3.39; 95 % CI 2.1 to 5.48; P < 0.001). Furthermore, tumor budding was associated with poor clinicopathologic factors like advanced T-stage, lymph node metastasis, lymphatic invasion, and venous invasion.

CONCLUSION

The findings of our study suggest that tumor budding is a promising independent prognostic factor and is correlated with poor clinicopathologic variables of esophageal carcinoma. The inclusion of tumor budding in future grading systems may help in improving currently available staging systems of esophageal carcinoma.

The prognostic value of separate lymphatic invasion and vascular invasion in oesophageal squamous cell carcinoma: a meta-analysis and systematic review

BACKGROUND

Lymphovascular invasion (LVI) is a factor correlated with a poor prognosis in oesophageal squamous cell carcinoma (ESCC). Lymphatic invasion (LI) and vascular invasion (VI) should be reported separately because they may indicate a difference in prognosis. The prognostic role of LI and VI in ESCC patients remains controversial. A meta-analysis was conducted to resolve this question.

METHODS

We searched the PubMed, EMBASE, Web of Science, Scopus and Cochrane Library databases for studies on the association between LI and VI and the prognosis of patients with ESCC. The PICOs (Participant, Intervention, Comparison, Outcome) strategy were selected for the systematic review and meta-analysis. The effect size (ES) was the hazard ratio (HR) or relative ratio (RR) with 95% confidence intervals (CI) for overall survival (OS) and recurrence-free survival (RFS).

RESULTS

A total of 27 studies with 5740 patients were included. We calculated the pooled results from univariate and multivariate analysis using the Cox proportional hazards method. The heterogeneity was acceptable in OS and RFS. According to the pooled results of multivariate analysis, both LI and VI were correlated with a worse OS. VI was a negative indicator for RFS, while the p value of VI was greater than 0.05. The prognostic role was weakened in subgroup analysis with studies using haematoxylin-eosin staining method.

CONCLUSIONS

Both LI and VI were indicators of a worse OS outcome. LI was a more significant indicator in predicting a worse RFS. More larger sample studies with immunohistochemical staining and good designs are required to detect the prognostic value of separate LI and VI in ESCC.

The prognostic role of angiolymphatic invasion in N0 esophageal carcinoma: a meta-analysis and systematic review

Background

Angiolymphatic invasion (ALI) plays an important role in lymph node metastasis. The presence of an ALI predicts a high risk for lymph node metastasis and a poor prognosis in patients with lymph node negative esophageal carcinoma. The independent prognostic value of ALI in node-negative patients remains controversial. A meta-analysis was conducted to investigate the relationship between ALI and prognosis in cases of lymph node negative esophageal carcinoma.

Methods

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for studies on the relationship between ALI and the prognosis of patients with esophageal carcinoma. Studies with N0 patients' survival data related to ALI were included. The effect size (ES) was the hazard ratio (HR) with 95% confidence intervals (CI) for cancer-specific survival (CSS), overall survival (OS) and recurrence-free survival (RFS).

Results

A total of 9 studies with 2,154 patients were included after applying the inclusion and exclusion criteria. The pooled HR showed that patients with ALI have a poor cancer specific survival (HR =2.54; 95% CI, 1.84-3.51; P<0.001), a poor overall survival (HR =2.84; 95% CI, 2.17-3.72; P<0.001) and a short disease free survival (HR =2.84; 95% CI: 1.85-4.37; P<0.001).

Conclusions

ALI could be used as an indicator for identifying high-risk patients with lymph node-negative esophageal carcinoma and can be used as an indicator for sub-stages in further stage classification.

Lymphovascular invasion as a poor prognostic indicator in thoracic esophageal carcinoma: a systematic review and meta-analysis

The ability to further stratify patients with esophageal carcinoma (EC) in the same stage into high-risk patients by the presence of lymphovascular invasion (LVI) may permit refinement of multi-modality therapy. However, the role of LVI in the prognosis of EC is not definite. A meta-analysis was conducted to investigate the relationship between LVI and EC prognosis. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for studies on the association between LVI and prognosis of EC. Only studies with patient survival data related to LVI were included. The effect size for this analysis was the hazard ratio (HR) with 95% confidence intervals (CI) for overall survival (OS) and recurrence-free survival (RFS). Thirty-five studies with 9876 patients were included according to the defined inclusion and exclusion criteria. LVI was a poor indicator for the OS (HR = 1.64, 95% CI: 1.44-1.87, P < 0.001) and RFS (HR = 1.79, 95% CI: 1.38-2.34, P < 0.001). However, the heterogeneity was medium in OS (I2 = 61.2%, P < 0.001) and extreme in RFS (I2 = 77.5%, P < 0.001). In subgroup analysis, heterogeneity was originated from the staining method and proportion of early disease (stage (I + II)). We concluded that LVI was a poor prognostic indicator in patients with EC, especially in those studies with the IHC staining method and a high proportion of early disease (stage (I + II)).

Pharmacoepigenetics and pharmacoepigenomics of gastrointestinal cancers

Our understanding of the epigenetic changes occurring in gastrointestinal cancers has gained tremendous advancements in recent years, and some epigenetic biomarkers are already translated into the clinics for cancer diagnostics. In parallel, pharmacoepigenetics and pharmacoepigenomics of solid tumors are relevant novel, but emerging and promising fields. Areas covered: A comprehensive review of the literature to summarize and update the emerging field of pharmacoepigenetics and pharmacoepigenomics of gastrointestinal cancers. Expert commentary: Several epigenetic modifications have been proposed to account for interindividual variations in drug response in gastrointestinal cancers. Similarly, single-agent or combined strategies with high doses of drugs that target epigenetic modifications (epi-drugs) were scarcely tolerated by the patients, and current research has moved to their combination with standard therapies to achieve chemosensitization, radiosensitization, and immune modulation of cancerous cells. In parallel, recent genome-wide technologies are revealing the pathways that are epigenetically deregulated during cancer-acquired resistance, including those targeted by non-coding RNAs. Indeed, novel, less toxic, and more specific molecules are under investigation to specifically target those pathways. The field is rapidly expanding and gathering together information coming from these investigations has the potential to lead to clinical applications in the coming new years.

Marital status is associated with superior survival in patients with esophageal cancer: a Surveillance, Epidemiology, and End Results study

The impact of marital status on survival among patients with esophageal cancer has not been evaluated in the U.S. population in depth. The aim of the study was to investigate the impact of marital status on survival among patients diagnosed with esophageal cancer. The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify patients diagnosed with esophageal cancer between 1973 and 2013. Cox regression analysis was performed to evaluate for association between marital status on both cancer-specific and overall survival. Of the 69,139 patients with esophageal cancer, 35,863 (52%) had adenocarcinoma and 21,573 (31%) had distant SEER stage. At the time of diagnosis, 39,805 (57%) patients were married, 10,116 (15%) were single, 8,417 (12%) were divorced or separated, and 10,801 (16%) were widowed. Married patients had superior cancer-specific and overall survival compared to unmarried patients. Multivariate analysis demonstrated that single (adjusted hazard ratio (HR)=1.14, 95%CI 1.11-1.17; P<0.001), divorced or separated (HR=1.16, 95%CI 1.13-1.19; P<0.001), and widowed (HR=1.22, 95%CI 1.19-1.26; P<0.001) compared to married patients had higher risk of death from all causes. In conclusion, marital status was associated with superior survival among U.S. patients with esophageal cancer in a large population-based study.