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Tang B, Wu F, Peng L, Leng X, Han Y, Wang Q, Wu J, Orlandini LC. Computed tomography-based radiomics nomogram for prediction of lympho-vascular and perineural invasion in esophageal squamous cell cancer patients: a retrospective cohort study. Cancer Imaging 2024; 24:131. [PMID: 39367492 PMCID: PMC11451056 DOI: 10.1186/s40644-024-00781-w] [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: 07/05/2024] [Accepted: 09/30/2024] [Indexed: 10/06/2024] Open
Abstract
PURPOSE Lympho-vascular invasion (LVI) and perineural invasion (PNI) have been established as prognostic factors in various types of cancers. The preoperative prediction of LVI and PNI has the potential to guide personalized medicine strategies for patients with esophageal squamous cell cancer (ESCC). This study investigates whether radiomics features derived from preoperative contrast-enhanced CT could predict LVI and PNI in ESCC patients. METHODS AND MATERIALS A retrospective cohort of 544 ESCC patients who underwent esophagectomy were included in this study. Preoperative contrast-enhanced CT images, pathological results of PNI and LVI, and clinical characteristics were collected. For each patient, the gross tumor volume (GTV-T) and lymph nodes volume (GTV-N) were delineated and four categories of radiomics features (first-order, shape, textural and wavelet) were extracted from GTV-T and GTV-N. The Mann-Whitney U test was used to select significant features associated with LVI and PNI in turn. Subsequently, radiomics signatures for LVI and PNI were constructed using LASSO regression with ten-fold cross-validation. Significant clinical characteristics were combined with radiomics signature to develop two nomogram models for predicting LVI and PNI, respectively. The area under the curve (AUC) and calibration curve were used to evaluate the predictive performance of the models. RESULTS The radiomics signature for LVI prediction consisted of 28 features, while the PNI radiomics signature comprised 14 features. The AUCs of the LVI radiomics signature were 0.77 and 0.74 in the training and validation groups, respectively, while the AUCs of the PNI radiomics signature were 0.69 and 0.68 in the training and validation groups. The nomograms incorporating radiomics signatures and significant clinical characteristics such as age, gender, thrombin time and D-Dimer showed improved predictive performance for both LVI (AUC: 0.82 and 0.80 in the training and validation group) and PNI (AUC: 0.75 and 0.72 in the training and validation groups) compared to the radiomics signature alone. CONCLUSION The radiomics features extracted from preoperative contrast-enhanced CT of gross tumor and lymph nodes have demonstrated their potential in predicting LVI and PNI in ESCC patients. Furthermore, the incorporation of clinical characteristics has shown additional value, resulting in improved predictive performance.
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Affiliation(s)
- Bin Tang
- Department of Radiation Oncology, Radiation Onocology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Fan Wu
- Department of Radiation Oncology, Radiation Onocology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Lin Peng
- Department of Thoracic Surgery, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yongtao Han
- Department of Thoracic Surgery, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Qifeng Wang
- Department of Radiation Oncology, Radiation Onocology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Junxiang Wu
- Department of Radiation Oncology, Radiation Onocology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Radiation Onocology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
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AbuQeis I, Zou Y, Ba YC, Teeti AA. Neuroscience of cancer: Research progress and emerging of the field. IBRAIN 2024; 10:305-322. [PMID: 39346791 PMCID: PMC11427805 DOI: 10.1002/ibra.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 10/01/2024]
Abstract
Cancer cells immediately expand and penetrate adjoining tissues, as opposed to metastasis, that is the spread of cancer cells through the circulatory or lymphatic systems to more distant places via the invasion process. We found that a lack of studies discussed tumor development with the nervous system, by the aspects of cancer-tissue invasion (biological) and chemical modulation of growth that cascades by releasing neural-related factors from the nerve endings via chemical substances known as neurotransmitters. In this review, we aimed to carefully demonstrate and describe the cancer invasion and interaction with the nervous system, as well as reveal the research progress and the emerging neuroscience of cancer. An initial set of 160 references underwent systematic review and summarization. Through a meticulous screening process, these data were refined, ultimately leading to the inclusion of 98 studies that adhered to predetermined criteria. The outcomes show that one formidable challenge in the realm of cancer lies in its intrinsic heterogeneity and remarkable capacity for rapid adaptation. Despite advancements in genomics and precision medicine, there is still a need to identify new molecular targets. Considering cancer within its molecular and cellular environment, including neural components, is crucial for addressing this challenge. In conclusion, this review provides good referential data for direct, indirect, biological, and chemical interaction for nerve tissue-tumor interaction, suggesting the establishment of new therapy techniques and mechanisms by controlling and modifying neuron networks that supply signals to tumors.
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Affiliation(s)
- Issam AbuQeis
- Department of Radiology Palestinian Ministry of Health Ramallah Palestine
- Department of Anatomy, Institute of Neuroscience, School of Basic Medicine Kunming Medical University Kunming China
| | - Yu Zou
- Department of Anatomy, Institute of Neuroscience, School of Basic Medicine Kunming Medical University Kunming China
| | - Ying-Chun Ba
- Department of Anatomy, Institute of Neuroscience, School of Basic Medicine Kunming Medical University Kunming China
| | - Abeer A Teeti
- Department of Chemistry, School of Science Hebron University Hebron Palestine
- Department of Epidemiology, School of Public Health Kunming Medical University Kunming China
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Zhou H, Zhou J, Qin C, Tian Q, Zhou S, Qin Y, Wu Y, Shi J, Feng F. Preoperative Prediction of Perineural Invasion in Oesophageal Squamous Cell Carcinoma Based on CT Radiomics Nomogram: A Multicenter Study. Acad Radiol 2024; 31:1355-1366. [PMID: 37949700 DOI: 10.1016/j.acra.2023.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the value of computed tomography (CT) radiomics nomogram in the preoperative prediction of perineural invasion (PNI) in oesophageal squamous cell carcinoma (ESCC) through a multicenter study. MATERIALS AND METHODS We retrospectively collected postoperative pathological data of 360 ESCC patients with definite PNI status (131 PNI-positive and 229 PNI-negative) from two centres. Radiomic features were extracted from the arterial-phase CT images, and the least absolute shrinkage and selection operator and logistic regression algorithm were used to screen valuable features for identifying the PNI status and calculating the radiomics score (Rad-score). A radiomics nomogram was established by integrating the Rad-score and clinical risk factors. A receiver operating characteristic curve was used to evaluate model performance, and decision curve analysis was used to evaluate the predictive performance of the radiomics nomogram in the training, internal validation, and external validation sets. RESULTS Twenty radiomics features were extracted from a full-volume tumour region of interest to construct the model, and the radiomics nomogram combined with radiomics features and clinical risk factors was superior to the clinical and radiomics models in predicting the PNI status of ESCC patients. The area under the curve values of the radiomics nomogram in the training, internal validation, and external validation sets were 0.856 (0.794-0.918), 0.832 (0.742-0.922), and 0.803 (0.709-0.898), respectively. CONCLUSION The radiomics nomogram based on CT has excellent predictive ability; it can non-invasively predict the preoperative PNI status of ESCC patients and provide a basis for preoperative decision-making.
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Affiliation(s)
- Hui Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Jianwen Zhou
- Department of Radiology, Dongtai People's Hospital, Yancheng, Jiangsu Province, China (J.Z.)
| | - Cai Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Qi Tian
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Siyu Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Yihan Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Yutao Wu
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Jian Shi
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.)
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China (H.Z., C.Q., Q.T., S.Z., Y.Q., Y.W., J.S., F.F.).
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Hardy K, Chmelo J, Joel A, Navidi M, Fergie BH, Phillips AW. Histological prognosticators in neoadjuvant naive oesophageal cancer patients. Langenbecks Arch Surg 2023; 408:184. [PMID: 37156834 DOI: 10.1007/s00423-023-02927-z] [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: 10/08/2022] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Prognosis of oesophageal cancer is primarily based upon the TNM stage of the disease. However, even in those with similar TNM staging, survival can be varied. Additional histopathological factors including venous invasion (VI), lymphatic invasion (LI) and perineural invasion (PNI) have been identified as prognostic markers yet are not part of TNM classification. The aim of this study is to determine the prognostic importance of these factors and overall survival in patients with oesophageal or junctional cancer who underwent transthoracic oesophagectomy as the unimodality treatment. METHODS Data from patients who underwent transthoracic oesophagectomy for adenocarcinoma without neoadjuvant treatment were reviewed. Patients were treated with radical resection, with a curative intent using a transthoracic Ivor Lewis or three staged McKeown approach. RESULTS A total of 172 patients were included. Survival was poorer when VI, LI and PNI were present (p<0.001), with the estimated survival being significantly worse (p<0.001) when patients were stratified according to the number of factors present. Univariable analysis of factors revealed VI, LI and PNI were all associated with survival. Presence of LI was independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis (OR 12.9 95% CI 3.6-46.6, p<0.001). CONCLUSION Histological factors of VI, LI and PNI are markers of aggressive disease and may have a role in prognostication and decision-making prior to treatment. The presence of LI as an independent marker of upstaging could be a potential indication for the use of neoadjuvant treatment in patients with early clinical disease.
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Affiliation(s)
- Kiera Hardy
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jakub Chmelo
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abraham Joel
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maziar Navidi
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bridget H Fergie
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
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Wang B, Su A, Li M, Wang X, Gao Y, Su L, Li W, Ma Y. Construction of a prognostic model for radical esophagectomy based on immunohistochemical prognostic markers combined with clinicopathological factors. Medicine (Baltimore) 2023; 102:e32889. [PMID: 36862875 PMCID: PMC9981367 DOI: 10.1097/md.0000000000032889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) has a poor prognosis and lacks effective biomarkers to evaluate prognosis and treatment. Glycoprotein nonmetastatic melanoma protein B (GPNMB) is a protein highly expressed in ESCC tissues screened by isobaric tags for relative and absolute quantitation proteomics, which has significant prognostic value in a variety of malignant tumors, but its relationship with ESCC remains unclear. By immunohistochemical staining of 266 ESCC samples, we analyzed the relationship between GPNMB and ESCC. To explore how to improve the ability of ESCC prognostic assessment, we established a prognostic model of GPNMB and clinicopathological features. The results suggest that GPNMB expression is generally positive in ESCC tissues and is significantly associated with poorer differentiation, more advanced American Joint Council on Cancer (AJCC) stage, and higher tumor aggressiveness (P < .05). Multivariate Cox analysis indicated that GPNMB expression was an independent risk factor for ESCC patients. A total of 188 (70%) patients were randomly selected from the training cohort and the four variables were automatically screened by stepwise regression based on the AIC principle: GPNMB expression, nation, AJCC stage and nerve invasion. Through the weighted term, we calculate the risk score of each patient, and by drawing the receiver operating characteristic curve, we show that the model has good prognostic evaluation performance. The stability of the model was verified by test cohort. Conclusion: GPNMB is a prognostic marker consistent with the characteristics of tumor therapeutic targets. For the first time, we constructed a prognostic model combining immunohistochemical prognostic markers and clinicopathological features in ESCC, which showed higher prognostic efficacy than AJCC staging system in predicting the prognosis of ESCC patients in this region.
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Affiliation(s)
- Bo Wang
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Xinjiang Medical University, Urumqi, China
| | - Anna Su
- Internal Medicine, Urumqi First People’s Hospital, Urumqi, China
| | - Mengyan Li
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Xuecheng Wang
- Thoracic Surgery, The Fifth Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Yongmei Gao
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Liping Su
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Wan Li
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Yuqing Ma
- Department of Pathology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
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Impact of Perineural Invasion and Preexisting Type 2 Diabetes on Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy. Cancers (Basel) 2023; 15:cancers15041122. [PMID: 36831461 PMCID: PMC9954405 DOI: 10.3390/cancers15041122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Neoadjuvant chemoradiotherapy (neoCRT) followed by surgery is the cornerstone treatment strategy in locally advanced esophageal squamous cell carcinoma (ESCC). Despite this high- intensity multimodality therapy, most patients still experience recurrences and metastases, especially those who do not achieve a pathological complete response (pCR) after neoCRT. Here, we focused on identifying poor prognostic factors. In this retrospective cohort study; we enrolled 140 patients who completed neoCRT plus surgery treatment sequence with no interval metastasis. Overall, 45 of 140 patients (32.1%) achieved a pCR. The overall survival, disease-free survival (DFS), and metastasis-free survival was significantly better in patients with a pCR than in patients with a non-pCR. In the non-pCR subgroup, the presence of perineural invasion (PNI) and preexisting type 2 diabetes (T2DM) were two factors adversely affecting DFS. After adjusting for other factors, multivariate analysis showed that the hazard ratio (HR) was 2.354 (95% confidence interval [CI] 1.240-4.467, p = 0.009) for the presence of PNI and 2.368 (95% CI 1.351-4.150, p = 0.003) for preexisting T2DM. Patients with a combination of both factors had the worst survival. In conclusion, PNI and preexisting T2DM may adversely affect the prognosis of patients with ESCC receiving neoadjuvant chemoradiotherapy.
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Singh AK, Singhal BM, Yadav SK, Kewlani V. Impact of Different Histopathological Factors on Recurrence and Survival in Operated Carcinoma Esophagus. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0042-1758813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Background Even with radical surgery, a significant percentage of patients of esophageal cancer experience recurrent disease.
Aims The aim of the current study is to define the impact of different histopathological factors on the recurrence and survival in carcinoma esophagus following surgery.
Materials and Methods A retrospective review of 182 patients of esophageal carcinoma, operated between January 2011 and December 2016, was done. In our study, 92 patients underwent upfront surgery and 90 took neo-adjuvant/perioperative treatment before planned surgery. To compare the proportion between two groups, chi-square test was used and to compare the median between the two groups, Mann—Whitney U test was used. Factors affecting the survival were analyzed using the Kaplan–Meier survival curve to compare the median survival time across groups log rank (Mantel–Cox) test was used.
Results Out of 182 patients, 55 patients developed recurrences, in which 19 were loco-regional and 36 were systemic. Patients with lymph node-positive disease on final histopathology had more recurrence than lymph node-negative (39.74%, 31/78) versus (23%, 24/104), p = 0.01 (significant). Patients with features such as PNI-positive, poor differentiation, lymph node-positive, ENE, and higher stage disease had statistically significant, lower DFS and OS with p-value < 0.05. Patients with adenocarcinoma histology had more systemic recurrences and statistically significant lower DFS than SCC with p-value < 0.05.
Conclusions Systemic recurrences are more common. PNI, ENE, grade, lymph node-positive disease, and higher pathologic stage had statistically significant negative impact on both DFS and OS. On multivariate analysis, whereas ENE had an impact on DFS alone.
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Affiliation(s)
- Ashok Kumar Singh
- Department of Surgical Oncology, Kalyan Singh Superspeciality Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Basant Mohan Singhal
- Department of Surgical Oncology, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Santosh Kumar Yadav
- General Surgery, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vishal Kewlani
- Department of Surgical Oncology, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
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Ma Y, Chen J, Yao X, Li Z, Li W, Wang H, Zhu J. Patterns and prognostic predictive value of perineural invasion in esophageal squamous cell carcinoma. BMC Cancer 2022; 22:1287. [PMID: 36482313 PMCID: PMC9733208 DOI: 10.1186/s12885-022-10386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathological phenotype of perineural invasion (PNI) in squamous cell carcinoma (ESCC) is prevalent but highly heterogeneous. METHODS Postoperative specimens from all patients with ESCC at Shaanxi Provincial People's Hospital were evaluated for PNI using haematoxylin and eosin (H&E) staining and S100 immunohistochemistry (IHC). We determined the correlation between PNI status and clinical outcomes. RESULTS Among 349 ESCC cases, PNI was identified in 127 patients (36.3%), and four subtypes of PNI were identified in our study. Correlation analysis confirmed that PNI was related to tumour invasion depth (pT stage) and lymph node status (pN stage) (P < 0.05). Multivariate analysis showed that PNI (P = 0.001) was an independent factor affecting disease-free survival (DFS) in ESCC, and a similar result was found for overall survival (OS) (P = 0.017). Further analysis revealed that PNI status was a prognostic factor of DFS (P < 0.001) and OS (P = 0.003) exclusively in pN-negative patients. We also found that patients with the PNI-a subtype had better DFS (P = 0.002) and OS (P = 0.002) than patients with the other three subtypes (PNI-b, c, d). CONCLUSION The pathological phenotypes of PNI are diverse, and the identification of PNI subtypes has important clinical guiding value.
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Affiliation(s)
- Yu Ma
- grid.440288.20000 0004 1758 0451Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Jie Chen
- grid.440288.20000 0004 1758 0451Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Xi Yao
- grid.440288.20000 0004 1758 0451Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Zhenzhen Li
- grid.440288.20000 0004 1758 0451Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Wensheng Li
- grid.440288.20000 0004 1758 0451Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Hongtao Wang
- grid.440288.20000 0004 1758 0451Department of Thoracic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
| | - Jianfei Zhu
- grid.440288.20000 0004 1758 0451Department of Thoracic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 People’s Republic of China
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Systematic review on outcomes of the use of adjuvant pharmacotherapy for treatment of cutaneous malignancies exhibiting perineural invasion: promising efficacy of anti-PD1 therapy. Arch Dermatol Res 2022; 315:1075-1082. [DOI: 10.1007/s00403-022-02482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/15/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
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Hernandez S, Serrano AG, Solis Soto LM. The Role of Nerve Fibers in the Tumor Immune Microenvironment of Solid Tumors. Adv Biol (Weinh) 2022; 6:e2200046. [PMID: 35751462 DOI: 10.1002/adbi.202200046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Indexed: 01/28/2023]
Abstract
The importance of neurons and nerve fibers in the tumor microenvironment (TME) of solid tumors is now acknowledged after being unexplored for a long time; this is possible due to the development of new technologies that allow in situ characterization of the TME. Recent studies have shown that the density and types of nerves that innervate tumors can predict a patient's clinical outcome and drive several processes of tumor biology. Nowadays, several efforts in cancer research and neuroscience are taking place to elucidate the mechanisms that drive tumor-associated innervation and nerve-tumor and nerve-immune interaction. Assessment of neurons and nerves within the context of the TME can be performed in situ, in tumor tissue, using several pathology-based strategies that utilize histochemical and immunohistochemistry principles, hi-plex technologies, and computational pathology approaches to identify measurable histopathological characteristics of nerves. These features include the number and type of tumor associated nerves, topographical location and microenvironment of neural invasion of malignant cells, and investigation of neuro-related biomarker expression in nerves, tumor cells, and cells of the TME. A deeper understanding of these complex interactions and the impact of nerves in tumor biology will guide the design of better strategies for targeted therapy in clinical trials.
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Affiliation(s)
- Sharia Hernandez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 West Holcombe Boulevard, Houston, TX, 77030, USA
| | - Alejandra G Serrano
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 West Holcombe Boulevard, Houston, TX, 77030, USA
| | - Luisa M Solis Soto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 West Holcombe Boulevard, Houston, TX, 77030, USA
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Bai L, Yan L, Guo Y, He L, Sun Z, Cao W, Lu J, Mo S. Perineural Invasion Is a Significant Indicator of High Malignant Degree and Poor Prognosis in Esophageal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:816270. [PMID: 35756642 PMCID: PMC9213664 DOI: 10.3389/fonc.2022.816270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Perineural invasion (PNI) is a malignant metastatic mode of tumors and has been reported in many tumors including esophageal cancer (EC). However, the role of PNI in EC has been reported differently. This systematic review and meta-analysis aims to focus on the role of PNI in EC. Methods Eight databases of CNKI, VIP, Wanfang, Scopus, Wiley, ISI, PubMed, and EBSCO are used for literature search. The association of PNI with gender, pathological stages of T and N (pT and pN), lymphovascular invasion (LVI), lymph node metastasis, 5-year overall survival (OS), and 5-year disease-free survival (DFS) was examined in the meta-analysis by Revman5.0 Software. The pooled OR/HR and 95% CI were used to assess the risk and prognostic value. Results Sixty-nine published studies were screened for analysis of PNI in EC. The incidence of PNI in esophageal squamous carcinoma (ESCC) and esophageal adenocarcinoma (EAC) was different, but not statistically significant (p > 0.05). The PNI-positive patients had a significantly higher risk of pT stage (OR = 3.85, 95% CI = 2.45–6.05, p < 0.00001), pN stage (OR = 1.86, 95% CI = 1.52–2.28, p < 0.00001), LVI (OR = 2.44, 95% CI = 1.55–3.85, p = 0.0001), and lymph node metastasis (OR = 2.87, 95% CI = 1.56–5.29, p = 0.0007). Furthermore, the cumulative analysis revealed a significant correlation between PNI and poor OS (HR = 1.37, 95% CI = 1.24–1.51, p < 0.0001), as well as poor DFS (HR = 1.55, 95% CI = 1.38–1.74, p < 0.0001). Conclusion PNI occurrence is significantly related to tumor stage, LVI, lymph node metastasis, OS, and DFS. These results indicate that PNI can serve as an indicator of high malignant degree and poor prognosis in EC.
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Affiliation(s)
- Liuyang Bai
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Liangying Yan
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yaping Guo
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou, China.,State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou, China
| | - Luyun He
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou, China.,State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou, China
| | - Zhiyan Sun
- Department of Special Service, No. 988 Hospital of the Joint Service Support Force of People's Liberation Army of China (PLA), Zhengzhou, China
| | - Wenbo Cao
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou, China.,State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou, China
| | - Jing Lu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou, China.,State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou, China
| | - Saijun Mo
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Collaborative Innovation Center of Henan Province for Cancer Chemoprevention, Zhengzhou, China.,State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou, China
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12
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Xie C, Chen Z, Xu J, Meng Z, Huang Z, Lin J. Influence of Lymphangio vascular (V) and perineural (N) invasion on survival of patients with resected esophageal squamous cell carcinoma (ESCC): a single-center retrospective study. PeerJ 2022; 10:e12974. [PMID: 35256918 PMCID: PMC8898008 DOI: 10.7717/peerj.12974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Background Lymphangio vascular invasion (LVI) and perineural invasion (PNI) are associated with survival following resection for gastrointestinal cancer. But the relationship between LVI/PNI and survival of esophageal squamous cell carcinoma (ESCC) is still unclear. We aim to demonstrate the prognostic significance of LVI/PNI in ESCC. Methods A total of 195 ESCC patients underwent curative surgery from 2012 to 2018 was collected in the 2nd Affiliated Hospital of Fujian Medical University. All the patients were divided into four groups based on the status of the neurovascular invasion: (1) neither LVI nor PNI (V0N0); (2) LVI alone (V1N0); (3) PNI alone (V0N1); (4) combined LVI and PNI (V1N1). First, the analysis included the Kaplan-Meier survival estimates with the Log rank test were performed to determine median overall survival (OS) in different groups divided according to the clinical factor, respectively. And the association between OS with multi clinical factors was examined using Cox regression analysis. Next, the risk factors for recurrence in patients with V1N1 were analyzed with univariate and multivariate logistic regression analyses, respectively. Results The cases in V0N0, V1N0, V0N1, and V1N1 groups were 91 (46.7%), 62 (31.8%), 9 (4.6%) and 33 (16.9%), respectively. The OS in the four groups was different (P < 0.001). The 1-, 3- and 5-year OS in V0N0 group was higher than that in V1N1 group, respectively (1-year OS: 93.4% vs 75.8%, 3-year OS: 53.8 % vs 24.2%, 5-year OS: 48.1% vs 10.5%). The OS in stage I-II for patients with V1N1 was significantly lower than that in the other groups (V0N0, V1N0, V0N1) (P < 0.001). The postoperative adjuvant chemotherapy was a significant impact factor of OS for ESCC patients with V1N1 (P = 0.004). Lymphatic invasion and LVI were significantly prognosis factors associated (P = 0.036, P = 0.030, respectively). The ulcerative type is a risk factor for V1N1 occurance (P = 0.040). Conclusions The LVI and PNI are important prognosis factors for ESCC patients. ESCC patients with simultaneous lymphangio vascular and perineural invasion (V1N1) showed worse OS than patients with either lymphangio vascular or perineural invasion alone (V1N0 or V0N1) or none (V0N0). In addition, adjuvant chemotherapy may prolong the OS for ESCC patients with V1N1.
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Affiliation(s)
- Chengke Xie
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhiyao Chen
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jie Xu
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhiyong Meng
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhijun Huang
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jianqing Lin
- Department of Thyroid & Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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13
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Goluba K, Kunrade L, Riekstina U, Parfejevs V. Schwann Cells in Digestive System Disorders. Cells 2022; 11:832. [PMID: 35269454 PMCID: PMC8908985 DOI: 10.3390/cells11050832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Proper functioning of the digestive system is ensured by coordinated action of the central and peripheral nervous systems (PNS). Peripheral innervation of the digestive system can be viewed as intrinsic and extrinsic. The intrinsic portion is mainly composed of the neurons and glia of the enteric nervous system (ENS), while the extrinsic part is formed by sympathetic, parasympathetic, and sensory branches of the PNS. Glial cells are a crucial component of digestive tract innervation, and a great deal of research evidence highlights the important status of ENS glia in health and disease. In this review, we shift the focus a bit and discuss the functions of Schwann cells (SCs), the glial cells of the extrinsic innervation of the digestive system. For more context, we also provide information on the basic findings regarding the function of innervation in disorders of the digestive organs. We find diverse SC roles described particularly in the mouth, the pancreas, and the intestine. We note that most of the scientific evidence concerns the involvement of SCs in cancer progression and pain, but some research identifies stem cell functions and potential for regenerative medicine.
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Affiliation(s)
| | | | | | - Vadims Parfejevs
- Faculty of Medicine, University of Latvia, House of Science, Jelgavas Str. 3, LV-1004 Riga, Latvia; (K.G.); (L.K.); (U.R.)
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14
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Zhang L, Shao J, Liu Z, Pan J, Li B, Yang Y, He Y, Han Y, Li Z. Occurrence and Prognostic Value of Perineural Invasion in Esophageal Squamous Cell Cancer: A Retrospective Study. Ann Surg Oncol 2021; 29:586-597. [PMID: 34426885 DOI: 10.1245/s10434-021-10665-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to explore the occurrence and prognostic value of perineural invasion (PNI) as a classic tumor pathological feature in esophageal squamous cell carcinoma (ESCC). METHODS We retrospectively enrolled 794 ESCC patients who underwent radical esophagectomy at Shanghai Chest Hospital from 2017 to 2018. The incidence, associated factors, and prognosis of PNI were analyzed. RESULTS PNI was identified in 15.7% (125/794) of patients. The presence of PNI was significantly associated with depth of invasion (p < 0.001), pN stage (p = 0.008), tumor stage (p < 0.001), and lymphovascular invasion (LVI; p < 0.001). Multivariate logistic regression analysis demonstrated that advanced pT stage and LVI were independently associated with the presence of PNI, while multivariate Cox regression analysis demonstrated that PNI was not an independent risk factor for poor overall survival (OS) or recurrence-free survival (RFS) in ESCC patients (OS hazard ratio [HR] 0.688, 95% confidence interval [CI] 0.448-1.056, p = 0.087; RFS HR 0.837, 95% CI 0.551-1.273, p = 0.406). In the PNI-positive patient subgroup, adjuvant therapy was associated with better OS and RFS. CONCLUSION PNI correlates with, and may be a concomitant consequence of, LVI and advanced tumor invasion (T3-4) in ESCC patients. Although PNI was not identified as an independent prognostic indicator, our results suggest ESCC patients with PNI should be considered for adjuvant therapy.
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Affiliation(s)
- Long Zhang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinchen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Pan
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Yang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi He
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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15
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Li J, Liu S, Li Z, Han X, Que L. Prognostic Value of Perineural Invasion in Oral Tongue Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:683825. [PMID: 34322385 PMCID: PMC8311439 DOI: 10.3389/fonc.2021.683825] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES A significant number of recently published research has outlined the contribution of perineural invasion (PNI) to clinical outcomes in oral tongue squamous cell carcinoma (OTSCC), but some results remain conflicting. This study aimed to determine whether patients with OTSCC with PNI have a worse prognosis than those without PNI. MATERIALS AND METHODS PubMed, Embase, and the Cochrane Library were queried for potentially eligible articles published up to December 2020. The primary outcomes were the hazard ratio (HR) for locoregional recurrence, overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). The random-effect model was used in all analyses. RESULTS Seventeen studies (4445 patients) were included. Using adjusted HRs, the presence of PNI was associated with a higher risk of locoregional recurrence (HR=1.73, 95%CI: 1.07-2.79, P=0.025, I2 = 33.1%, Pheterogeneity=0.224), worse OS (HR=1.94, 95%CI: 1.39-2.72, P<0.001, I2 = 0.0%, Pheterogeneity=0.838), worse DFS (HR=2.13, 95%CI: 1.53-2.96, P<0.001, I2 = 48.4%, Pheterogeneity=0.071), and worse CSS (HR=1.93, 95%CI: 1.40-2.65, P<0.001, I2 = 25.5%, Pheterogeneity=0.251). PNI had an impact on locoregional recurrence in early-stage OTSCC but not in all stages, and on OS, DFS, and CSS in all-stage and early-stage OTSCC. The sensitivity analyses showed that the results were robust. CONCLUSION The presence of PNI significantly affects the locoregional recurrence and survival outcomes among patients with OTSCC.
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Affiliation(s)
- Jiajia Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shan Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhangao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xinxin Han
- Department of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University, Xi’an, China
| | - Lin Que
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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16
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Zhao D, Chen J, Wang Y, Zhang L, Zhang J, Zhang W, Fan J, Li J, Zhan Q. Feed-forward activation of STAT3 signaling limits the efficacy of c-Met inhibitors in esophageal squamous cell carcinoma (ESCC) treatment. Mol Carcinog 2021; 60:481-496. [PMID: 34018249 DOI: 10.1002/mc.23306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 01/12/2023]
Abstract
c-Hepatocyte growth factor receptor (Met) inhibitors have demonstrated clinical benefits in some types of solid tumors. However, the efficacy of c-Met inhibitors in esophageal squamous cell carcinoma (ESCC) remains unclear. In this study, we discovered that c-Met inhibitors induced "Signal Transducer and Activator of Transcription (STAT3)-addiction" in ESCC cells, and the feedback activation of STAT3 in ESCC cells limits the tumor response to c-Met inhibition. Mechanistically, c-Met inhibition increased the autocrine of several cytokines, including CCL2, interleukin 8, or leukemia inhibitory factor, and facilitated the interactions between the receptors of these cytokines and Janus Kinase1/2 (JAK1/2) to resultantly activate JAKs/STAT3 signaling. Pharmacological inhibition of c-Met together with cytokines/JAKs/STAT3 axis enhanced cancer cells regression in vitro. Importantly, combined c-Met and STAT3 inhibitors synergistically suppressed tumor growth and promoted the apoptosis of tumor cells without producing systematic toxicity. These findings suggest that inhibition of the STAT3 feedback loop may augment the response to c-Met inhibitors via the STAT3-mediated oncogene addiction in ESCC cells.
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Affiliation(s)
- Di Zhao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jie Chen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingyuan Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jing Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weimin Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiawen Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jinting Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qimin Zhan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Molecular Oncology, Peking University Cancer Hospital & Institute, Beijing, China
- Shenzhen Bay Laboratory, Institute of Cancer Research, Shenzhen, China
- Research Unit of Molecular Cancer Research, Chinese Academy of Medical Sciences, Beijing, China
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17
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Wang H, Zheng Q, Lu Z, Wang L, Ding L, Xia L, Zhang H, Wang M, Chen Y, Li G. Role of the nervous system in cancers: a review. Cell Death Discov 2021; 7:76. [PMID: 33846291 PMCID: PMC8041826 DOI: 10.1038/s41420-021-00450-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
Nerves are important pathological elements of the microenvironment of tumors, including those in pancreatic, colon and rectal, prostate, head and neck, and breast cancers. Recent studies have associated perineural invasion with tumor progression and poor outcomes. In turn, tumors drive the reprogramming of neurons to recruit new nerve fibers. Therefore, the crosstalk between nerves and tumors is the hot topic and trend in current cancer investigations. Herein, we reviewed recent studies presenting direct supporting evidences for a better understanding of nerve-tumor interactions.
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Affiliation(s)
- Huan Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Qiming Zheng
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Zeyi Lu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Liya Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Lifeng Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Liqun Xia
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Hao Zhang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Mingchao Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Yicheng Chen
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China.
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China.
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18
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Kim HE, Park SY, Kim H, Kim DJ, Kim SI. Prognostic effect of perineural invasion in surgically treated esophageal squamous cell carcinoma. Thorac Cancer 2021; 12:1605-1612. [PMID: 33811752 PMCID: PMC8107023 DOI: 10.1111/1759-7714.13960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Although perineural invasion is a well known prognostic factor used in several cancers, its prognostic role in esophageal squamous cell carcinoma remains controversial. Here, we investigated the prognostic role of perineural invasion in surgically treated esophageal squamous cell carcinoma. Methods We retrospectively reviewed the medical records of 316 patients who underwent esophagectomy and lymph node dissection for esophageal squamous cell carcinoma between 2007 and 2016. Results Overall, 287 men (mean age: 62.73 ± 7.97 years) were included in the study. The median follow‐up period was 35.97 ± 30.99 months, perineural invasion was confirmed in 25 patients, and three‐year overall and disease‐free survival were significantly lower in the perineural invasion group than in the no‐perineural invasion group (75.9% vs. 40.0%, p < 0.001; 70.3% vs. 21.6%, p < 0.001). Cumulative incidences of locoregional recurrence and distant metastasis over three years were higher in the perineural invasion group (13.8% vs. 9.6%, p = 0.009 and 52.8% vs. 14.6%, p < 0.001). On performing multivariable analysis, perineural invasion, pathological stage, incomplete resection, and neoadjuvant therapy were adverse risk factors for disease‐free survival. The concordance index increased when perineural invasion was included in the model (0.712 vs. 0.723). On subgroup analysis, perineural invasion demonstrated a prognostic value in node‐negative patients (79.4% vs. 35.7%, p = 0.012). Conclusions Perineural invasion was found to be an adverse risk factor for disease‐free survival in surgically treated patients with esophageal squamous cell carcinoma. Close observation and individualized adjuvant therapy may be helpful for patients with perineural invasion.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ill Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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19
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Li P, Li Y, Zhang C, Ling YH, Jin JT, Yun JP, Cai MY, Luo RZ. Clinicopathological and Prognostic Characteristics of Esophageal Spindle Cell Squamous Cell Carcinoma: An Analysis of 43 Patients in a Single Center. Front Oncol 2021; 11:564270. [PMID: 33777730 PMCID: PMC7991578 DOI: 10.3389/fonc.2021.564270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Esophageal spindle cell squamous cell carcinoma (ESCSCC) is a distinct subtype of esophageal carcinoma with unique morphologic and clinicopathologic features. This study aimed to characterize the clinicopathologic manifestations and postoperative prognostic factors of ESCSCC. Methods In this study, 43 ESCSCC patients who underwent esophagectomy at Sun Yat-sen University Cancer Center between January 2001 and December 2014 were identified. 200 patients with conventional squamous cell carcinoma during the same period were sampled as a control. Hematoxylin and eosin-stained slides and available data were reviewed, and pertinent clinicopathologic features were retrospectively analyzed. Results Among the ESCSCC patients, the median age was 60.5 years, with a male-to-female ratio of 2.58:1. The five-year disease-free survival and cancer-specific survival rates were 51.6 and 55.5%, respectively. In the univariate analysis, drinking abuse, tumor size, macroscopic type, perineural invasion, pT, preoperative blood white blood cell count, preoperative blood neutrophil count, and preoperative blood neutrophil to lymphocyte ratio were significantly correlated with the cancer-specific survival and disease-free survival of the ESCSCC patients. The multivariate analysis showed that macroscopic type, perineural invasion, and preoperative blood neutrophil to lymphocyte ratio were independent prognostic factors for cancer-specific survival; macroscopic type, perineural invasion, tumor size, and pT were independent prognostic factors for disease-free survival. Moreover, the combined prognostic model for cancer-specific survival (including macroscopic type, perineural invasion, and preoperative blood neutrophil to lymphocyte ratio), the combined prognostic model for disease-free survival (including macroscopic type, perineural invasion, and tumor size) significantly stratified patients according to risk (low, intermediate, and high) to predict cancer-specific survival, disease-free survival, respectively. In terms of esophageal conventional squamous cell carcinoma cohort, there was no significant difference in long-term outcome when compared with ESCSCC. Though five independent prognostic variables (macroscopic type, perineural invasion, preoperative blood neutrophil to lymphocyte ratio, tumor size, and pT) were indentified in ESCSCC, univariate analysis demonstrated that perineural invasion, preoperative blood neutrophil to lymphocyte ratio were correlated with esophageal conventional squamous cell carcinoma on cancer-specific survival; whereas only perineural invasion on disease-free survival. Conclusions The proposed two new prognostic models might aid in risk stratification and personalized management for patients with esophageal spindle cell squamous cell carcinoma who received radical surgery.
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Affiliation(s)
- Peng Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yang Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chao Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Hong Ling
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jie-Tian Jin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing-Ping Yun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mu-Yan Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong-Zhen Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
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20
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Kang J, Lee HP, Kim HR, Kim JH, Jung HY, Lee GH, Song HJ, Kim DH, Choi KD, Ahn JY, Ryu JS, Cho KJ, Lee MY, Kim SB, Kim YH, Park SR. Validation of the post-neoadjuvant staging system of the American joint committee on cancer, 8th edition, in patients treated with neoadjuvant chemoradiotherapy followed by curative esophagectomy for localized esophageal squamous cell carcinoma. Surg Oncol 2020; 35:491-497. [PMID: 33130441 DOI: 10.1016/j.suronc.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The American Joint Committee on Cancer 8th edition staging system presents separate classifications for pTNM and post-neoadjuvant ypTNM (ypTNM-8th) to enhance prognostic prediction after neoadjuvant therapy and surgery. We aimed to validate the ypTNM-8th staging system and to compare the prognostication performance of ypTNM-8th with that of pTNM-7th and pTNM-8th in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT). METHODS We reviewed 207 ESCC patients treated with nCRT between January 2007 and December 2014 and compared the Akaike information criterion (AIC) and Harrell's C-index to determine the prognostic performance of each TNM system. RESULTS Survival curve analysis of pTNM-7th and -8th showed a stepwise drop in survival from ypT0N0 to advanced stages, whereas the survival outcome of ypStage III showed a better prognosis than that of ypStage II according to ypTNM-8th. Lymphovascular invasion, perineural invasion, and tumor regression grade were significantly associated with overall survival on univariate analysis. Each TNM system showed significant p-values for trend (p < 0.0001 each), but after adjusting for prognostic factors, ypTNM-8th did not significantly predict survival (p = 0.15), whereas pTNM-7th remained significant (p < 0.001). pTNM-7th incorporating ypT0N0M0 and ypT0 (is)N + M0 as separate groups was superior in prognostication as its AIC was smaller and its C-index was higher than those of pTNM-8th and ypTNM-8th, respectively. CONCLUSIONS Because ypTNM-8th did not provide sufficient prognostication for patients with ESCC treated with nCRT followed by esophagectomy, more sophisticated prognostic classification should be developed for the ypTNM staging system in these patients.
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Affiliation(s)
- Jihoon Kang
- Department of Oncology, Republic of Korea; Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han Pil Lee
- Department of Oncology, Republic of Korea; Thoracic and Cardiovascular Surgery, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Kyung-Ja Cho
- Pathology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Yong-Hee Kim
- Thoracic and Cardiovascular Surgery, Republic of Korea.
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21
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Guo YN, Tian DP, Gong QY, Huang H, Yang P, Chen SB, Billan S, He JY, Huang HH, Xiong P, Lin WT, Guo D, Marom M, Gil Z, Su M. Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2020; 27:4371-4381. [PMID: 32519146 DOI: 10.1245/s10434-020-08667-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) at pN0M0 can be more locally aggressive and disseminated than those with lymph node and distant metastasis. Perineural invasion (PNI) is reported as a poor prognostic factor in cancer and is thought to be related to regional tumor spread and metastasis. However, its clinicopathological role and meaning for treatment in pN0M0 ESCC are unknown. PATIENTS AND METHODS We applied scoring methods of PNI and lymphatic and vascular invasion (LI, VI) based on immunohistochemistry staining on tumor tissues of pN0M0 ESCC patients. ROC analyses, Kaplan-Meier analyses, Cox regression, and χ2 test were performed for survival analysis, comparison of PNI with LI and VI, and exploration of the relevance between PNI and other clinicopathological features. RESULTS Presence of PNI was significantly associated with poor survival in pN0M0 patients, whereas LI and VI were not predictive of outcome (P > 0.05). Neural invasion index (NII), defined as the ratio of the number of tumor-invaded nerves to the total number of nerves per tumor microsection, was the most consistent measure of PNI (P = 0.006, HR = 6.892, 1.731-27.428). Postoperative radiotherapy significantly improved survival in high-NII patients (P = 0.035, HR = 0.390, 0.163-0.936). CONCLUSIONS PNI is an important risk factor for the outcome of pN0M0 ESCC patients. NII can be used for risk assessment and to tailor adjuvant radiotherapy in this population.
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Affiliation(s)
- Yuan-Ning Guo
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Dong-Ping Tian
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Qing-Yun Gong
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Hao Huang
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Peng Yang
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Shao-Bin Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Salem Billan
- The Radiation Oncology Institute, The Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel
| | - Jia-Yu He
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Hai-Hua Huang
- Department of Pathology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Pan Xiong
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Wen-Ting Lin
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Dan Guo
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Moshe Marom
- Guangdong Dynavolt Renewable Energy Technology, Shantou, China
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, The Head and Neck Center, Department of Otolaryngology Head and Neck Surgery, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Min Su
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China.
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22
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Hsu CP, Chuang CY, Hsu PK, Chien LI, Lin CH, Yeh YC, Hsu HS, Wu YC. Lymphovascular Invasion as the Major Prognostic Factor in Node-Negative Esophageal Cancer After Primary Esophagectomy. J Gastrointest Surg 2020; 24:1459-1468. [PMID: 31273552 DOI: 10.1007/s11605-019-04310-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies addressing both lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with esophageal squamous cell carcinoma (ESCC) treated with or without neoadjuvant therapy are limited. We aimed to analyze the incidence and prognostic significance of LVI and PNI in patients with thoracic ESCC. METHODS This retrospective study included 520 patients with ESCC: 174 patients after neoadjuvant treatment followed by surgery and 346 after primary esophagectomy, from two medical centers. The relationships between LVI, PNI, and other histological factors were evaluated. The Cox regression model was used for survival analysis. RESULTS Positive LVI and PNI were noted in 35.6% and 22.4% of patients with residual primary tumor after neoadjuvant treatment and in 39.6% and 24.0% of patients who underwent primary esophagectomy, respectively. In patients with neoadjuvant treatments, the 5-year overall survival rates were 12.7% and 28.3% in patients with positive LVI and negative LVI, respectively (p = 0.001). The 5-year overall survival rates were 6.4% and 29.9% in patients with positive PNI and negative PNI, respectively (p < 0.001). In patients who did not receive neoadjuvant treatment, the 5-year overall survival rates were 28.2% and 61.1% in patients with positive LVI and negative LVI, respectively (p < 0.001). The 5-year overall survival rates were 30.2% and 52.5% in patients with positive PNI and negative PNI (p < 0.001). In subgroup analysis, the presence of PNI was an independent prognostic factor in patients with neoadjuvant treatments, whereas the presence of LVI had more significant prognostic impact in patients with node-negative ESCC after primary esophagectomy. CONCLUSIONS Both LVI and PNI statuses are significant prognostic factors for patients with ESCC. However, the prognostic impact of LVI was majorly in the subgroup of node-negative patients who received primary esophagectomy.
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Affiliation(s)
- Chung-Ping Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Thoracic Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Chung-Yang Rd., 970, Hualien, Taiwan.
| | - Cheng-Yen Chuang
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Kuei Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Shui Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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23
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Griffin N, Rowe CW, Gao F, Jobling P, Wills V, Walker MM, Faulkner S, Hondermarck H. Clinicopathological Significance of Nerves in Esophageal Cancer. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1921-1930. [PMID: 32479822 DOI: 10.1016/j.ajpath.2020.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
Nerves are emerging promoters of cancer progression, but the innervation of esophageal cancer and its clinicopathologic significance remain unclear. In this study, nerves were analyzed by immunohistochemistry in a cohort of 260 esophageal cancers, including 40 matched lymph node metastases and 137 normal adjacent esophageal tissues. Nerves were detected in 38% of esophageal cancers and were more associated with squamous cell carcinomas (P = 0.04). The surrounding or invasion of nerves by cancer cells (perineural invasion) was detected in 12% of esophageal cancers and was associated with reduced survival (P = 0.04). Nerves were found to express the following receptors for nerve growth factor (NGF): neurotrophic receptor tyrosine kinase 1 and nerve growth factor receptor. An association was suggested between high production of NGF by cancer cells and the presence of nerves (P = 0.02). In vitro, NGF production in esophageal cancer cells was shown by Western blot, and esophageal cancer cells were able to induce neurite outgrowth in the PC12 neuronal cells. The neurotrophic activity of esophageal cancer cells was inhibited by anti-NGF blocking antibodies. Together, these data suggest that innervation is a feature in esophageal cancers that may be driven by cancer cell-released NGF.
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Affiliation(s)
- Nathan Griffin
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Christopher W Rowe
- Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia; Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Fangfang Gao
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Phillip Jobling
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Vanessa Wills
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Marjorie M Walker
- Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia; Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sam Faulkner
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Hubert Hondermarck
- Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia.
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24
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Tumor SUVs on 18F-FDG PET/CT and Aggressive Pathological Features in Esophageal Squamous Cell Carcinoma. Clin Nucl Med 2020; 45:e128-e133. [PMID: 31977480 DOI: 10.1097/rlu.0000000000002926] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Considerable discrepancies are observed between clinical staging and pathological staging after surgical resection in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the relationships between tumor SUVs on FDG PET/CT and aggressive pathological features in resected ESCC patients. METHODS A total of 220 patients with surgically resected clinical stage I-II ESCC without neoadjuvant treatment were retrospectively analyzed. SUVmax of the primary tumor was measured on pretreatment FDG PET/CT. Pathological features included depth of tumor invasion, lymph node metastasis, tumor differentiation, lymphatic vessel tumor embolus, perineural invasion, Ki-67 index, and p53 protein expression. Receiver operating characteristic curve analysis was used to determine an optimal cutoff of SUVmax to predict pathologically advanced disease. Differences in pathological features associated with SUVmax were examined by t test or χ test. RESULTS The number of patients upstaged from clinical stage I-II to pathological stage III-IV was 43 (19.5%). Receiver operating characteristic curve analysis showed that the optimal cutoff SUVmax of 4.0 had good performance for predicting locally advanced disease (area under the receiver operating characteristic curve = 0.844, P < 0.001). Higher tumor SUVmax was significantly associated with advanced depth of tumor invasion (deeper than submucosa, P < 0.001), positive lymph node metastasis (P < 0.001), presence of lymphatic vessel tumor embolus (P < 0.001), presence of perineural invasion (P < 0.001), higher Ki-67 index (P = 0.025), and poor tumor differentiation (P = 0.039). CONCLUSIONS SUVmax measured on pretreatment FDG PET/CT is significantly associated with aggressive pathological features and may help clinicians identify patients at risk of advanced disease.
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25
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Sang C, Chao C, Wang M, Zhang Y, Luo G, Zhang X. Identification and validation of hub microRNAs dysregulated in esophageal squamous cell carcinoma. Aging (Albany NY) 2020; 12:9807-9824. [PMID: 32412911 PMCID: PMC7288914 DOI: 10.18632/aging.103245] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/17/2020] [Indexed: 12/21/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the deadliest cancers worldwide, and its morbidity is exacerbated by the lack of early symptoms. Bioinformatics analyses enable discovery of differentially expressed genes and non-protein-coding RNAs of potential prognostic and/or therapeutic relevance in ESCC and other cancers. Using bioinformatics tools, we searched for dysregulated miRNAs in two ESCC microarray datasets from the Gene Expression Omnibus (GEO) database. After identification of three upregulated and five downregulated miRNAs shared between databases, protein-protein interaction (PPI) network analysis was used to identify the top 10 hub-gene targets. Thereafter, a miRNA-gene interaction network predicted that most hub genes are regulated by miR-196a-5p and miR-1-3p, which are respectively upregulated and downregulated in ESCC. Functional enrichment analyses in the GO and KEGG databases indicated the potential involvement of these miRNAs in tumorigenesis-related processes and pathways, while both differential expression and correlation with T stage were demonstrated for each miRNA in a cohort of ESCC patients. Overexpression showed that miR-196a-5p increased, whereas miR-1-3p attenuated, proliferation and invasion in human ESCC cell lines grown in vitro. These findings suggest miR-196a-5p and miR-1-3p jointly contribute to ESCC tumorigenesis and are potential targets for diagnosis and treatment.
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Affiliation(s)
- Chen Sang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Ce Chao
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Min Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Youpu Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Guanghua Luo
- Comprehensive Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
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26
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Patel AK, Pan X, Vila DM, Frankel WL, Chen W, Perry KA, Merritt RE, D'Souza DM, Wuthrick EJ, Williams TM. Perineural invasion predicts for locoregional failure in patients with oesophageal adenocarcinoma treated with neoadjuvant chemoradiotherapy. J Clin Pathol 2020; 74:228-233. [PMID: 32317290 DOI: 10.1136/jclinpath-2020-206424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 11/04/2022]
Abstract
AIM The prognostic significance of perineural invasion (PNI) in oesophageal adenocarcinoma (EAC) is unclear. We examined the association of PNI with clinical outcomes in patients treated with neoadjuvant chemoradiotherapy (nCRT) and surgery. METHODS We performed a single institutional retrospective study. We evaluated the association of PNI with locoregional recurrence-free survival (LRFS), distant metastasis-free survival, disease-free survival (DFS) and overall survival using log-rank and Cox proportional hazard modelling. RESULTS 29 out of 73 patients (40%) had PNI at the time of surgery. The median follow-up was 20.1 months. The median DFS was 18.4 months for patients with PNI vs 41.3 months for patients without PNI (p<0.05). The median LRFS was 23.3 months for patients with PNI and median not reached for patients without PNI (p<0.01). In a multivariate model including age and pathological variables, PNI remained a significant independent predictor of LRFS (HR 0.20, 95% CI 0.07 to 0.60; p=0.004). CONCLUSIONS For patients with EAC treated with nCRT, PNI found at the time of surgery is significantly associated with worse LRFS. Our data support attempts to validate this finding and perhaps testing the role of adjuvant therapy in patients with PNI.
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Affiliation(s)
- Ankur K Patel
- Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Diana M Vila
- Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Wendy L Frankel
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Wei Chen
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kyle A Perry
- Division of General and Gastrointestinal Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert E Merritt
- Division of Thoracic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evan J Wuthrick
- Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Terence M Williams
- Department of Radiation Oncology, Ohio State University James Cancer Hospital, Columbus, Ohio, USA
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27
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Triaca V, Carito V, Fico E, Rosso P, Fiore M, Ralli M, Lambiase A, Greco A, Tirassa P. Cancer stem cells-driven tumor growth and immune escape: the Janus face of neurotrophins. Aging (Albany NY) 2019; 11:11770-11792. [PMID: 31812953 PMCID: PMC6932930 DOI: 10.18632/aging.102499] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/17/2019] [Indexed: 05/12/2023]
Abstract
Cancer Stem Cells (CSCs) are self-renewing cancer cells responsible for expansion of the malignant mass in a dynamic process shaping the tumor microenvironment. CSCs may hijack the host immune surveillance resulting in typically aggressive tumors with poor prognosis.In this review, we focus on neurotrophic control of cellular substrates and molecular mechanisms involved in CSC-driven tumor growth as well as in host immune surveillance. Neurotrophins have been demonstrated to be key tumor promoting signaling platforms. Particularly, Nerve Growth Factor (NGF) and its specific receptor Tropomyosin related kinase A (TrkA) have been implicated in initiation and progression of many aggressive cancers. On the other hand, an active NGF pathway has been recently proven to be critical to oncogenic inflammation control and in promoting immune response against cancer, pinpointing possible pro-tumoral effects of NGF/TrkA-inhibitory therapy.A better understanding of the molecular mechanisms involved in the control of tumor growth/immunoediting is essential to identify new predictive and prognostic intervention and to design more effective therapies. Fine and timely modulation of CSCs-driven tumor growth and of peripheral lymph nodes activation by the immune system will possibly open the way to precision medicine in neurotrophic therapy and improve patient's prognosis in both TrkA- dependent and independent cancers.
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Affiliation(s)
- Viviana Triaca
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), International Campus A. Buzzati-Traverso, Monterotondo Scalo, Rome, Italy
| | - Valentina Carito
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), at Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Elena Fico
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), at Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Pamela Rosso
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), at Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), at Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Paola Tirassa
- Institute of Biochemistry and Cell Biology, National Research Council (CNR), at Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
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28
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Gu J, Xu W, Peng C, Zhu Y, Wang D, Wang X, Li Y, Wei G, Zhang Z, Zhong Y, Zhao S, Shi M, Cheng D, Ying X, Jin J, Chen H. Perineural invasion is related to p38 mitogen-activated protein kinase pathway activation and promotes tumor growth and chemoresistance in pancreatic cancer. J Cell Biochem 2019; 120:11775-11783. [PMID: 30756419 DOI: 10.1002/jcb.28457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/16/2018] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
Metastasis is a key component of cancer progression and is strongly associated with poor prognosis. Perineural invasion is thought to be related to pain, tumor recurrence, and other conditions. However, the exact molecular mechanism is unclear. This study was conducted to identify the key components and signaling pathways involved in the perineural invasion of pancreatic cancer and alterations in the phenotype after the interaction between the dorsal root ganglion (DRG) and pancreatic cancer cells. The results indicated that the p38 mitogen-activated protein kinase signaling pathway was activated after coculture of the DRG and pancreatic cancer cells and lead to the promotion of cell growth and chemoresistance.
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Affiliation(s)
- Jiangning Gu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.,Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chenghong Peng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.,Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Youwei Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.,Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Di Wang
- Department of Scientific Research, Eyes & ENT Hospital of Fudan University, Shanghai, China
| | - Xuelong Wang
- Key Laboratory of Computational Biology, Chinese Academy of Sciences-Max Planck Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Ying Li
- Key Laboratory of Computational Biology, Chinese Academy of Sciences-Max Planck Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Gang Wei
- Key Laboratory of Computational Biology, Chinese Academy of Sciences-Max Planck Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Zhiqiang Zhang
- Key Laboratory of Computational Biology, Chinese Academy of Sciences-Max Planck Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yiming Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.,Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shulin Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Minmin Shi
- Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dongfeng Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiayang Ying
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiabin Jin
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.,Research Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
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Zhong X, Huang G, Ma Q, Liao H, Liu C, Pu W, Xu L, Cai Y, Guo X. Identification of crucial miRNAs and genes in esophageal squamous cell carcinoma by miRNA-mRNA integrated analysis. Medicine (Baltimore) 2019; 98:e16269. [PMID: 31277149 PMCID: PMC6635243 DOI: 10.1097/md.0000000000016269] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is a malignancy that severely threatens human health and carries a high incidence rate and a low 5-year survival rate. MicroRNAs (miRNAs) are commonly accepted as a key regulatory function in human cancer, but the potential regulatory mechanisms of miRNA-mRNA related to ESCC remain poorly understood.The GSE55857, GSE43732, and GSE6188 miRNA microarray datasets and the gene expression microarray datasets GSE70409, GSE29001, and GSE20347 were downloaded from Gene Expression Omnibus databases. The differentially expressed miRNAs (DEMs) and differentially expressed genes (DEGs) were obtained using GEO2R. Gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis for DEGs were performed by Database for Annotation, Visualization and Integrated Discovery (DAVID). A protein-protein interaction (PPI) network and functional modules were established using the STRING database and were visualized by Cytoscape. Kaplan-Meier analysis was constructed based on The Cancer Genome Atlas (TCGA) database.In total, 26 DEMs and 280 DEGs that consisted of 96 upregulated and 184 downregulated genes were screened out. A functional enrichment analysis showed that the DEGs were mainly enriched in the ECM-receptor interaction and cytochrome P450 metabolic pathways. In addition, MMP9, PCNA, TOP2A, MMP1, AURKA, MCM2, IVL, CYP2E1, SPRR3, FOS, FLG, TGM1, and CYP2C9 were considered to be hub genes owing to high degrees in the PPI network. MiR-183-5p was with the highest connectivity target genes in hub genes. FOS was predicted to be a common target gene of the significant DEMs. Hsa-miR-9-3p, hsa-miR-34c-3p and FOS were related to patient prognosis and higher expression of the transcripts were associated with a poor OS in patients with ESCC.Our study revealed the miRNA-mediated hub genes regulatory network as a model for predicting the molecular mechanism of ESCC. This may provide novel insights for unraveling the pathogenesis of ESCC.
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Affiliation(s)
- Xiaowu Zhong
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College
- Translational Medicine Research Center
- Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Guangcheng Huang
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College
| | - Qiang Ma
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College
| | | | - Chang Liu
- Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Wenjie Pu
- Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lei Xu
- Translational Medicine Research Center
| | - Yan Cai
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College
| | - Xiaolan Guo
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College
- Translational Medicine Research Center
- Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
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Han D, Yuan Y, Chai J, Zhang G, Wang L, Ren A, Song P, Fu Z, Yu J. Subclinical Lesions of the Primary Clinical Target Volume Margin in Esophageal Squamous Cell Carcinoma and Association With FDG PET/CT. Front Oncol 2019; 9:336. [PMID: 31114759 PMCID: PMC6503095 DOI: 10.3389/fonc.2019.00336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/11/2019] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: An accurate delineation of the primary clinical target volume (CTVp) in esophageal squamous cell carcinoma (ESCC) significantly affects the outcomes of radiotherapy. However, when basing the CTVp on the primary gross tumor volume, there are no consistent guidelines for the size of the margin. We compared preoperative 18F-fluorodeoxyglucose (FDG) PET/CT images and large slices of resected pathological ESCC specimens for evidence and prediction of subclinical lesions. We also investigated associations between the maximum standardized uptake value (SUVmax), metabolic tumor volumes (MTVs), and lesions to improve estimates of the CTVp. Methods:55 patients underwent FDG PET/CT before surgery, and the SUVmax and MTVs were determined. To ensure that the in situ distances between the primary and secondary tumors were preserved, the esophageal specimens collected during radical surgery were processed to minimize shrinkage, and subclinical lesions were characterized by pathological examination. A 2-dimensional logistic regression model was used to assess the associations between clinicopathological features and microscopic spread of the lesions. Results: Subclinical lesions in pathological specimens were characterized as direct invasion, multicentric occurrence lesions, intra-mural metastasis, vascular invasion, and perineural invasion in 56.4, 40.0, 30.9, 21.8, and 18.2% of patients, respectively. The mean distances of the subclinical lesions from the primary tumor were 0.79 ± 1.28 cm and 0.87 ± 1.00 cm in the cranial and caudal directions, respectively. Together the SUVmax and MTV values could predict the presence of subclinical lesions that were not detectable in PET/CT images. Conclusions: To cover 94.5% of ESCC subclinical lesions in the CTVp, a 3-cm margin along the cranial-caudal axis should be added to the primary gross tumor volume as defined by FDG-PET/CT, as well as a cutoff SUVmax value of 2.5. Although preoperative FDG PET/CT images may not reveal lesions directly, the SUVmax and MTV measurements together could predict their presence.
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Affiliation(s)
- Dali Han
- Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China.,Key Laboratory of Radiation Oncology of Shandong Province, Jinan, China
| | - Yinping Yuan
- Department of Pathology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China
| | - Jie Chai
- Department of General Surgery, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China
| | - Guifang Zhang
- Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China.,Key Laboratory of Radiation Oncology of Shandong Province, Jinan, China
| | - Lili Wang
- Department of Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China
| | - Aijun Ren
- Department of Oncology, Yucheng City People's Hospital, Dezhou, China
| | - Pingping Song
- Department of Thorax Surgery, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China
| | - Zheng Fu
- Department of Nuclear Medicine, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, China.,Key Laboratory of Radiation Oncology of Shandong Province, Jinan, China
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Li X, Li H, Dong X, Wang X, Zhu J, Cheng Y, Fan P. Expression of NF-κB and TLR-4 is associated with the occurrence, progression and prognosis of esophageal squamous cell carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:5850-5859. [PMID: 31949671 PMCID: PMC6963060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/20/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND As a crucial regulator of inflammation and immune responses, the NF-κB transcription factor regulates the transcription of target genes which are closely related with cell survival, cell proliferation, apoptosis, invasion and metastasis. The toll-like receptor (TLR) family is critical in aiding pathogen recognition and the subsequent activation of innate immunity. TLR4, one of the TLR family members, is the main receptor of innate immunity and functions to identify pathogens. However, the significance of the expressions of both NF-κB and TLR-4 in the occurrence, development and prognosis of esophageal squamous cell carcinoma (ESCC) remains unclear. METHODS NF-κB and TLR-4 expressions were analyzed in tissue microarrays made up of low grade intraepithelial neoplasia (LGIN), high grade intraepithelial neoplasia (HGIN), early-stage ESCC, advanced ESCC tissue samples, as well as normal healthy esophageal mucosa. Chi-squared tests and Kaplan-Meier plots were utilized to determine the prognostic values of the NF-κB and TLR-4 expressions. RESULTS We discovered that NF-κB and TLR-4 expressions were progressively increasing from normal esophageal mucosa, LGIN, HGIN and were highest in early-stage ESCC. Interestingly, TLR-4 and NF-κB expressions were attenuated in advanced ESCC tissue. Suppressed expressions of TLR-4 and NF-κB correlated to increasingly malignant ESCC. Additionally, there was a positive correlation between NF-κB and TLR-4 expressions. CONCLUSION TLR-4 and NF-κB are associated with the occurrence, development and malignant evolution of ESCC.
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Affiliation(s)
- Xiang Li
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Haiying Li
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Xiuli Dong
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Xiaoming Wang
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Junhan Zhu
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Yaozhen Cheng
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
| | - Ping Fan
- Department of Pathology, Wuwei Academy of Medical Sciences (Wuwei Tumor Hospital) Wuwei, Gansu, China
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Liu Q, Li W, Yang S, Liu Z. High expression of uPA related to p38MAPK in esophageal cancer indicates poor prognosis. Onco Targets Ther 2018; 11:8427-8434. [PMID: 30568465 PMCID: PMC6278697 DOI: 10.2147/ott.s181701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The aim of the study was to investigate the relationship between urokinase-type plasminogen activator (uPA) and mitogen-activated protein kinase 38 (p38MAPK), and preliminarily analyze their relationship with clinical characteristics of esophageal cancer. Materials and methods Immunohistochemistry and Western blot were used to detect the expressions of uPA and p38MAPK in patients with esophageal cancer. The relationship between them and clinicopathological features was analyzed by chi-squared test and Spearman correlation. Prognosis was performed using Kaplan–Meier and Cox proportional hazard models analysis. Results The expressions of uPA and p38MAPK proteins were significantly higher in esophageal squamous cell carcinoma or adenocarcinoma than in normal esophageal mucosa tissue (both P<0.0001). The expression of uPA was significantly correlated with the depth of invasion of esophageal cancer (P=0.0067), tumor size (P=0.0364), and pathological stage (P<0.0001); p38MAPK expression vs esophageal cancer tissue type (P=0.0043), esophageal cancer infiltration depth (P=0.0097), tumor size (P=0.0015), and pathological stage (P<0.0001). Both were not significantly associated with lymph node staging, gender, age, and esophageal cancer histological type. There was a positive correlation between uPA and p38MAPK expressions (r=0.7301, P=0.0104). Kaplan–Meier analysis showed that the overall survival time of patients with positive expression of uPA or p38MAPK protein was significantly shorter, and the time of recurrence or metastasis of esophageal cancer was significantly earlier in patients with uPA-positive expression. Multivariate analysis of Cox model showed that uPA, p38MAPK, and pathological staging were independent factors influencing survival. Conclusion The expressions of uPA and p38MAPK may play an important role in the progression of esophageal cancer, and there is a close relationship between the two proteins, which may be one of the prognostic indicators.
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Affiliation(s)
- Qilong Liu
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510089, Guangdong, China
| | - Wenfeng Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510089, Guangdong, China
| | - Shibin Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510089, Guangdong, China
| | - Zhaoguo Liu
- Department of General Thoracic Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510089, Guangdong, China,
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Hsu PK, Chien LI, Lin CH, Yeh YC, Chuang CY, Hsu HS, Wu YC, Hsu CP. Impact of perineural invasion as a histopathological prognostic factor in ypStage II/III oesophageal squamous cell carcinoma†. Eur J Cardiothorac Surg 2018; 55:927-933. [DOI: 10.1093/ejcts/ezy380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/05/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Po-Kuei Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Yen Chuang
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Han-Shui Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Ping Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Current choices and prospects in management of postoperative esophageal cancer patients. Asian J Surg 2018; 42:81-84. [PMID: 30121147 DOI: 10.1016/j.asjsur.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 11/21/2022] Open
Abstract
Locally advanced esophageal cancer is usually dealt with multimodal therapies. The current treatment of choice is neoadjuvant chemoradiation with surgery, but several other choices are also available for adenocarcinoma. For example, adjuvant therapy can be added to the patients received upfront surgery or neoadjuvant therapy in certain conditions. However, squamous cell carcinoma has no such flexibility. This article will address the reason to this remarkable difference, also the current evidence and perspective of adjuvant therapy for esophageal squamous cell carcinoma.
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Tsai CY, Yeh CJ, Chao YK, Chang HK, Tseng CK, Liu YH. Perineural invasion through the sheath in posttherapy esophagectomy specimens predicts poor survival in patients with esophageal squamous cell carcinoma. Eur J Surg Oncol 2017; 43:1970-1976. [DOI: 10.1016/j.ejso.2017.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/26/2016] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
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The role of enteric neurons in the development and progression of colorectal cancer. Biochim Biophys Acta Rev Cancer 2017; 1868:420-434. [PMID: 28847715 DOI: 10.1016/j.bbcan.2017.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023]
Abstract
The enteric nervous system (ENS) is the intrinsic neural network of the gastrointestinal tract, which is essential for regulating gut functions and intestinal homeostasis. The importance of the ENS is underscored by the existence of severe gastrointestinal diseases, such as Hirschsprung's disease and intestinal pseudo-obstruction, which arise when the ENS fails to develop normally or becomes dysregulated. Moreover, it is known that enteric neurons are involved in intestinal inflammation. However, the role of the ENS in colorectal cancer (CRC) carcinogenesis remains poorly understood, even though processes like perineural invasion and neoneurogenesis are important factors in CRC. Here we summarize how enteric neurons are affected during CRC and discuss the influence of enteric neurons, either direct or indirect, on the development and/or progression of CRC. Finally, we illustrate how the ENS could be targeted as a potential anti-cancer therapy, establishing the ENS as an integral part of the tumor microenvironment.
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Prognosis and Progression of ESCC Patients with Perineural Invasion. Sci Rep 2017; 7:43828. [PMID: 28256609 PMCID: PMC5335559 DOI: 10.1038/srep43828] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/01/2017] [Indexed: 12/11/2022] Open
Abstract
Perineural invasion (PNI) has been recognized as a poor prognostic factor in several malignancies, but the definition and pathogenesis of PNI in esophageal squamous cell carcinoma (ESCC) remains to be defined. PNI was evaluated by H&E staining and S100 immunohistochemistry. The predictive value of PNI in the prognosis of ESCC patients was analyzed. PNI was evaluated in vitro and in vivo. A total of 54 specimens (17.88%) were defined as PNI-a and 99 specimens (32.78%) as PNI-b. S100 staining was superior to H&E staining for PNI detection (50.66% vs 27.15%, P < 0.001, κ = 0.506). Tumor depth (P = 0.001), tumor stage (P = 0.010), and vascular invasion (P < 0.001) were significantly associated with PNI. PIN-a and PNI-b had significant lower disease free survival (DFS) and disease specific survival (DSS) than PNI-0 patients, and the prognosis of PNI-b patients was significantly worse than PNI-a patients for DFS (P = 0.009). PNI was an independent predictor for DFS and DSS in ESCC as evaluated by univariate and multivariate analyses. ESCC cells could metastasize along the nerve in vitro and in vivo, and PNI was a dynamic process. S100 staining significantly improved the accuracy of PNI detection. PNI was associated with local recurrence and poor prognosis of ESCC patients.
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Jeon J, Lee J, Moon D, Yang H, Kim M, Lee GK, Zo J. Prognostic significance of venous invasion and maximum standardized uptake value of 18F-FDG PET/CT in surgically resected T1N0 esophageal squamous cell carcinoma. Eur J Surg Oncol 2017; 43:471-477. [DOI: 10.1016/j.ejso.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022] Open
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Tu CC, Hsu PK, Chien LI, Liu WC, Huang CS, Hsieh CC, Hsu HS, Wu YC. Prognostic histological factors in patients with esophageal squamous cell carcinoma after preoperative chemoradiation followed by surgery. BMC Cancer 2017; 17:62. [PMID: 28103913 PMCID: PMC5244588 DOI: 10.1186/s12885-017-3063-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background Pathological response is an important marker for tumor aggressiveness in patients with esophageal squamous cell carcinoma (ESCC) who receive preoperative chemoradiation followed by esophagectomy. We aim to evaluate the prognostic value of histological factors after trimodality treatments. Methods 91 patients who received preoperative chemoradiation followed by transthoracic esophagectomy between 2009 and 2014 were included. The pathological examination was reviewed. Overall survival and disease free survival were recorded. Survival analysis was performed using the Cox regression model, and the survival curves were compared by the log-rank test. Results Survival analysis showed lymphovascular invasion (LVI, hazard ratio [HR]: 2.009, p = 0.029), perineural invasion (PNI, HR: 2.226, p = 0.019), ypN stage (HR: 2.041, p = 0.019), extracapsular invasion (ECI, HR: 2.804, p = 0.003), and incomplete resection (HR: 1.897, p = 0.039) as unfavorable prognostic factors affecting overall survival (OS). Moreover, tumor regression grade (TRG, HR: 1.834, p = 0.038), LVI (HR: 1.975, p = 0.038), ECI (HR: 2.836, p = 0.003), and incomplete resection (HR: 2.254, p = 0.007) adversely affected disease-free survival (DFS). Prognostic classification based on poor primary tumor (TRG2/3, LVI(+), and PNI (+)), lymph node (ypN(+) and ECI(+)), and surgical (incomplete resection) factors significantly predicts OS (p = 0.013) and DFS (p = 0.017). However, the use of postoperative adjuvant therapy was not a significant prognostic factor even in medium- and high-risk ESCC patients who underwent trimodality treatments. Conclusions Histological factors, including primary tumor, lymph node, and surgical factors has high prognostic value for predicting outcomes in ESCC patients receiving preoperative chemoradiation followed by surgery.
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Affiliation(s)
- Cheng-Che Tu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Chen Liu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Sheng Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Cheng Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Han-Shui Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Zhang H, Li H, Ma Q, Yang FY, Diao TY. Predicting malignant transformation of esophageal squamous cell lesions by combined biomarkers in an endoscopic screening program. World J Gastroenterol 2016; 22:8770-8778. [PMID: 27818592 PMCID: PMC5075551 DOI: 10.3748/wjg.v22.i39.8770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the association of p53, carcinoembryonic antigen (CEA) and CA19-9 protein expression with esophageal carcinogenesis.
METHODS An iodine staining endoscopic screening program of esophageal lesions was carried out in the high-incidence area of Feicheng County, China. Seventy-seven patients with basal cell hyperplasia (BCH), 247 with low-grade dysplasia (LGD), 51 with high-grade dysplasia (HGD), 134 with invasive cancer, and 80 normal controls diagnosed by mucous membrane biopsy pathology were enrolled. Immunohistochemical detection of p53, CEA and CA19-9 proteins was performed. In the ROC curve analysis, the expression of a single biomarker and the expression of a combination of biomarkers were used to predict the risk of these four esophageal lesions.
RESULTS The positive rates of p53 protein expression in invasive cancer, HGD, LGD, BCH and the normal control groups were 53.0%, 52.9%, 35.6%, 27.3% and 20.0%, respectively; the positive rates of CA19-9 protein expression were 44.0%, 33.3%, 16.5%, 9.2% and 6.2%, respectively; the positive rates of CEA protein expression were 74.6%, 60.8%, 23.3%, 23.7% and 16.2%, respectively. The positive rates of the combined expression of the three biomarkers were 84.3%, 76.5%, 47.6%, 42.9% and 27.5%, respectively. In the receiver operating characteristic curves of the combination of the three biomarkers, the specificity was 88.8% for the normal controls, and the sensitivity was 58.2% for invasive cancer, 25.5% for HGD, 11.2% for LGD, and 6.5% for BCH.
CONCLUSION p53, CEA and CA19-9 protein expression was correlated with esophageal carcinogenesis, and testing for the combination of these biomarkers is useful for identifying high-risk patients with precancerous lesions.
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Joo YH, Cho KJ, Lee YS, Kim SY, Kim MS. Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma. Acta Otolaryngol 2016; 136:1069-73. [PMID: 27192156 DOI: 10.1080/00016489.2016.1183041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of PNI in HPSCC. METHODS The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI. RESULTS PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001). CONCLUSION Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, the Catholic University of Korea, Seoul, Korea
| | - Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, the Catholic University of Korea, Seoul, Korea
| | - Youn-Soo Lee
- Department of Hospital Pathology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, the Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, the Catholic University of Korea, Seoul, Korea
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Prognostic Value of Perineural Invasion in Esophageal and Esophagogastric Junction Carcinoma: A Meta-Analysis. DISEASE MARKERS 2016; 2016:7340180. [PMID: 27051075 PMCID: PMC4802032 DOI: 10.1155/2016/7340180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/16/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Here we aimed to clarify the prognostic significance of perineural invasion (PNI) in esophageal and esophagogastric junction (EGJ) carcinoma. METHODS A comprehensive literature search for relevant reports published up to July 2015 was performed using Pubmed and Embase databases. The pooled HR and 95% CI for overall survival (OS) and disease-free survival (DFS) were used to assess the prognostic value. The association of PNI with pathological characteristics was evaluated by OR and 95% CI. RESULTS A total of 13 cohorts were retrieved, covering 2770 patients treated by surgery. The cumulative analysis revealed a statistical correlation between PNI and poor OS (HR = 1.76, 95% CI: 1.54-2.20, and P < 0.00001), as well as poor DFS (HR = 1.96, 95% CI: 1.42-2.71, and P < 0.001). Moreover, analysis of 1475 patients showed improved PNI in T3 + T4 (OR = 0.39, 95% CI: 0.21-0.70, and P = 0.002), N+ (OR = 0.52, 95% CI: 0.40-0.69, and P < 0.00001), and G3 + G4 (OR = 0.66, 95% CI: 0.48-0.90, and P = 0.008) patients compared with T1 + T2, N-, and G1 + G2 ones, respectively. No significant heterogeneity was found between the studies. CONCLUSIONS PNI is an adverse prognostic biomarker in esophageal and EGJ carcinoma. Moreover, PNI implies advanced T, N stage and poor cell differentiation.
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Overexpression of Suprabasin is Associated with Proliferation and Tumorigenicity of Esophageal Squamous Cell Carcinoma. Sci Rep 2016; 6:21549. [PMID: 26899563 PMCID: PMC4761926 DOI: 10.1038/srep21549] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/27/2016] [Indexed: 12/27/2022] Open
Abstract
Suprabasin is a recently identified oncoprotein that is upregulated in multiple cancers. However, the clinical significance and biological role of suprabasin in human esophageal squamous cell carcinoma (ESCC) remains unclear. In the current study, we reported that suprabasin was markedly overexpressed in ESCC cell lines and tissues at both mRNA and protein levels, and this was associated with advanced clinical stage, tumor-nodes-metastasis (TNM) classification, histological differentiation, tumor size and poorer survival. Furthermore, we found that both proliferation and tumorigenicity of ESCC cells were significantly induced by suprabasin overexpression, but inhibited by suprabasin knock-down. Moreover, we demonstrated that upregulation of suprabasin activated the Wnt/β-catenin signaling pathway and led to nuclear localization of β-catenin and upregulation of Cyclin D1 and c-Myc. Together, our results suggest that suprabasin plays an important oncogenic role in promoting proliferation and tumorigenesis of ESCC.
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Han D, Yuan Y, Song X, Yu Y, Yu J. What Is the Appropriate Clinical Target Volume for Esophageal Squamous Cell Carcinoma? Debate and Consensus Based on Pathological and Clinical Outcomes. J Cancer 2016; 7:200-6. [PMID: 26819644 PMCID: PMC4716853 DOI: 10.7150/jca.13873] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/18/2015] [Indexed: 11/12/2022] Open
Abstract
Accurate delineation of clinical target volume (CTV) is critical in the effective management of squamous cell carcinoma (SCC) of esophagus using radiation therapy. Accurate delineation may improve the probability of local control and reduce the risk of complications. However, there are no consistent standards on the proper size of the margins added to the gross tumor volume (GTV). Different institutions and radiation oncologists have discordant opinions. In this paper, we review pathological and clinical outcomes to determine the most appropriate CTV for squamous cell carcinomas (SCC) of esophagus. The CTV for esophageal carcinoma should ensure that all subclinical lesions are encompassed regardless of the physical distance. The most precise method for delineating a reasonable CTV is to combine advanced imaging techniques, such as PET/CT and EUS, which allows the detection and prediction of subclinical lesions based on tumor characteristics such as the pathological type, differentiation, T disease, length and lymph node status.
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Affiliation(s)
- Dali Han
- 1. Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, Shandong Province, China.; 3. Shandong Province Key Laboratory of Radiation Oncology, Jinan, Shandong Province, China
| | - Yinping Yuan
- 2. Department of Pathology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, Shandong Province, China.; 3. Shandong Province Key Laboratory of Radiation Oncology, Jinan, Shandong Province, China
| | - Xuqing Song
- 4. Department of Radiation Oncology, Jining Cancer Hospital, Jining, Shandong Province, China
| | - Yonghua Yu
- 1. Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, Shandong Province, China.; 3. Shandong Province Key Laboratory of Radiation Oncology, Jinan, Shandong Province, China
| | - Jinming Yu
- 1. Department of Radiation Oncology, Shandong University Affiliated Shandong Cancer Hospital and Institute, Jinan, Shandong Province, China.; 3. Shandong Province Key Laboratory of Radiation Oncology, Jinan, Shandong Province, China
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Shaikh T, Zaki MA, Dominello MM, Handorf E, Konski AA, Cohen SJ, Shields A, Philip P, Meyer JE. Patterns and predictors of failure following tri-modality therapy for locally advanced esophageal cancer. Acta Oncol 2015; 55:303-8. [PMID: 26581671 DOI: 10.3109/0284186x.2015.1110252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy. MATERIALS AND METHODS We retrospectively reviewed patients who underwent chemoradiation followed by esophagectomy between 2006 and 2011 at two NCI-designated cancer centers. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher's exact test, non-parametric Wilcoxon rank-sum test, and multiple logistic regression. Kaplan-Meier curves were generated for relapse-free survival (RFS) and overall survival. RESULTS A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). There were a total of six (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes (LN) assessed (p = 0.01) and close/positive margins (p < 0.01). Regional nodal failure was correlated with fewer LN assessed (p < 0.01) and larger pretreatment tumor size (p = 0.04). Patients with ≤13 LN evaluated had an inferior locoregional RFS versus patients with >13 LN evaluated (p = 0.003). Distant recurrence was correlated with higher pathologic nodal stage (p < 0.001), ulceration (p = 0.017), perineural invasion (p = 0.029), residual disease (p = 0.004), and higher post-treatment PET SUV max (p = 0.049). Patients with a pathologic complete response (OR 0.19, 95% CI 0.05-0.68) were less likely to experience distant recurrence. CONCLUSION Tumor and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.
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Affiliation(s)
- Talha Shaikh
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A. Zaki
- Department of Radiation Oncology, Wayne State University, Detroit, MI, USA
| | | | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andre A. Konski
- Department of Radiation Oncology, University of Pennsylvania, Chester, PA, USA
| | - Steven J. Cohen
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Anthony Shields
- Department of Medical Oncology, Wayne State University, Detroit, MI, USA
| | - Philip Philip
- Department of Medical Oncology, Wayne State University, Detroit, MI, USA
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Lagarde SM, Phillips AW, Navidi M, Disep B, Immanuel A, Griffin SM. The presence of lymphovascular and perineural infiltration after neoadjuvant therapy and oesophagectomy identifies patients at high risk for recurrence. Br J Cancer 2015; 113:1427-33. [PMID: 26554656 PMCID: PMC4815887 DOI: 10.1038/bjc.2015.354] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 12/16/2022] Open
Abstract
Background: In patients treated for oesophageal cancer the importance of lymphovascular and perineural invasion (PNI) after neoadjuvant therapy has yet to be established. The aim of this study was to assess the incidence and prognostic significance of these factors in a consecutive series of patients with cancer of the oesophagus or gastro-oesophageal junction (GOJ) who underwent neoadjuvant therapy followed by oesophagectomy. Methods: Clinical and pathology results from patients with potentially curable adenocarcinoma, or squamous cell carcinoma of the oesophagus or GOJ were reviewed. Patients were treated with neoadjuvant chemotherapy or chemoradiation followed by transthoracic oesophagectomy and two-field lymphadenectomy. The presence of venous invasion (VI), lymph vessel invasion (LI) and perineural invasion (PNI) were correlated with clinical outcomes. Results: A total of 396 patients underwent oesophagectomy after neoadjuvant therapy for oesophageal cancer. Venous invasion was identified in 150 (38%) of patients, LI in 203 (51%) patients and PNI in 204 (52%) patients. In all, 123 (31%) patients had no evidence of either VI, LI or PNI. A total of 96 (24%) had a combination of two factors and 94 (24%) had all three factors. The presence of VI, LI and PNI was significantly related to tumour stage (P=0.001). Median overall survival was 170.8 months when all three factors were absent, 44.0 months when one factor was present, 27.1 months when two factors were present and 16.0 months when all were present. Multivariate analyses revealed VI, LI and PNI or a combination of these factors were independent predictors of prognosis. Conclusions: In oesophageal cancer patients treated with neoadjuvant therapy followed by oesophagectomy the presence of VI, LI and PNI has an important prognostic impact and may identify patients at high risk of recurrence who would benefit from adjuvant therapies.
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Affiliation(s)
- S M Lagarde
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
| | - A W Phillips
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
| | - M Navidi
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
| | - B Disep
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
| | - A Immanuel
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
| | - S M Griffin
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne NE1 4LP, UK
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Sheng L, Ji Y, Du X. Perineural invasion correlates with postoperative distant metastasis and poor overall survival in patients with PT1-3N0M0 esophageal squamous cell carcinoma. Onco Targets Ther 2015; 8:3153-7. [PMID: 26604784 PMCID: PMC4629978 DOI: 10.2147/ott.s90909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to determine the prognostic value of perineural invasion (PNI) in patients with PT1-3N0M0 esophageal squamous cell carcinoma (ESCC) who underwent curative resection. A total of 148 patients with PT1-3N0M0 ESCC, who underwent surgery in Zhejiang Cancer Hospital (Hangzhou, People's Republic of China), between 2006 and 2009, were evaluated in this retrospective study. The effects of PNI on distant metastasis-free survival (DMFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. Independent prognostic factors were identified by multivariate Cox analysis. Positive PNI was identified in 25.0% of all the cases. The depth of invasion (PT stage) was closely associated with the PNI positivity (P<0.001). The 5-year DMFS rate and OS rate of the PNI-positive patients were significantly worse than those of the PNI-negative patients (DMFS: 37.2% vs 62.3%, P=0.009; OS: 31.3% vs 74.3%, P,0.001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor for both DMFS (hazard ratio [HR] =2.35, P=0.039) and OS (HR =3.56, P=0.002). Our results suggest that PNI was a predictor of distant metastasis and independently associated with prognosis of patients with PT1-3N0M0 ESCC.
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Affiliation(s)
- Liming Sheng
- Department of Radiotherapy, Zhejiang Cancer Hospital and Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang, People's Republic of China
| | - Yongling Ji
- Department of Radiotherapy, Zhejiang Cancer Hospital and Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang, People's Republic of China
| | - Xianghui Du
- Department of Radiotherapy, Zhejiang Cancer Hospital and Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang, People's Republic of China
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Ning ZH, Zhao W, Li XD, Chen LJ, Xu B, Gu WD, Shao YJ, Xu Y, Huang J, Pei HL, Jiang JT. The status of perineural invasion predicts the outcomes of postoperative radiotherapy in locally advanced esophageal squamous cell carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:6881-6890. [PMID: 26261575 PMCID: PMC4525909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/25/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Prognosis of locally advanced esophageal squamous cell carcinoma (ESCC) remains dismal even after curative resection and adjuvant radiotherapy. New biomarkers for predicting prognosis and treatment outcomes are needed for improved treatment stratification of patients with locally advanced ESCC. The prognostic and treatment predictive significance of perineural invasion (PNI) in the locally advanced ESCC remains unclear. This study aimed to examine the effect of PNI on the outcomes of locally advanced ESCC patients after curative resection with or without postoperative radiotherapy (PORT). PATIENTS AND METHODS We retrospectively reviewed 262 consecutive locally advanced ESCC patients who underwent curative resection. Tumors sections were re-evaluated for PNI by an independent pathologist blinded to the patients' outcomes. Overall survival (OS) and disease-free survival (DFS) were determined using the Kaplan-Meier method; univariate log-rank test and multivariate Cox proportional hazard model were used to evaluate the prognostic value of PNI. RESULTS Finally, 243 patients were analyzed and enrolled into this study, of which 132 received PORT. PNI was identified in 22.2% (54/243) of the pathologic sections. The 5-year DFS was favorable for PNI-negative patients versus PNI-positive patients (21.3% vs. 36.7%, respectively; P = 0.005). The 5-year OS was 40.3% for PNI-negative patients versus 21.7% for PNI-positive patients (P < 0.001). On multivariate analysis, PNI was an independent prognostic factor. In a subset analysis for patients received PORT, PNI was evaluated as a prognostic predictor as well (P < 0.05). In contrast to patients without PORT, PORT couldn't improve the disease recurrence and survival in locally advanced ESCC patients with PNI-positive (P > 0.05). CONCLUSIONS PNI could serve as an independent prognostic factor and prognosticate treatment outcomes in locally advanced ESCC patients. The PNI status should be considered when stratifying high-risk locally advanced ESCC patients for adjuvant radiotherapy. Future prospective study is warranted to confirm our results.
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Affiliation(s)
- Zhong-Hua Ning
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
- Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Wei Zhao
- Department of Pathology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Xiao-Dong Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Lu-Jun Chen
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Bin Xu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Wen-Dong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Ying-Jie Shao
- Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Yun Xu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Jin Huang
- Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Hong-Lei Pei
- Department of Radiation Oncology, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
| | - Jing-Ting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital, Soochow University185 Juqian Road, Changzhou 213003, China
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A versatile orthotopic nude mouse model for study of esophageal squamous cell carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:910715. [PMID: 25834829 PMCID: PMC4365327 DOI: 10.1155/2015/910715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/20/2015] [Indexed: 12/29/2022]
Abstract
Increasing evidence indicates tumor-stromal interactions play a crucial role in cancer. An in vivo esophageal squamous cell carcinoma (ESCC) orthotopic animal model was developed with bioluminescence imaging established with a real-time monitoring platform for functional and signaling investigation of tumor-stromal interactions. The model was produced by injection of luciferase-labelled ESCC cells into the intraesophageal wall of nude mice. Histological examination indicates this orthotopic model is highly reproducible with 100% tumorigenesis among the four ESCC cell lines tested. This new model recapitulates many clinical and pathological properties of human ESCC, including esophageal luminal stricture by squamous cell carcinoma with nodular tumor growth, adventitia invasion, lymphovascular invasion, and perineural infiltration. It was tested using an AKT shRNA knockdown of ESCC cell lines and the in vivo tumor suppressive effects of AKT knockdown were observed. In conclusion, this ESCC orthotopic mouse model allows investigation of gene functions of cancer cells in a more natural tumor microenvironment and has advantages over previous established models. It provides a versatile platform with potential application for metastasis and therapeutic regimen testing.
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50
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Saito S, Morishima K, Ui T, Hoshino H, Matsubara D, Ishikawa S, Aburatani H, Fukayama M, Hosoya Y, Sata N, Lefor AK, Yasuda Y, Niki T. The role of HGF/MET and FGF/FGFR in fibroblast-derived growth stimulation and lapatinib-resistance of esophageal squamous cell carcinoma. BMC Cancer 2015; 15:82. [PMID: 25884729 PMCID: PMC4345039 DOI: 10.1186/s12885-015-1065-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 02/02/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although advanced esophageal squamous-cell carcinoma (ESCC) is treated using a multidisciplinary approach, outcomes remain unsatisfactory. The microenvironment of cancer cells has recently been shown to strongly influence the biologic properties of malignancies. We explored the effect of supernatant from esophageal fibroblasts on the cell growth and chemo-resistance of ESCC cell lines. METHODS We used 22 ESCC cell lines, isolated primary human esophageal fibroblasts and immortalized fibroblasts. We first examined cell proliferation induced by fibroblast supernatant. The effect of supernatant was evaluated to determine whether paracrine signaling induced by fibroblasts can influence the proliferation of cancer cells. Next, we examined the effects of adding growth factors HGF, FGF1, FGF7, and FGF10, to the culture medium of cancer cells. These growth factors are assumed to be present in the culture supernatants of fibroblasts and may exert a paracrine effect on the proliferation of cancer cells. We also examined the intrinsic role of HGF/MET and FGFs/FGFR in ESCC proliferation. In addition, we examined the inhibitory effect of lapatinib on ESCC cell lines and studied whether the fibroblast supernatants affect the inhibitory effect of lapatinib on ESCC cell proliferation. Finally, we tested whether the FGFR inhibitor PD-173074 could eliminate the rescue effect against lapatinib that was induced by fibroblast supernatants. RESULTS The addition of fibroblast supernatant induces cell proliferation in the majority of cell lines tested. The results of experiments to evaluate the effects of adding growth factors and kinase inhibitors suggests that the stimulating effect of fibroblasts was attributable in part to HGF/MET or FGF/FGFR. The results also indicate diversity in the degree of dependence on HGF/MET and FGF/FGFR among the cell lines. Though lapanitib at 1 μM inhibits cell proliferation by more than 50% in the majority of the ESCC cell lines, fibroblast supernatant can rescue the growth inhibition of ESCC cells. However, the rescue effect is abrogated by co-treatment with FGFR inhibitor. CONCLUSION These results demonstrate that cell growth of ESCC depends on diverse receptor tyrosine kinase signaling, in both cell-autonomous and cell-non-autonomous manners. The combined inhibition of these signals may hold promise for the treatment of ESCC.
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Affiliation(s)
- Shin Saito
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Kazue Morishima
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Takashi Ui
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Hiroko Hoshino
- Department of Integrative Pathology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Daisuke Matsubara
- Department of Integrative Pathology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Shumpei Ishikawa
- Department of Genomic Pathology, Medical Research Institute, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-0034, Japan.
| | - Hiroyuki Aburatani
- Division of Genome Science, Research Center for Advanced Science and Technology, University of Tokyo, 4-6-1 Komaba, Meguro, Tokyo, 153-8904, Japan.
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Yoshikazu Yasuda
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
| | - Toshiro Niki
- Department of Integrative Pathology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
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