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Yu Y, Zheng H, Liu L, Li H, Zheng Q, Wang Z, Wu Y, Li J. Predicting Severe Radiation Esophagitis in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Definitive Chemoradiotherapy: Construction and Validation of a Model Based in the Clinical and Dosimetric Parameters as Well as Inflammatory Indexes. Front Oncol 2021; 11:687035. [PMID: 34249736 PMCID: PMC8264773 DOI: 10.3389/fonc.2021.687035] [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: 03/28/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objective Radiation esophagitis (RE) is common in patients treated with radiotherapy (RT) for locally advanced esophageal squamous cell carcinoma (ESCC). We aim to construct a nomogram predicting the severe RE (grade ≥2) in patients with ESCC receiving definitive chemoradiotherapy (dCRT). Materials and Methods Logistic regression was performed to evaluate the risk factors in predicting RE. Nomogram was built based on the multivariate analysis result. The model was validated using the area under the receiver operating curve (ROC) curve (AUC), calibration curves, and decision curve analyses (DCA). Spearman correlation analysis was used to evaluate the correlation between inflammation indexes. Results A total of 547 patients with stage II–IVA ESCC treated with dCRT from the retrospective study were included. Two hundred and thirty-two of 547 patients (42.4%) developed grade ≥2 RE. Univariate analysis indicated that gender (p = 0.090), RT dose (p < 0.001), targeted therapy (p = 0.047), tumor thickness (p = 0.013), lymphocyte-monocyte ratio (LMR, p = 0.016), neutrophil-lymphocyte ratio (NLR, p < 0.001), and platelet-lymphocyte ratio (PLR, p < 0.001) were the significant factors for a higher incidence of RE. In multivariate analysis, RT dose [p < 0.001; odds ratio (OR), 4.680; 95% confidence interval (CI), 2.841–6.709], NLR (p < 0.001; OR, 0.384; 95% CI, 0.239–0.619), and PLR (p < 0.001; OR, 3.539; 95% CI: 2.226–5.626) were independently associated grade ≥2 RE and were involved in the nomogram. ROC curves showed the AUC of the nomogram was 0.714 (95% CI, 0.670–0.757), which was greater than each factor alone (RT dose: 0.615; NLR: 0.596; PLR: 0.590). Calibration curves showed good consistency between the actual observation and the predicted RE. DCA showed satisfactory positive net benefits of the nomogram among most threshold probabilities. Conclusions The study demonstrated that RT dose, NLR, and PLR were independent risk factors for grade ≥2 RE in patients with locally advanced ESCC receiving dCRT. A predictive model including all these factors was built and performed better than it based on each separately. Further validation in large patient populations is still warranted.
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Affiliation(s)
- Yilin Yu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hongying Zheng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lingyun Liu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hui Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Qunhao Zheng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhiping Wang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yahua Wu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
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Zhu H, Pan W, Chen Y, Chen H, Zuo Y, Sun X. What Is the Optimal Radiotherapy Target Size for Non-Operable Esophageal Cancer? A Meta-Analysis. Oncol Res Treat 2019; 42:470-479. [PMID: 31344698 DOI: 10.1159/000501594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022]
Abstract
Definitive radiotherapy has an affirmative role in treating non-operable esophageal cancer; however, the controversy between elective lymph node irradiation (ENI) and involved-field irradiation (IFI) still remains. To ascertain the benefits and disadvantages of the two radiation target volumes, we performed a meta-analysis with 7 related publications. According to our findings, patients treated with ENI and IFI had nearly identical 1, 2, and 3-year survival rates (pooled odds ratio [OR] = 1.004, p = 0.980, and pooled OR = 1.15, p = 0.594, and pooled OR = 0.918, p = 0.679, respectively). Likewise, no significant differences were detected in local recurrence rates (pooled OR = 1.04, p = 0.883), regional recurrence rates (pooled OR = 0.65, p = 0.555), and distant metastasis rates (pooled OR = 1.29, p = 0.309) between the two treatment groups. However, IFI could significantly decrease the incidences of acute radiation esophagitis (pooled OR = 2.30, p = 0.001) and late pneumonia (pooled OR = 2.52, p = 0.04) compared with ENI. This meta-analysis provides evidence that IFI is more feasible for non-operable esophageal cancer than ENI.
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Affiliation(s)
- Huiping Zhu
- Department of Oncology, the Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
| | - Wei Pan
- Department of Oncology, The Second Hospital of Nanjing Jiangning, Nanjing, China
| | - Yong Chen
- Department of Medical Oncology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hui Chen
- Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Zuo
- Department of Oncology, the Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
| | - Xinchen Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China,
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Kiefer T, Krahl D, Hirt C, Völler H, Völkel L, Daeschlein G. Influence of Treatment Caused Impairments on Anxiety and Depression in Patients with Cancer of the Esophagus or the Esophagogastric Junction. J Gastrointest Cancer 2019; 51:30-34. [PMID: 30613926 DOI: 10.1007/s12029-018-00193-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated. METHOD Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed. RESULTS We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0-13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0-15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety. CONCLUSIONS Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Seebad 84, 15562, Rüdersdorf bei, Berlin, Germany.
| | - Dorothea Krahl
- Klinik am See, Seebad 84, 15562, Rüdersdorf bei, Berlin, Germany
| | - Carsten Hirt
- Department of Internal Medicine C, Hematology/Oncology, University of Greifswald, Greifswald, Germany
| | - Heinz Völler
- Klinik am See, Seebad 84, 15562, Rüdersdorf bei, Berlin, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Lorenz Völkel
- Klinik am See, Seebad 84, 15562, Rüdersdorf bei, Berlin, Germany
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
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Retrospective analysis of safety profile of high-dose concurrent chemoradiotherapy for patients with oesophageal squamous cell carcinoma. Radiother Oncol 2018; 129:293-299. [PMID: 30270099 DOI: 10.1016/j.radonc.2018.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the safety profile and efficacy of high-dose (60 Gy) concurrent chemoradiotherapy (CCRT) compared with standard-dose (50.4-54 Gy) CCRT. MATERIALS AND METHODS Patients with oesophageal squamous cell carcinoma (OSCC) undergoing CCRT were eligible for a propensity score matched cohort (1:1 for high dose versus standard dose). Adverse events, local control (LC) and overall survival (OS) were assessed. RESULTS A total of 380 patients with good balance in observed co-variables were enrolled. OS and LC rates of patients receiving high-dose CCRT were significantly higher than those receiving standard-dose CCRT, with the 10-year OS at 24% versus 13.3%, respectively. In contrast, there was a trend towards increased grades 2-3 acute oesophagitis toxicity among patients receiving high-dose versus standard-dose CCRT (37.4% versus 27.9%, respectively). None experienced grade 5 acute oesophagitis and grade 4 acute toxicities were rare. Similar rates of late radiation oesophagitis, radiation pneumonitis, gastrointestinal reactions and haematological toxicities were observed between patients receiving high-dose versus standard-dose CCRT. Six patients (3.2%) receiving high-dose CCRT experienced >grade 3 leucocytopaenia, and two (1.1%) received standard-dose CCRT, whereas none experienced >grade 3 thrombocytopaenia or anaemia. Three patients (2.3%) receiving high-dose CCRT died of infections caused by myelosuppression. Multivariate analysis showed that anaemia is a significant independent predictor of poor prognosis. CONCLUSIONS Compared with standard-dose CCRT, high-dose CCRT yielded more favourable local control and survival outcomes for patients with OSCC. Grades 2-3 acute oesophagitis toxicity in patients undergoing high-dose CCRT increased, whereas severe, life-threatening toxicities (>grade 3) did not.
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Luo Y, Mao Q, Wang X, Yu J, Li M. Radiotherapy for esophageal carcinoma: dose, response and survival. Cancer Manag Res 2017; 10:13-21. [PMID: 29343986 PMCID: PMC5749557 DOI: 10.2147/cmar.s144687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Esophageal cancer (EC) is an extremely aggressive, lethal malignancy that is increasing in incidence worldwide. At present, definitive chemoradiotherapy is accepted as the standard treatment for locally advanced EC. The EC guidelines recommend a radiation dose of 50.4 Gy for definitive treatment, yet the outcomes for patients who have received standard-dose radiotherapy remain unsatisfactory. However, some studies indicate that a higher radiation dose could improve local tumor control, and may also confer survival benefits. Some studies, however, suggest that high-dose radiotherapy does not bring survival benefit. The available data show that most failures occurred in the gross target volume (especially in the primary tumor) after definitive chemoradiation. Based on those studies, we hypothesize that at least for some patients, more intense local therapy may lead to better local control and survival. The aim of this review is to evaluate the radiation dose, fractionation strategies, and predictive factors of response to therapy in functional imaging for definitive chemoradiotherapy in esophageal carcinoma, with an emphasis on seeking the predictive model of response to CRT and trying to individualize the radiation dose for EC patients.
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Affiliation(s)
- Yijun Luo
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Qingfeng Mao
- School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences.,Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaoli Wang
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Jinming Yu
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Minghuan Li
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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Kiefer T, Krahl D, Osthoff K, Thuss-Patience P, Bunse J, Adam U, Jansen MH, Ott R, Pfitzmann R, Pross M, Kohlmann T, Daeschlein G, Buhlert H, Völler H, Hirt C. Importance of Pancreatic Enzyme Replacement Therapy after Surgery of Cancer of the Esophagus or the Esophagogastric Junction. Nutr Cancer 2017; 70:69-72. [DOI: 10.1080/01635581.2017.1374419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas Kiefer
- Department of Rehabilitation/Internal Medicine, Klinik am See, Rüdersdorf, Germany
| | - Dorothea Krahl
- Department of Rehabilitation/Internal Medicine, Klinik am See, Rüdersdorf, Germany
| | - Kathrin Osthoff
- Department of Rehabilitation/Internal Medicine, Klinik am See, Rüdersdorf, Germany
| | - Peter Thuss-Patience
- Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin-Franklin/Charité, Berlin, Germany
| | - Jörg Bunse
- Department of General and Visceral Surgery, Sana Hospital Lichtenberg, Sana Hospitals Berlin-Brandenburg, Affiliated Teaching, Hospital to the Charité, Berlin, Germany
| | - Ulrich Adam
- Department of Surgery, Humboldt-Klinikum, Berlin, Germany
| | - Marc H. Jansen
- Department of Surgery, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rudolf Ott
- Department of Surgery, Waldkrankenhaus Berlin-Spandau, Berlin, Germany
| | - Robert Pfitzmann
- Department of Surgery, DRK Kliniken, Berlin-Mitte, Berlin, Germany
| | - Matthias Pross
- Department of Surgery, DRK Kliniken Berlin, Köpenick, Berlin, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Methods of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - Hermann Buhlert
- Department of Rehabilitation/Internal Medicine, Klinik am See, Rüdersdorf, Germany
| | - Heinz Völler
- Department of Rehabilitation/Internal Medicine, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Carsten Hirt
- Department of Internal Medicine C, Hematology/Oncology, University of Greifswald, Greifswald, Germany
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7
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Role of Adjuvant Treatment in Esophageal Cancer With Incidental Pathologic Node Positivity. Ann Thorac Surg 2017; 104:267-274. [DOI: 10.1016/j.athoracsur.2017.01.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 11/21/2022]
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8
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Lee A, Khulusi S, Watson R. Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review. J Adv Nurs 2017; 73:2270-2282. [DOI: 10.1111/jan.13308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Amanda Lee
- Faculty of Health Sciences; University of Hull; Hull UK
| | - Sam Khulusi
- Queens Centre for Oncology and Haematology; Cottingham Hull UK
| | - Roger Watson
- Faculty of Health Sciences; University of Hull; Hull UK
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Chen CY, Li CC, Chien CR. Does higher radiation dose lead to better outcome for non-operated localized esophageal squamous cell carcinoma patients who received concurrent chemoradiotherapy? A population based propensity-score matched analysis. Radiother Oncol 2016; 120:136-9. [PMID: 27207358 DOI: 10.1016/j.radonc.2016.04.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/11/2016] [Accepted: 04/28/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The optimal radiotherapy dose for non-operated localized esophageal squamous cell carcinoma (NOL-ESCC) patients undergoing concurrent chemoradiotherapy (CCRT) is hotly debated. METHODS We identified eligible patients diagnosed within 2008-2013 from Taiwan Cancer Registry and constructed a propensity score matched cohort (1:1 for high dose (⩾60Gy) vs standard dose (50-50.4Gy)) to balance observable potential confounders. We compared the hazard ratio (HR) of death between standard and high radiotherapy dose groups during the entire follow-up period. We performed sensitivity analysis (SA) to evaluate the robustness of our finding regarding potential unobserved confounders & index date definition. RESULTS Our study population constituted 648 patients with well balance in observed co-variables. The HR of death when high dose was compared to standard dose was 0.75 (95% confidence interval 0.64-0.88). Our result was sensitive to potential unobserved confounders but robust to alternative index date definition in SA. CONCLUSIONS We found that higher than standard radiotherapy dose may lead to better survival for NOL-ESCC patients undergoing CCRT.
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Affiliation(s)
- Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital, Taiwan
| | - Chia-Chin Li
- Cancer Center, China Medical University Hospital, Taiwan
| | - Chun-Ru Chien
- Cancer Center, Department of Radiation Oncology, China Medical University Hospital; School of Medicine, College of Medicine, China Medical University, Taiwan.
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Haefner MF, Lang K, Krug D, Koerber SA, Uhlmann L, Kieser M, Debus J, Sterzing F. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. JOURNAL OF RADIATION RESEARCH 2015; 56:742-749. [PMID: 25907360 PMCID: PMC4497395 DOI: 10.1093/jrr/rrv022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome.
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Affiliation(s)
- Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Lorenz Uhlmann
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Meinhard Kieser
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Florian Sterzing
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
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11
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Ma G, Zhang X, Ma Q, Rong T, Long H, Lin P, Fu J, Zhang L. A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgical therapy: an observational study. Eur J Surg Oncol 2015; 41:541-7. [PMID: 25659876 DOI: 10.1016/j.ejso.2015.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 12/06/2014] [Accepted: 01/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Identifying patients with esophageal squamous cell carcinoma (ESCC) with negative prognostic factors, which have an extremely low survival rate, has been problematic. METHODS We retrospectively collected clinical data for 648 patients with lymph node-negative ESCC who were treated at the Sun Yat-Sen University Cancer Center from 1990 to 2005. Survival difference was compared using Kaplan-Meier analysis and multivariate Cox regression analysis. RESULTS We identified advancing age, smoking history, alcohol consumption history, decreased forced expiratory volume in 1 s (FEV1), surgical procedure, tumor location, number of resected lymph nodes, poor tumor differentiation, and surgical stage as independent prognostic risk factors. Furthermore, based on the results of multivariate analysis, we constructed a novel scoring system that included the factors of age, smoking history, alcohol consumption history, number of resected lymph nodes, tumor differentiation, and surgical stage. Risk score (RS) was computed with the scoring system, and patients were divided into Class A (RS: 0-5) and Class B (RS: 6-10). P < 0.001 indicated statistical significance. A significant difference (p < 0.001) demonstrated that Class B was strongly related to a low survival rate and poor prognosis. CONCLUSION We developed a new simple flexible scoring system of high prognostic significance, which has the potential to guide postoperative therapeutic strategies and follow-up frequency and to provide better prognostic information for patients and their families.
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Affiliation(s)
- G Ma
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - X Zhang
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - Q Ma
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - T Rong
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - H Long
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - P Lin
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China
| | - J Fu
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China.
| | - L Zhang
- Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, China.
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Sun MM, Zhang MZ, Chen Y, Li SL, Zhang W, Ya GW, Chen KS. Mechanistic target of rapamycin small interfering RNA and rapamycin synergistically inhibit tumour growth in a mouse xenograft model of human oesophageal carcinoma. J Int Med Res 2013. [PMID: 23206445 DOI: 10.1177/030006051204000502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To investigate the effect of mechanistic target of rapamycin (mTOR)-specific small interfering RNA (siRNA) and rapamycin on tumour size and levels of hypoxia inducible factor 1α(HIF-1α), vascular endothelial growth factor (VEGF) and mTOR proteins, and mTOR mRNA, in a mouse xenograft model of human oesophageal carcinoma. METHODS Tumours were induced in BALB/c nude mice using the human oesophageal squamous cell carcinoma cell line, EC1, injected subcutaneously. Animals were divided into four treatment groups (n = 5 per group) after 7 days: control (phosphate buffered saline, daily intraperitoneal [i.p.] injection); 50 μg/kg rapamycin, daily i.p. injection; 3 μg/kg mTOR siRNA, daily i.p. injection; combined mTOR siRNA and rapamycin, daily i.p. injections. Tumour volume was measured 21 days after xenograft. Levels of mTOR, VEGF and HIF-1α were assessed via immunohistochemistry and in situ hybridization. RESULTS mTOR siRNA and/or rapamycin significantly decreased tumour volume and levels of HIF-1α, VEGF and mTOR protein, and mTOR mRNA. Combination treatment was significantly more effective than either treatment alone. CONCLUSIONS mTOR siRNA and/or rapamycin inhibited the growth of oesophageal carcinoma in vivo. This may represent a novel and effective treatment strategy for oesophageal carcinoma.
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Affiliation(s)
- M M Sun
- Department of Oncology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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