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Li Z, Li Y, Liu X, Zheng Y, Sun H, Liang G, Wang Z, Xing W. Stratification of lymph node metastasis improves diagnostic efficiency in thoracic esophageal squamous cell carcinoma. Dis Esophagus 2023; 36:doad017. [PMID: 37013856 DOI: 10.1093/dote/doad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Difference of the short diameter of lymph nodes in the main regions of esophageal squamous cell carcinoma (ESCC) and its value in the diagnosis of lymph nodes need to explore. METHODS The clinical data of patients with thoracic ESCC who underwent surgical treatment in our hospital were collected. The short diameters of the largest lymph node in each region of the patient were measured by preoperative enhanced computed tomography (CT) and were compared with the postoperative pathology. RESULTS A total of 477 patients with thoracic ESCC who did not receive neoadjuvant therapy were enrolled in this study. The receiver operating characteristic curve suggested that the short diameters of the paracardial nodes, the left gastric nodes, the right recurrent laryngeal nerve nodes, and the left recurrent laryngeal nerve nodes could well predict the postoperative pathology of the lymph nodes, with area under curve (AUC) of 0.958, 0.937, 0.931, and 0.915, the corresponding cut-off values of 5.7 mm, 5.7 mm, 5.5 mm, and 4.8 mm, the corresponding sensitivities of 94.7%, 85.4%, 88.7%, and 79.4%, and the corresponding specificities of 93.7%, 96.3%, 86.2%, and 95.0%, respectively. The AUC of the thoracic paraesophageal lymph nodes, the subcarinal nodes and all regional lymph nodes were 0.845, 0.688, and 0.776, respectively. CONCLUSION Region-based criterion for lymph node metastasis of thoracic ESCC is beneficial to improve the diagnostic efficiency of preoperative CT.
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Affiliation(s)
- Zhenxuan Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Guanghui Liang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Zongfei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wenqun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Sun S, Yang W, Yang Y, Fan M, Wang F, He L, Han B, Chen C. Nomogram for predicting survival after lymphatic metastasis in esophageal cancer: A SEER analysis. Medicine (Baltimore) 2023; 102:e34189. [PMID: 37543759 PMCID: PMC10402951 DOI: 10.1097/md.0000000000034189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Lymphatic metastasis (LM) is a significant mechanism for the spread of esophageal cancer (EC) and predicts the poor prognosis of EC patients. This research aimed to assess the survival of patients with LM from EC by developing a nomogram. In this retrospective study, EC patients with LM from 2004 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were divided by year of diagnosis into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were employed to determine the prognostic factors of LM, and a nomogram was constructed. The discrimination and calibration of the nomogram were compared by the C-index, area under the curve value, and calibration plots. The survival time difference was compared using Kaplan-Meier curves. A total of 11,695 patients with EC were included in this analysis. LM occurred in 56.5% (n = 6614) of EC patients. In the post-propensity score matching (PSM) cohort, patients with LM had significantly lower median overall survival (OS) than those without LM. Multivariate Cox regression was used to identify the eleven independent prognostic factors. The C-index was 0.709 in both the training and test sets, revealing the good predictive performance of the nomogram. Based on the results of calibration plots and the receiver operating characteristic (ROC) curve, we demonstrate the great performance of the prognostic model. The survival time of EC patients with LM was remarkably lower than that of EC patients without LM. The nomogram model established in this study can precisely predict the survival of EC patients with LM.
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Affiliation(s)
- Shuo Sun
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Wenwen Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Yanjiang Yang
- Qilu hospital of Shandong University, Shandong University, Jinan, Shandong province, China
| | - Mengmeng Fan
- School of Management, Lanzhou University, Lanzhou, Gansu Province, China
| | - Feng Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Li He
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Biao Han
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
- Gansu Province International Cooperation Base for Research and Application of Key Technology of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Chang Chen
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
- Gansu Province International Cooperation Base for Research and Application of Key Technology of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
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Xu YH, Lu P, Gao MC, Wang R, Li YY, Song JX. Progress of magnetic resonance imaging radiomics in preoperative lymph node diagnosis of esophageal cancer. World J Radiol 2023; 15:216-225. [PMID: 37545645 PMCID: PMC10401402 DOI: 10.4329/wjr.v15.i7.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/11/2023] [Accepted: 06/30/2023] [Indexed: 07/24/2023] Open
Abstract
Esophageal cancer, also referred to as esophagus cancer, is a prevalent disease in the cardiothoracic field and is a leading cause of cancer-related mortality in China. Accurately determining the status of lymph nodes is crucial for developing treatment plans, defining the scope of intraoperative lymph node dissection, and ascertaining the prognosis of patients with esophageal cancer. Recent advances in diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging (MRI) have improved the effectiveness of MRI for assessing lymph node involvement, making it a beneficial tool for guiding personalized treatment plans for patients with esophageal cancer in a clinical setting. Radiomics is a recently developed imaging technique that transforms radiological image data from regions of interest into high-dimensional feature data that can be analyzed. The features, such as shape, texture, and waveform, are associated with the cancer phenotype and tumor microenvironment. When these features correlate with the clinical disease outcomes, they form the basis for specific and reliable clinical evidence. This study aimed to review the potential clinical applications of MRI-based radiomics in studying the lymph nodes affected by esophageal cancer. The combination of MRI and radiomics is a powerful tool for diagnosing and treating esophageal cancer, enabling a more personalized and effectual approach.
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Affiliation(s)
- Yan-Han Xu
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Peng Lu
- Department of Imaging, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Ming-Cheng Gao
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Rui Wang
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Yang-Yang Li
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Jian-Xiang Song
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
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Xu L, Guo J, Qi S, Xie HN, Wei XF, Yu YK, Cao P, Zhang RX, Chen XK, Li Y. Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma. Front Oncol 2022; 12:887047. [PMID: 36263210 PMCID: PMC9573997 DOI: 10.3389/fonc.2022.887047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The left tracheobronchial (4L) lymph nodes (LNs) are considered as regional LNs for esophageal squamous cell carcinoma (ESCC), but there is a controversy about routine prophylactic 4L LN dissection for all resectable ESCCs. This study aimed to develop a nomogram for preoperative prediction of station 4L lymph node metastases (LNMs). Methods A total of 522 EC patients in the training cohort and 370 in the external validation cohort were included. The prognostic impact of station 4L LNM was evaluated, and multivariable logistic regression analyses were performed to identify independent risk factors of station 4L LNM. A nomogram model was developed based on multivariable logistic regression analysis. Model performance was evaluated in both cohorts in terms of calibration, discrimination, and clinical usefulness. Results The incidence of station 4L LNM was 7.9% (41/522) in the training cohort. Patients with station 4L LNM exhibited a poorer 5-year overall survival rate than those without (43.2% vs. 71.6%, p < 0.001). In multivariate logistic regression analyses, six variables were confirmed as independent 4L LNM risk factors: sex (p = 0.039), depth of invasion (p = 0.002), tumor differentiation (p = 0.016), short axis of the largest 4L LNs (p = 0.001), 4L conglomeration (p = 0.006), and 4L necrosis (p = 0.002). A nomogram model, containing six independent risk factors, demonstrated a good performance, with the area under the curve (AUC) of 0.921 (95% CI: 0.878–0.964) in the training cohort and 0.892 (95% CI: 0.830–0.954) in the validation cohort. The calibration curve showed a good agreement on the presence of station 4L LNM between the risk estimation according to the model and histopathologic results on surgical specimens. The Hosmer–Lemeshow test demonstrated a non-significant statistic (p = 0.691 and 0.897) in the training and validation cohorts, which indicated no departure from the perfect fit. Decision curve analysis indicated that the model had better diagnostic power for 4L LNM than the traditional LN size criteria. Conclusions This model integrated the available clinical and radiological risk factors, facilitating in the precise prediction of 4L LNM in patients with ESCC and aiding in personalized therapeutic decision-making regarding the need for routine prophylactic 4L lymphadenectomy.
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Affiliation(s)
- Lei Xu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Guo
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shu Qi
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hou-nai Xie
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiu-feng Wei
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-kui Yu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ping Cao
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Rui-xiang Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-kai Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yin Li, ; Xian-kai Chen,
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yin Li, ; Xian-kai Chen,
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Iwata R, Shiomi S, Aikou S, Yagi K, Yamashita H, Seto Y. Optimal settings of near-infrared fluorescence imaging with indocyanine green for intraoperative detection of lymph node metastasis in esophageal cancer. Gan To Kagaku Ryoho 2022; 70:924-929. [PMID: 35951247 DOI: 10.1007/s11748-022-01859-7] [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: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Lymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for intraoperative diagnosis of lymph node metastasis (LNM) in various cancers. Accurate prediction of LNM intraoperatively may allow minimization of the extent of lymphadenectomy. However, a consistent method and diagnostic ability, allowing application of NIR-guided lymphatic flow mapping to esophageal cancer (EC), have not been established due to the multidirectional and complex characteristics of lymphatic flow in the esophagus. Herein, we present a novel NIR-guided surgical technique for predicting lymph node stations potentially containing LNM in EC with high diagnostic accuracy derived from appropriately adjusting the ICG injection setting.
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Affiliation(s)
- Ryohei Iwata
- Department of Gastrointestinal Surgery, Nihon University Hospital, 1-6 Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Shinichiro Shiomi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Susumu Aikou
- Department of Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-0071, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Nihon University Hospital, 1-6 Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Yan Z, Xu X, Lu J, You Y, Xu J, Xu T. Development and validation of a nomogram for prediction of cervical lymph node metastasis in middle and lower thoracic esophageal squamous cell carcinoma. BMC Gastroenterol 2022; 22:163. [PMID: 35369868 PMCID: PMC8978436 DOI: 10.1186/s12876-022-02243-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/28/2022] [Indexed: 01/03/2023] Open
Abstract
Abstract
Background
Estimates of cervical lymph node (LN) metastasis in patients with middle and lower thoracic esophageal squamous cell carcinoma (ESCC) are important. A nomogram is a useful tool for individualized prediction.
Methods
A total of 235 patients were enrolled in this study. Univariate and multivariate analyses were performed to screen for independent risk factors and construct a nomogram to predict the risk of cervical LN metastasis. The nomogram performance was assessed by discrimination, calibration, and clinical use.
Results
Totally, four independent predictors, including the maximum diameter of tumor, paraesophageal lymph node status, recurrent laryngeal nerve lymph node status, and the CT-reported cervical LN status, were enrolled in the nomogram. The AUC of the nomogram model in the training and validation dataset were 0.833 (95% CI 0.762–0.905), 0.808 (95% CI 0.696–0.920), respectively. The calibration curve demonstrated a strong consistency between nomogram and clinical findings in predicting cervical LN metastasis. Decision curve analysis demonstrated that the nomogram was clinically useful.
Conclusion
We developed a nomogram that could be conveniently used to predict the individualized risk of cervical LN metastasis in patients with middle and lower thoracic ESCC.
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Optimal criteria for predicting lymph node metastasis in esophageal squamous cell carcinoma by anatomical location using preoperative computed tomography: a retrospective cohort study. Surg Today 2022; 52:1185-1193. [PMID: 35122521 DOI: 10.1007/s00595-022-02460-4] [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: 10/06/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Predicting lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) is critical for selecting appropriate treatments despite the low accuracy of computed tomography (CT) for detecting LNM. Variation in potential nodal sizes among locations or patients' clinicopathological background factors may impact the diagnostic quality. This study explored the optimal criteria and diagnostic ability of CT by location. METHODS We retrospectively reviewed preoperative CT scans of 229 patients undergoing curative esophagectomy. We classified nodal stations into six groups: Cervical (C), Right-upper mediastinal (UR), Left-upper mediastinal (UL), Middle mediastinal (M), Lower mediastinal (L), and Abdominal (A). We then measured the short-axial diameter (SAD) of the largest lymph node in each area. We used receiver operating characteristics analyses to evaluate the CT diagnostic ability and determined the cut-off values for the SAD in all groups. RESULTS Optimal cut-offs were 6.5 mm (M), 6 mm (C, L, and A), and 5 mm (UR and UL). Diagnostic abilities differed among locations, and UR had the highest sensitivity. A multivariate analysis showed poor differentiation to be an independent risk factor for a false-negative diagnosis (p = 0.044). CONCLUSIONS Optimal criteria and diagnostic abilities for predicting LNM in ESCC varied among locations, and poor differentiation might contribute to failure to detect LNM.
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Everson MA, Garcia-Peraza-Herrera L, Wang HP, Lee CT, Chung CS, Hsieh PH, Chen CC, Tseng CH, Hsu MH, Vercauteren T, Ourselin S, Kashin S, Bisschops R, Pech O, Lovat L, Wang WL, Haidry RJ. A clinically interpretable convolutional neural network for the real-time prediction of early squamous cell cancer of the esophagus: comparing diagnostic performance with a panel of expert European and Asian endoscopists. Gastrointest Endosc 2021; 94:273-281. [PMID: 33549586 DOI: 10.1016/j.gie.2021.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Intrapapillary capillary loops (IPCLs) are microvascular structures that correlate with the invasion depth of early squamous cell neoplasia and allow accurate prediction of histology. Artificial intelligence may improve human recognition of IPCL patterns and prediction of histology to allow prompt access to endoscopic therapy for early squamous cell neoplasia where appropriate. METHODS One hundred fifteen patients were recruited at 2 academic Taiwanese hospitals. Magnification endoscopy narrow-band imaging videos of squamous mucosa were labeled as dysplastic or normal according to their histology, and IPCL patterns were classified by consensus of 3 experienced clinicians. A convolutional neural network (CNN) was trained to classify IPCLs, using 67,742 high-quality magnification endoscopy narrow-band images by 5-fold cross validation. Performance measures were calculated to give an average F1 score, accuracy, sensitivity, and specificity. A panel of 5 Asian and 4 European experts predicted the histology of a random selection of 158 images using the Japanese Endoscopic Society IPCL classification; accuracy, sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Expert European Union (EU) and Asian endoscopists attained F1 scores (a measure of binary classification accuracy) of 97.0% and 98%, respectively. Sensitivity and accuracy of the EU and Asian clinicians were 97%, 98% and 96.9%, 97.1%, respectively. The CNN average F1 score was 94%, sensitivity 93.7%, and accuracy 91.7%. Our CNN operates at video rate and generates class activation maps that can be used to visually validate CNN predictions. CONCLUSIONS We report a clinically interpretable CNN developed to predict histology based on IPCL patterns, in real time, using the largest reported dataset of images for this purpose. Our CNN achieved diagnostic performance comparable with an expert panel of endoscopists.
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Affiliation(s)
| | | | - Hsiu-Po Wang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | | - Ming-Hung Hsu
- Department of Internal Medicine, E-Da Hospital/ I-Shou University, Kaohsiung, Taiwan
| | - Tom Vercauteren
- Department of Interventional Image Computing, Kings College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, United Kingdom
| | - Sergey Kashin
- Department of Gastroenterology, Yaroslavl Oncology Hospital, Yaroslavl, Russian Federation
| | - Raf Bisschops
- Department of Gastroenterology, UZ Leuven, Leuven, Belgium
| | - Oliver Pech
- Department of Gastroenterology, Krankenhaus Barmherzige Bruder, Regensburg, Germany
| | - Laurence Lovat
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/ I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Rehan J Haidry
- University College London Hospitals, London, United Kingdom
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Hagens E, Tukanova K, Jamel S, van Berge Henegouwen M, Hanna GB, Gisbertz S, Markar SR. Prognostic relevance of lymph node regression on survival in esophageal cancer: a systematic review and meta-analysis. Dis Esophagus 2021; 35:6248490. [PMID: 33893494 PMCID: PMC8752080 DOI: 10.1093/dote/doab021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/02/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The prognostic value of histomorphologic regression in primary esophageal cancer has been previously established, however the impact of lymph node (LN) response on survival still remains unclear. The aim of this review was to assess the prognostic significance of LN regression or downstaging following neoadjuvant therapy for esophageal cancer. METHODS An electronic search was performed to identify articles evaluating LN regression or downstaging after neoadjuvant therapy. Random effects meta-analyses were performed to assess the influence of regression in the LNs and nodal downstaging on overall survival. Histomorphologic tumor regression in LNs was defined by the absence of viable cells or degree of fibrosis on histopathologic examination. Downstaged LNs were defined as pN0 nodes by the tumor, node, and metastasis classification, which were positive prior to treatment neoadjuvant. RESULTS Eight articles were included, three of which assessed tumor regression (number of patients = 292) and five assessed downstaging (number of patients = 1368). Complete tumor regression (average rate of 29.1%) in the LNs was associated with improved survival, although not statistically significant (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.26-1.06; P = 0.17). LNs downstaging (average rate of 32.2%) was associated with improved survival compared to node positivity after neoadjuvant treatment (HR = 0.41, 95%CI = 0.22-0.77; P = 0.005). DISCUSSION The findings of this meta-analysis have shown a survival benefit in patients with LN downstaging and are suggestive for considering LN downstaging to ypN0 as an additional prognostic marker in staging and in the comparative evaluation of differing neoadjuvant regimens in clinical trials. No statistically significant effect of histopathologic regression in the LNs on long-term survival was seen.
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Affiliation(s)
- Eliza Hagens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands,Address correspondence to: Mr Sheraz R. Markar, Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, South Wharf Road, London W2 1NY, UK. Tel: +44 (0)207 886 2125; fax: +44 (0)207 8862125; (during review process: )
| | - Karina Tukanova
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sara Jamel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Suzanne Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK,Address correspondence to: Mr Sheraz R. Markar, Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, South Wharf Road, London W2 1NY, UK. Tel: +44 (0)207 886 2125; fax: +44 (0)207 8862125; (during review process: )
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Predicting Lymph Node Metastasis Using Computed Tomography Radiomics Analysis in Patients With Resectable Esophageal Squamous Cell Carcinoma. J Comput Assist Tomogr 2021; 45:323-329. [PMID: 33512851 DOI: 10.1097/rct.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES We investigated the value of radiomics data, extracted from pretreatment computed tomography images of the primary tumor (PT) and lymph node (LN) for predicting LN metastasis in esophageal squamous cell carcinoma (ESCC) patients. MATERIALS AND METHODS A total 338 ESCC patients were retrospectively assessed. Primary tumor, the largest short-axis diameter LN (LSLN), and PT and LSLN interaction term (IT) radiomic features were calculated. Subsequently, the radiomic signature was combined with clinical risk factors in multivariable logistic regression analysis to build various clinical-radiomic models. Model performance was evaluated with respect to the fit, overall performance, differentiation, and calibration. RESULTS A clinical-radiomic model, which combined clinical and PT-LSLN-IT radiomic signature, showed favorable discrimination and calibration. The area under curve value was 0.865 and 0.841 in training and test set. CONCLUSIONS A venous computed tomography radiomic model based on the PT, LSLN, and IT radiomic features represents a novel noninvasive tool for prediction LN metastasis in ESCC.
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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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Li S, Peng D, Yin ZQ, Zhu W, Hu XT, Liu CW. Effect of DEC1 on the proliferation, adhesion, invasion and epithelial-mesenchymal transition of osteosarcoma cells. Exp Ther Med 2020; 19:2360-2366. [PMID: 32104304 DOI: 10.3892/etm.2020.8459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
Differentiated embryonic chondrocyte-expressed gene 1 (DEC1) is associated with various types of human cancer; however, there is limited data regarding the functions of DEC1 in osteosarcoma. The present study aimed to examine the expression of DEC1 in human osteosarcoma tissues and cell lines. Furthermore, the effects of DEC1 on the proliferation, adhesion, invasion and epithelial-mesenchymal transition (EMT) of osteosarcoma cells were investigated. Using reverse transcription-quantitative PCR and western blot analysis, it was found that the expression levels of DEC1 were higher in human osteosarcoma tissues and osteosarcoma cell lines than in the controls. Both gain- and loss-of-function experiments suggested that DEC1 promotes the proliferation, adhesion and invasion of osteosarcoma cells in vitro, as determined by MTT, cell adhesion and cell invasion assays, respectively. Additionally, DEC1 was found to upregulate the mesenchymal markers N-cadherin and vimentin, whilst downregulating the epithelial marker E-cadherin. In conclusion, this present study showed increased expression levels of DEC1 in human osteosarcoma tissues and cell lines, and identified that DEC1 may exert its effect on osteosarcoma progression by promoting cell proliferation, adhesion and invasion. Furthermore, DEC1 was shown to have an inducible effect on EMT in osteosarcoma cell lines, thus contributing to the aggressiveness of osteosarcoma cells. This initial study indicated that DEC1 may serve as a novel molecular target for the treatment of osteosarcoma.
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Affiliation(s)
- Shuai Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Dan Peng
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Zi-Qing Yin
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Wei Zhu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Xuan-Tao Hu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Cong-Wei Liu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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Zhang R, Lau LHS, Wu PIC, Yip HC, Wong SH. Endoscopic Diagnosis and Treatment of Esophageal Squamous Cell Carcinoma. Methods Mol Biol 2020; 2129:47-62. [PMID: 32056169 DOI: 10.1007/978-1-0716-0377-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) is a deadly disease, partly because it is often diagnosed late in disease stage. An accurate early diagnosis by endoscopy could detect advanced carcinoma as well as curable dysplasia and early ESCC. This could save patients from incurable advanced malignancy. Important progress has been made in high-quality endoscopic diagnosis, including magnifying endoscopy, narrowband imaging, and other image enhancement, as well as in techniques in endoscopic resection. These emerging techniques will aid the early diagnosis of ESCC that lead to higher chance of curing the cancer.
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Affiliation(s)
- Ru Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Division of Gastroenterology, Department of Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Louis H S Lau
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter I C Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Hon-Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sunny H Wong
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Bourbonné V, Pradier O, Schick U, Servagi-Vernat S. Cancer of the oesophagus and lymph nodes management in the neoadjuvant or definitive radiochemotherapy setting. Cancer Radiother 2019; 23:682-687. [DOI: 10.1016/j.canrad.2019.07.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
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15
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Li H, Zhang ZR. Current status and future direction of lymph node dissection in radical surgery for esophageal cancer. J Thorac Dis 2019; 11:S1678-S1682. [PMID: 31516741 DOI: 10.21037/jtd.2019.05.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Surgical resection is the main treatment for esophageal cancer. Lymph node dissection is an essential part of radical surgery for esophageal cancer. However, the extent of dissection, numbers of lymph nodes, and sentinel lymph nodes in lymphadenectomy are still under debate. However, a clinical practice consensus has gradually formed despite this dispute.
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Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhi-Rong Zhang
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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16
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Lee JY, Kim YH, Park YJ, Park SB, Chung HW, Zo JI, Shim YM, Lee KS, Choi JY. Improved detection of metastatic lymph nodes in oesophageal squamous cell carcinoma by combined interpretation of fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography. Cancer Imaging 2019; 19:40. [PMID: 31227017 PMCID: PMC6588863 DOI: 10.1186/s40644-019-0225-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Background We sought to evaluate the diagnostic performance of fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the detection of metastatic lymph nodes by combined interpretation of PET/CT images in patients with oesophageal squamous cell carcinoma. Methods Two hundred three patients with oesophageal squamous cell carcinoma underwent 18F-FDG PET/CT before oesophagectomy and lymph node dissection. Maximum standardized uptake value (SUVmax), mean Hounsfield unit (HU), short axis diameter (size), and visual CT attenuation (high, iso-, low) were evaluated on noncontrast CT and PET images following PET/CT scan. In this combined interpretation protocol, the high attenuated lymph nodes were considered benign, even if the SUVmax value was high. The diagnostic accuracy of each method was compared using the postoperative histologic result as a reference standard. Results A total of 1099 nodal stations were dissected and 949 nodal stations were proven to demonstrate metastasis. SUVmax and size of the malignant lymph nodes were higher than those of the benign nodes, and visual CT attenuation was significantly different among the two groups (P < 0.001). Using cutoff values of 2.6 for SUVmax and 10.2 mm for size, the combined interpretation of an SUVmax of more than 2.6 with iso- or low CT attenuation [area under the curve (AUC): 0.846, 95% confidence interval (CI): 0.824–0.867] showed significantly better diagnostic performance for detecting malignant lymph nodes than SUVmax only (AUC: 0.791, 95% CI: 0.766–0.815) and size (AUC: 0.693, 95% CI: 0.665–0.720) methods (P < 0.001) in a receiver operating characteristic curve analysis. Conclusions The diagnostic accuracy of PET/CT for nodal metastasis in oesophageal squamous cell carcinoma was improved by the combined interpretation of 18F-FDG uptake and visual CT attenuation pattern.
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Affiliation(s)
- Ji Young Lee
- Department of Nuclear Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Soo Bin Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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17
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Everson M, Herrera L, Li W, Luengo IM, Ahmad O, Banks M, Magee C, Alzoubaidi D, Hsu HM, Graham D, Vercauteren T, Lovat L, Ourselin S, Kashin S, Wang HP, Wang WL, Haidry RJ. Artificial intelligence for the real-time classification of intrapapillary capillary loop patterns in the endoscopic diagnosis of early oesophageal squamous cell carcinoma: A proof-of-concept study. United European Gastroenterol J 2019; 7:297-306. [PMID: 31080614 PMCID: PMC6498793 DOI: 10.1177/2050640618821800] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Intrapapillary capillary loops (IPCLs) represent an endoscopically visible feature of early squamous cell neoplasia (ESCN) which correlate with invasion depth - an important factor in the success of curative endoscopic therapy. IPCLs visualised on magnification endoscopy with Narrow Band Imaging (ME-NBI) can be used to train convolutional neural networks (CNNs) to detect the presence and classify staging of ESCN lesions. Methods A total of 7046 sequential high-definition ME-NBI images from 17 patients (10 ESCN, 7 normal) were used to train a CNN. IPCL patterns were classified by three expert endoscopists according to the Japanese Endoscopic Society classification. Normal IPCLs were defined as type A, abnormal as B1-3. Matched histology was obtained for all imaged areas. Results This CNN differentiates abnormal from normal IPCL patterns with 93.7% accuracy (86.2% to 98.3%) and sensitivity and specificity for classifying abnormal IPCL patterns of 89.3% (78.1% to 100%) and 98% (92% to 99.7%), respectively. Our CNN operates in real time with diagnostic prediction times between 26.17 ms and 37.48 ms. Conclusion Our novel and proof-of-concept application of computer-aided endoscopic diagnosis shows that a CNN can accurately classify IPCL patterns as normal or abnormal. This system could be used as an in vivo, real-time clinical decision support tool for endoscopists assessing and directing local therapy of ESCN.
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Affiliation(s)
- M Everson
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Lcgp Herrera
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - W Li
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - I Muntion Luengo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - O Ahmad
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - M Banks
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - C Magee
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - D Alzoubaidi
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - H M Hsu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - D Graham
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - T Vercauteren
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - L Lovat
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Ourselin
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, London, UK
| | - S Kashin
- Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - R J Haidry
- Division of Surgery and Interventional Science, University College London (UCL), UK
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
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18
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Li B, Hu H, Zhang Y, Zhang J, Sun Y, Xiang J, Chen H. Esophageal squamous cell carcinoma patients with positive lymph nodes benefit from extended radical lymphadenectomy. J Thorac Cardiovasc Surg 2019; 157:1275-1283.e1. [DOI: 10.1016/j.jtcvs.2018.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/26/2018] [Accepted: 11/10/2018] [Indexed: 01/01/2023]
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Militano V, Muthu S, Farooq N, Sajjan R. First case on fluorodeoxyglucose positron emission tomography/computerized tomography of a distant skip metastases to parotid node from esophageal adenocarcinoma. World J Nucl Med 2018; 17:302-304. [PMID: 30505232 PMCID: PMC6216740 DOI: 10.4103/wjnm.wjnm_82_17] [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] [Indexed: 11/17/2022] Open
Abstract
We are presenting the first case of a gastro-oesophageal junction adenocarcinoma with metastasis only to the intraparotid lymph node simulating Warthin's tumor. A 66-year-old man underwent an esophagogastroduodenoscopy that found circumferential ulcerated esophageal tumor beginning 40 cm from incisors resulting in stricture and two discrete erosions in the proximal third of esophagus. Biopsies from the stricture have demonstrated a poorly differentiated gastric adenocarcinoma. Computerized tomography (CT) confirmed the site of primary without evidence of distant metastasis. Positron emission tomography/CT showed high uptake in the known carcinoma in distal esophagus involving the gastro-oesophageal junction extending into the cardia of the stomach, the maximum standardized uptake value (SUVmax) 7.4. Furthermore, there was a focus of high-grade tracer activity, SUVmax 6.2, in the left intraparotid nodule which was initially thought to represent Warthin's tumor rather than metastasis; there was no evidence to suggest metastases elsewhere. Fine needle aspiration and biopsy from the enlarged intraparotid lymph node revealed that the histology was consistent with a poorly differentiated adenocarcinoma, metastasis from upper gastrointestinal tract.
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Affiliation(s)
- Vincenzo Militano
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Sivakumar Muthu
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Naheed Farooq
- Department of General Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rakesh Sajjan
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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20
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Qin T, Lu XT, Li YG, Liu Y, Yan W, Li N, Sun YY. Effect of Period 2 on the proliferation, apoptosis and migration of osteosarcoma cells, and the corresponding mechanisms. Oncol Lett 2018; 16:2668-2674. [PMID: 30013663 DOI: 10.3892/ol.2018.8952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/30/2018] [Indexed: 12/18/2022] Open
Abstract
Period 2 (per2) is a core circadian clock gene. Dysregulation of the per2 gene has been identified in a number of types of human cancer and may be associated with a poor prognosis. To confirm the influence of per2 gene on MNNG/HOS human osteosarcoma cells, small interfering (si)RNA against per2 or plasmids containing per2 were transfected into MNNG/HOS cells, and the proliferation, apoptosis and migration were observed. The present study demonstrated that per2 knockdown significantly enhanced MNNG/HOS cell proliferation and migration and protected MNNG/HOS cells from apoptosis. Per2 overexpression inhibited MNNG/HOS cell proliferation and migration and promoted apoptosis. Furthermore, the protein expression of phosphorylated (p)-protein kinase B (Akt) and Bcl-2 were inhibited in per2-overexpressing cells, while the expression of p27, p21 and cleaved caspase-3 was promoted. In contrast, the expression of p-Akt and Bcl-2 was promoted in per2-knockdown cells, and p27, p21 and cleaved caspase-3 were decreased. This initial study may provide an alternative therapeutic strategy for the treatment of osteosarcoma.
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Affiliation(s)
- Tao Qin
- Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Xiao-Ting Lu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Yong-Gang Li
- Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Yan Liu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Wenjiang Yan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Na Li
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Yuan-Yuan Sun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
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Barret M, Prat F. Diagnosis and treatment of superficial esophageal cancer. Ann Gastroenterol 2018; 31:256-265. [PMID: 29720850 PMCID: PMC5924847 DOI: 10.20524/aog.2018.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 02/07/2023] Open
Abstract
Endoscopy allows for the screening, early diagnosis, treatment and follow up of superficial esophageal cancer. Endoscopic submucosal dissection has become the gold standard for the resection of superficial squamous cell neoplasia. Combinations of endoscopic mucosal resection and radiofrequency ablation are the mainstay of the management of Barrett’s associated neoplasia. However, protruded, non-lifting or large lesions may be better managed by endoscopic submucosal dissection. Novel ablation tools, such as argon plasma coagulation with submucosal lifting and cryoablation balloons, are being developed for the treatment of residual Barrett’s esophagus, since iatrogenic strictures still hamper the development of extensive circumferential resections in the esophagus. Optimal surveillance modalities after endoscopic resection are still to be determined. The assessment of the risk of lymph-node metastases, as well as of the need for additional treatments based on qualitative and quantitative histological criteria, balanced to the patient’s condition, requires a dedicated multidisciplinary team decision process. The need for trained endoscopists, expert pathologists and surgeons, and specialized multidisciplinary meetings underlines the role of expert centers in the management of superficial esophageal cancer.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Paris, France
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Wang Y, Zhang L, Ye D, Xia W, Jiang J, Wang X, Zhang M, Wang F. A retrospective study of pattern of recurrence after radical surgery for thoracic esophageal carcinoma with or without postoperative radiotherapy. Oncol Lett 2018; 15:4033-4039. [PMID: 29556283 DOI: 10.3892/ol.2018.7807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/11/2018] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to investigate the recurrence pattern of thoracic esophageal cancer (TEC) following radical surgery for guiding postoperative radiotherapy (PRT). Patterns of recurrence were analyzed in patients with recurrence for the first time after radical surgery at the First Affiliated Hospital of Anhui Medical University (Anhui, China) from January 2012 to December 2015. A total of 244 patients were reviewed in the study. The mean recurrence time for patients with PRT was >1 month longer than that for patients without PRT. The lymphatic, anastomotic and hematological recurrence ratios were 87.9 vs. 69.2%, 4.0 vs. 11.5% and 8.0 vs. 17.2%, respectively for patients without and with PRT. The most common recurrence regions were staion1 and station 2-4 (30.0 vs. 36.5% and 37.2% vs. 23.1%, respectively, for patients without and with PRT). The lymphatic recurrence of upper TEC was almost in station1 and station 2-4 (infield). The middle and lower TEC also had a high probability of lymphatic recurrence in station 1 and station 2-4 (totally 76.3 vs. 57.6% and 61.9 vs. 61.1%, respectively). The recurrence ratio significantly decreased in station 2-4 (infield) for middle TEC patients with PRT compared with patients without PRT (P=0.03), while no significant differences in the lymphatic recurrence ratios were observed in other regions (P>0.05). The differences of recurrence ratios in station 7, station 8 and celiac regions (infield) for lower TEC patients without and with PRT also demonstrated no statistical significance (P>0.05). The results of the present study indicated that the lower neck, supraclavicular regions and upper mediastinal regions (station 1, 2 and 4) should be included in the clinic target volume (CTV) for PRT, while lower mediastinal regions, celiac regions and anastomotic may not be included in CTV.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Li Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Dongmei Ye
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wanli Xia
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Jun Jiang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Xiumei Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Mingxia Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Zeng Y, Liang W, Liu J, He J. Endoscopic Treatment Versus Esophagectomy for Early-Stage Esophageal Cancer: a Population-Based Study Using Propensity Score Matching. J Gastrointest Surg 2017; 21:1977-1983. [PMID: 29030780 DOI: 10.1007/s11605-017-3563-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic treatment (ET) is an alternative for selected patients with early-stage esophageal cancer. The primary aim of this study was to compare overall survival (OS) and esophageal cancer-specific survival (ECSS) of such patients after ET or esophagectomy. METHODS Propensity score matching (PSM) and Cox regression analysis were used to compare OS and ECSS of 2661 patients with ET or esophagectomy for early-stage (Tis-T1N0M0) disease. Patient information was retrieved from the Surveillance, Epidemiology, and End Results database. Subgroup analyses by T stage and tumor histology were also performed. RESULTS There were significant differences in age, sex ratio, year of diagnosis, cancer site, cancer stage, differentiation grade, tumor histology, tumor size, lymph nodes examined, and receipt of radiation therapy in the two treatment groups. PSM created 621 patient pairs. Multivariate analysis found no significant differences in OS (HR = 1.216, P = 0.279) or ECSS (HR = 0.692, P = 0.179) in the esophagectomy and ET groups. The results were similar for subgroup analyses limited to stage Tis, T1a, and T1b patients. ET was also associated with similar OS and ECSS in esophageal adenocarcinoma and squamous cell carcinoma patients. CONCLUSION In this population-based study using PSM, patients with stage Tis and T1N0M0 esophageal cancer with ET had OS and ECSS comparable to those treated by esophagectomy after adjusting for clinical variables. The results support ET as an alternative to esophagectomy in early esophageal cancer.
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Affiliation(s)
- Yuan Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
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24
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Liu J, Wang Z, Shao H, Qu D, Liu J, Yao L. Improving CT detection sensitivity for nodal metastases in oesophageal cancer with combination of smaller size and lymph node axial ratio. Eur Radiol 2017; 28:188-195. [PMID: 28677059 DOI: 10.1007/s00330-017-4935-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/03/2017] [Accepted: 06/08/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC). METHODS The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis. RESULTS A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%). CONCLUSION Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC. KEY POINTS • CT is widely used to assess metastatic lymph nodes. • CT has low sensitivity in detecting metastases using conventional criteria. • Diagnostic sensitivity of CT was improved by using lymph node axial ratio. • New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%. • New diagnostic criteria may help clinicians assess patients with oesophageal cancer.
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Affiliation(s)
- Jianfang Liu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.,Capital Medical University Electric Power Teaching Hospital, Beijing, 100027, China
| | - Zhu Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Huafei Shao
- Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, 264000, China
| | - Dong Qu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jian Liu
- Meitan General Hospital, Beijing, 100028, China
| | - Libo Yao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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25
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Rutegård M, Lagergren P, Johar A, Rouvelas I, Lagergren J. The prognostic role of coeliac node metastasis after resection for distal oesophageal cancer. Sci Rep 2017; 7:43744. [PMID: 28256597 PMCID: PMC5335647 DOI: 10.1038/srep43744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/30/2017] [Indexed: 11/09/2022] Open
Abstract
It is uncertain whether coeliac node metastasis precludes long-term survival in distal oesophageal cancer. This nationwide population-based cohort study included patients who underwent surgical resection for stage III or IV distal oesophageal cancer in 1987-2010 with follow-up until 2014. A minority (17.0%) had neoadjuvant therapy. The prognosis in patients with coeliac node metastasis was compared with patients with no such metastasis and patients with more distant metastasis. Multivariable Cox proportional-hazards regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of disease-specific and overall mortality. Among 446 patients, 346 (77.6%) had no coeliac node metastasis, 56 (12.6%) had coeliac node metastasis, and 44 (9.9%) had more distant metastasis. Compared to coeliac node negative patients, coeliac node positive patients were at a 52% increased risk of disease-specific mortality (HR = 1.52, 95% CI 1.10-2.10), while patients with more distant metastasis had a 27% statistically non-significant increase (HR = 1.27, 95% CI 0.88-1.83). Patients with distant metastasis had no increase in disease-specific mortality compared to those with coeliac node metastasis (HR 0.71, 95% CI 0.40-1.27). Thus, patients with distal oesophageal cancer with coeliac node metastasis seem to have a similarly poor survival as patients with more distant metastasis, and thus may not benefit from surgery.
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Affiliation(s)
- Martin Rutegård
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ioannis Rouvelas
- Center for Digestive Diseases, Karolinska University Hospital, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden.,Division of Cancer Studies, King's College London, United Kingdom
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26
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Nakajo M, Kajiya Y, Jinguji M, Nakabeppu Y, Nakajo M, Nihara T, Yoshiura T. Current clinical status of 18F-FLT PET or PET/CT in digestive and abdominal organ oncology. Abdom Radiol (NY) 2017; 42:951-961. [PMID: 27770160 DOI: 10.1007/s00261-016-0947-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) or PET/computed tomography (CT) using 18F-3'-fluoro-3'-deoxythymidine (18F-FLT) offers noninvasive assessment of cell proliferation in human cancers in vivo. The present review discusses the current status on clinical applications of 18F-FLT-PET (or PET/CT) in digestive and abdominal oncology by comparing with 18F-fluorodeoxyglucose (18F-FDG)-PET (or PET/CT). The results of this review show that although 18F-FLT uptake is lower in most cases of digestive and abdominal malignancies compared with 18F-FDG uptake, 18F-FLT-PET can be used to detect primary tumors. 18F-FLT-PET has shown greater specificity for N staging than 18F-FDG-PET which can show false-positive uptake in areas of inflammation. However, because of the high background uptake in the liver and bone marrow, it has a limited role of assessing liver and bone metastases. Instead, 18F-FLT-PET will be a powerful tool for monitoring response to treatment and provide prognostic information in digestive and abdominal oncology.
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Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan.
| | - Yoriko Kajiya
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Megumi Jinguji
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yoshiaki Nakabeppu
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masayuki Nakajo
- Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Tohru Nihara
- Department of Gastroentenology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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28
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Encinas de la Iglesia J, Corral de la Calle MA, Fernández Pérez GC, Ruano Pérez R, Álvarez Delgado A. Esophageal cancer: anatomic particularities, staging, and imaging techniques. RADIOLOGIA 2016; 58:352-65. [PMID: 27469407 DOI: 10.1016/j.rx.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.
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Affiliation(s)
| | | | - G C Fernández Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - R Ruano Pérez
- Servicio de Medicina Nuclear, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Álvarez Delgado
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Mohiuddin K, Dorer R, El Lakis MA, Hahn H, Speicher J, Hubka M, Low DE. Outcomes of Surgical Resection of T1bN0 Esophageal Cancer and Assessment of Endoscopic Mucosal Resection for Identifying Low-Risk Cancers Appropriate for Endoscopic Therapy. Ann Surg Oncol 2016; 23:2673-8. [PMID: 27020584 DOI: 10.1245/s10434-016-5138-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Invasive esophageal cancers have been managed historically with esophagectomy. Low-risk T1b patients are being proposed for nonsurgical management. The purpose of this study was to evaluate the ability of endoscopic mucosal resections (EMR) to identify low-risk T1b patients and to review surgical treatment outcomes for T1b cancer. METHODS All esophageal cancer patients, in an institutional review board-approved prospective database, between 2000 and 2013 with clinical stage (cT1bN0), pathological stage (pT1bN0), and no neoadjuvant therapy were retrospectively reviewed. RESULTS Fifty-one patients, 38 pT1b and 13 cT1b, were assessed. All cT1b had preoperative EMR and five were found to be understaged at esophagectomy. pT1bN0 patients had a mean age of 66 years, mean BMI of 30, and 95 % had adenocarcinoma. Thirty-eight pT1bN0 patients underwent esophagectomy with a median hospital length of stay (LOS) of 9 days. Complications occurred in 14 patients, but 71 % were minor (Accordion score 1-2). In-hospital 30- and 90-day mortality was zero. EMR specimens were re-reviewed to assess low-risk criteria. Degree of differentiation and the presence of lymphovascular invasion could be assessed in all EMR specimens; however, assessment of submucosal invasion limited to the superficial submucosal layer could not be determined in the majority of cases. Kaplan-Meier 5-year overall survival in pT1bN0 patients was 78.7 %. CONCLUSIONS Clinical staging of superficial esophageal cancer can be inaccurate especially in submucosal tumors. EMR should be routinely used for preoperative staging. Healthy patients with clinical tumor stage greater than cT1a should undergo multidisciplinary review and be considered for surgical resection.
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Affiliation(s)
- Kamran Mohiuddin
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Russell Dorer
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Mustapha A El Lakis
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Hejin Hahn
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - James Speicher
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
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30
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Modulation of E-cadherin expression promotes migration ability of esophageal cancer cells. Sci Rep 2016; 6:21713. [PMID: 26898709 PMCID: PMC4761978 DOI: 10.1038/srep21713] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/22/2016] [Indexed: 12/22/2022] Open
Abstract
Losing the E-cadherin plays an important role in the metastasis of cancer. The regulation of the expression of E-cadherin is unclear. Circadian rhythm alteration is associated with the pathogenesis of a number of cancers. This study aims to investigate the role of one of the circadian proteins, period-2 (Per2) in repressing the expression of E-cadherin in esophageal cancer (esophageal cancer). We observed that the levels of circadian protein Per2 were significantly increased and E-cadherin was significantly decreased in the tissue of human esophageal cancer with metastasis as compared with non-metastatic esophageal cancer. Overexpression of Per2 in the esophageal cancer cells markedly repressed the expression of E-cadherin. The pHDAC1 was detected in human esophageal cancer with metastasis, which was much less in the esophageal cancer tissue without metastasis. Overexpression of Per2 increased the levels of pHDAC1 as well as the E-cadherin repressors at the E-cadherin promoter locus. Overexpression of Per2 markedly increased the migratory capacity of esophageal cancer cells, which was abolished by the inhibition of HDAC1. We conclude that Per-2 plays an important role in the esophageal cancer cell metastasis, which may be a novel therapeutic target for the treatment of esophageal cancer.
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31
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Dong Y, Guan H, Huang W, Zhang Z, Zhao D, Liu Y, Zhou T, Li B. Precise delineation of clinical target volume for crossing-segments thoracic esophageal squamous cell carcinoma based on the pattern of lymph node metastases. J Thorac Dis 2016; 7:2313-20. [PMID: 26793353 DOI: 10.3978/j.issn.2072-1439.2015.12.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This work aims to investigate lymph node metastases (LNM) pattern of crossing-segments thoracic esophageal squamous cell carcinoma (ESCC) and its significance in clinical target volume (CTV) delineation. METHODS From January 2000 to December 2014, 3,587 patients with thoracic ESCC underwent surgery including esophagectomy and lymphadenectomy at Shandong Cancer Hospital and Institute. Information of tumor location based on preoperative endoscopic ultrasonography (EUS) and postoperative pathological results were retrospectively collected. The extent of the irradiation field was determined based on LNM pattern. RESULTS Among the patients reviewed, 1,501 (41.8%) were crossing-segments thoracic ESCC patients. The rate of LNM were 12.1%, 15.2%, 8.0%, 3.0%, and 7.1% in neck, upper mediastinum, middle mediastinum, lower mediastinum, and abdominal cavity for patients with upper-middle thoracic ESCC, 10.3%, 8.2%, 11.0%, 4.8%, 8.2% for middle-upper thoracic ESCC, 4.8%, 4.8%, 24.1%, 6.3%, 22.8% for middle-lower thoracic ESCC and 3.9%, 3.1%, 22.8%, 11.9%, 25.8% for lower-middle thoracic ESCC, respectively. The top three sites of LNM were 105 (12.1%), 108 (6.1%), 101 (6.1%) for upper-middle thoracic ESCC, 108 (8.2%), 105 (7.5%), 106 (6.8%) for middle-upper thoracic ESCC, 1 (18.8%), 108 (17.9%), 107 (9.6%) for middle-lower thoracic ESCC, 1 (21.3%), 108 (16.1%), 107 (10.1%) for lower-middle thoracic ESCC. CONCLUSIONS Crossing-segments thoracic ESCC was remarkably common among patients. When delineating their CTV, tumor location should be taken into consideration seriously. For upper-middle and middle-upper thoracic ESCC, abdominal cavity may be free from irradiation. For middle-lower and lower-middle thoracic ESCC, besides irradiation of relative mediastinal, irradiation of abdominal cavity can't be neglected.
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Affiliation(s)
- Yuanli Dong
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Hui Guan
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Wei Huang
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Zicheng Zhang
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Dongbo Zhao
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yang Liu
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Tao Zhou
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Baosheng Li
- 1 Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China ; 2 School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250117, China ; 3 Department of Thoracic Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan 250117, China
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Han Y, Sun S, Guo J, Ge N, Wang S, Liu X, Wang G, Hu J, Wang S. Is endoscopic ultrasonography useful for endoscopic submucosal dissection? Endosc Ultrasound 2016; 5:284-290. [PMID: 27803900 PMCID: PMC5070285 DOI: 10.4103/2303-9027.191606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is an innovative advance in the treatment of early gastrointestinal (GI) cancer without lymph node metastases and precancerous lesions as it is an effective and safe therapeutic method. ESD has also been a promising therapeutic option for removal of submucosal tumors (SMTs) for improving the completeness of resection of a large lesion. Endoscopic ultrasonography (EUS) can be used to detect the depth of invasion during the preoperative evaluation because of its close proximity to the lesion. EUS-guided fine-needle aspiration can be used to increase the diagnostic accuracy of EUS in determining the malignant lymph node. EUS is considered to be a useful imaging procedure to characterize early GI cancer, which is suspicious for submucosal invasion, and the most accurate procedure for detecting and diagnosing SMTs for further treatment. In the process of ESD, EUS can also be used to detect surrounding blood vessels and the degree of fibrosis; this may be helpful for predicting procedure time and decreasing the risk of bleeding and perforation. EUS-guided injection before ESD renders the endoscopic resection safe and accurate. Therefore, EUS plays an important role in the use of ESD. However, compared to conventional endoscopic staging, EUS sometimes can under or overstage the lesion, and the diagnostic accuracy is controversial. In this review, we summarize the latest research findings regarding the role of EUS in ESD.
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Affiliation(s)
- Ye Han
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Jinlong Hu
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Shupeng Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
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Cho JW, Choi SC, Jang JY, Shin SK, Choi KD, Lee JH, Kim SG, Sung JK, Jeon SW, Choi IJ, Kim GH, Jee SR, Lee WS, Jung HY. Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View. Clin Endosc 2014; 47:523-9. [PMID: 25505718 PMCID: PMC4260100 DOI: 10.5946/ce.2014.47.6.523] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/28/2013] [Accepted: 10/05/2013] [Indexed: 12/23/2022] Open
Abstract
One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.
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Affiliation(s)
- Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Suck Chei Choi
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Young Jang
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wan Sik Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cao K, Jiang W, Cao P, Zou Q, Xiao S, Zhou J, Huang C. Talen-mediated girdin knockout downregulates cell proliferation, migration and invasion in human esophageal carcinoma ECA109 cells. Mol Med Rep 2014; 10:848-54. [PMID: 24865549 DOI: 10.3892/mmr.2014.2268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/15/2014] [Indexed: 11/06/2022] Open
Abstract
Girdin is an actin-binding Akt substrate that is involved in the regulation of cell migration. Accumulating evidence has revealed that girdin has regulatory effects on invasion and metastasis in several types of cancer. However, the role of girdin in esophageal squamous cell carcinomas (ESCCs) is yet to be investigated. In the present study, tissue microarray data revealed that among 95 cases of ESCC, 27 cases (28.7%) exhibited a low expression of girdin, while 67 cases (71.3%) had an enhanced expression of girdin. However, among 78 cases of adjacent tissues, 64 cases (82.1%) did not express girdin and 14 cases (17.9%) exhibited a low expression of girdin. Furthermore, the expression of girdin was significantly associated with the tumor stage, lymph node metastasis stage, and tumor, lymph node and metastasis stage. Of note, the mean survival time of girdin-positive cases was only 30.62±2.99 months, while it was 53.37±5.02 months in girdin-negative cases, indicating that girdin protein expression is an independent prognostic factor of poor survival. Talen-mediated girdin knockout (KO) significantly suppressed cellular proliferation, migration and invasion in ESCC ECA109 cells. In conclusion, the present study suggested that girdin protein expression was significantly correlated with cancer progression and poor prognosis in ESCCs, and that girdin had a positive role in the regulation of cell proliferation, migration and invasion in ESCC cells. Therefore, girdin may be a potential candidate for the development of novel prognostic tools and therapeutic strategies for ESCCs.
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Affiliation(s)
- Ke Cao
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Wenting Jiang
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Peiguo Cao
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Qiong Zou
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Sheng Xiao
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Jianda Zhou
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
| | - Chenghui Huang
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, P.R. China
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Shin KE, Lee KS, Choi JY, Kim HK, Shim YM. Esophageal malignancy and staging. Semin Roentgenol 2014; 48:344-53. [PMID: 24034266 DOI: 10.1053/j.ro.2013.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kyung Eun Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Moon SH, Kim HS, Hyun SH, Choi YS, Zo JI, Shim YM, Lee KH, Kim BT, Choi JY. Prediction of occult lymph node metastasis by metabolic parameters in patients with clinically N0 esophageal squamous cell carcinoma. J Nucl Med 2014; 55:743-8. [PMID: 24700884 DOI: 10.2967/jnumed.113.130716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED The aim of this study was to investigate the value of (18)F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. METHODS The study comprised 143 consecutive patients (mean age ± SD, 63.9 ± 8.6 y; range, 31.8-81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, (18)F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUV max), mean SUV (SUV mean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. RESULTS Univariate analysis indicated that clinical T classification, SUV max, SUV mean, MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2-4, SUV max ≥ 4.8, SUV mean ≥ 3.2, MTV ≥ 5.5 cm(3), TLG ≥ 220, and diameter ≥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7-12.4; P = 0.003) and SUV max (HR, 3.5; 95% CI, 1.3-9.2; P = 0.012) were independent risk factors. The combination of SUV max and clinical T classification (HR, 13.2; 95% CI, 5.4-31.9; P < 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUV max or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV max were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. CONCLUSION SUV max, combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus.
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Affiliation(s)
- Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and
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Vallböhmer D, Sisic L, Blank S, Kraus S, Stoecklein NH, Knoefel WT, Büchler MW, Ott K. Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences. Oncol Res Treat 2014; 37:97-104. [DOI: 10.1159/000360177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/14/2014] [Indexed: 11/19/2022]
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Haidry RJ, Butt MA, Dunn J, Banks M, Gupta A, Smart H, Bhandari P, Smith LA, Willert R, Fullarton G, John M, Pietro MD, Penman I, Novelli M, Lovat LB. Radiofrequency ablation for early oesophageal squamous neoplasia: Outcomes form United Kingdom registry. World J Gastroenterol 2013; 19:6011-6019. [PMID: 24106401 PMCID: PMC3785622 DOI: 10.3748/wjg.v19.i36.6011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To report outcomes on patients undergoing radiofrequency ablation (RFA) for early oesophageal squamous neoplasia from a National Registry.
METHODS: A Prospective cohort study from 8 tertiary referral centres in the United Kingdom. Patients with squamous high grade dysplasia (HGD) and early squamous cell carcinoma (ESCC) confined to the mucosa were treated. Visible lesions were removed by endoscopic mucosal resection (EMR) before RFA. Following initial RFA treatment, patients were followed up 3 monthly. Residual flat dysplasia was treated with RFA until complete reversal dysplasia (CR-D) was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond. The main outcome measures were CR-D at 12 mo from start of treatment, long term durability, progression to cancer and adverse events.
RESULTS: Twenty patients with squamous HGD/ESCC completed treatment protocol. Five patients (25%) had EMR before starting RFA treatment. CR-D was 50% at 12 mo with a median of 1 RFA treatment, mean 1.5 (range 1-3). Two further patients achieved CR-D with repeat RFA after this time. Eighty per cent with CR-D remain dysplasia free at latest biopsy, with median follow up 24 mo (IQR 17-54). Six of 20 patients (30%) progressed to invasive cancer at 1 year. Four patients (20%) required endoscopic dilatations for symptomatic structuring after treatment. Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient. The other 2 patients required only a single dilatation to achieve an adequate symptomatic response. One patient developed cancer during follow up after end of treatment protocol.
CONCLUSION: The role of RFA in these patients remains unclear. In our series 50% patients responded at 12 mo. These figures are lower than limited published data.
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Sentinel node mapping in esophageal squamous cell carcinoma using intra-operative combined blue dye and radiotracer techniques. Esophagus 2013. [DOI: 10.1007/s10388-013-0390-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Accuracy of sentinel node biopsy in esophageal carcinoma: a systematic review and meta-analysis of the pertinent literature. Surg Today 2013; 44:607-19. [PMID: 23715926 DOI: 10.1007/s00595-013-0590-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/04/2013] [Indexed: 02/07/2023]
Abstract
The use of sentinel node surgery for esophageal carcinoma is still under investigation. We evaluated the data available in the literature on this topic, and herein present the results in a systematic review format. PUBMED, SCOPUS, the ISI web of knowledge and the information from the annual meetings of the Japan Esophageal Society were searched using the search terms: "(esophagus OR esophageal) AND sentinel". The outcomes of interest were the detection rate and sensitivity. Overall, 18 studies were included. The pooled detection rate was 89.2% [82.6-93.5]. Patients with T1 and two tumors had a 17% higher detection rate compared to those with T3 and four tumors. The pooled sensitivity was 84% [78-88%]. The sensitivity was higher for adenocarcinoma compared to squamous cell carcinoma (SCC) (91 vs. 81%). In the SCC patients, there was a trend toward decreased sensitivity associated with an increasing tumor depth (T1:88%, T2:76%, T3:50%). Our analysis indicated that sentinel node biopsy is useful in adenocarcinoma patients. For SCC patients, including only cN0 patients (preferably T1 and 2) would increase the detection rate and sensitivity. Due to the limited number of high-quality studies, drawing any more definite conclusions is impossible. Large cohort studies with a standardized and consistent design will be needed in the future.
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Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review. World J Gastroenterol 2013; 19:1424-37. [PMID: 23539431 PMCID: PMC3602502 DOI: 10.3748/wjg.v19.i9.1424] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/22/2012] [Accepted: 08/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/T1b esophageal neoplasms.
METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. “Neural networks” as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the “feature selection and root cause analysis”, was used to identify the most important predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients.
RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559), P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P < 0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+).
CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma in-situ component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.
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Li Z, Rice TW. Diagnosis and staging of cancer of the esophagus and esophagogastric junction. Surg Clin North Am 2012; 92:1105-26. [PMID: 23026272 DOI: 10.1016/j.suc.2012.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal/esophagogastric junction cancer staging in the 7th edition of the AJCC staging manual is data driven and harmonized with gastric staging. New definitions are Tis, T4, regional lymph node, N, and M. Nonanatomic characteristics (histopathologic cell type, histologic grade, cancer location) and TNM classifications determine stage groupings. Classifications before treatment define clinical stage (cTNM or ycTNM). Current best clinical staging modalities include endoscopic ultrasonography for T and N and CT/PET for M. Classifications at resection define pathologic stage (pTNM or ypTNM). Accurate pathologic stage requires communication/cooperation between surgeon and pathologist. Classifications are defined at retreatment (rTNM) and autopsy (aTNM).
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Affiliation(s)
- Zhigang Li
- Department of Thoracic and Cardiovascular Surgery, The Second Military Medical University, Changhai Hospital, Shanghai, People's Republic of China
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Vallbohmer D, Oh DS, Peters JH. The role of lymphadenectomy in the surgical treatment of esophageal and gastric cancer. Curr Probl Surg 2012; 49:471-515. [PMID: 22793506 DOI: 10.1067/j.cpsurg.2012.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kayani B, Zacharakis E, Ahmed K, Hanna GB. Lymph node metastases and prognosis in oesophageal carcinoma--a systematic review. Eur J Surg Oncol 2011; 37:747-53. [PMID: 21839394 DOI: 10.1016/j.ejso.2011.06.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 02/09/2011] [Accepted: 06/28/2011] [Indexed: 12/27/2022] Open
Abstract
Oesophageal cancer is the 7th most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The 7th edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.
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Affiliation(s)
- B Kayani
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK
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