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Habu T, Kumagai S, Bando H, Fujisawa T, Mishima S, Kotani D, Nakamura M, Hojo H, Sakashita S, Kinoshita T, Yano T, Mitsunaga S, Nishikawa H, Koyama S, Kojima T. Definitive chemoradiotherapy induces T-cell-inflamed tumor microenvironment in unresectable locally advanced esophageal squamous cell carcinoma. J Gastroenterol 2024:10.1007/s00535-024-02120-z. [PMID: 38819498 DOI: 10.1007/s00535-024-02120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Chemoradiotherapy (CRT) modulates the tumor immune microenvironment of multiple cancer types, including esophageal cancer, which potentially induces both immunogenicity and immunosuppression by upregulating the presentation of tumor-specific antigens and immune checkpoint molecules in tumors, respectively. The prognostic effects of immune modification by CRT in esophageal squamous cell carcinoma (ESCC) remain controversial because of the lack of detailed immunological analyses using paired clinical specimens before and after CRT. We aimed to clarify the immunological changes in the tumor microenvironment caused by CRT and elucidate the predictive importance of clinical response and prognosis and the rationale for the necessity of subsequent programmed cell death protein 1 (PD-1) inhibitor treatment. METHODS In this study, we performed a comprehensive immunological analysis of paired biopsy specimens using multiplex immunohistochemistry before and after CRT in patients with unresectable locally advanced ESCC. RESULTS CRT significantly increased the intra-tumoral infiltration and PD-1 expression of CD8+ T cells and conventional CD4+ T cells but decreased those of regulatory T cells and the accumulation of tumor-associated macrophages. Multivariate analysis of tumor-infiltrating T-cell phenotypes revealed that the density of PD-1+CD8+ T cells in the tumor after CRT could predict a confirmed complete response and favorable survival. CONCLUSIONS This study showed that CRT improved the immunological characteristics of unresectable locally advanced ESCC and identified the density of PD-1+CD8+ T cells as a predictive factor for prognosis. This finding supports the rationale for the necessity of subsequent PD-1 inhibitor treatment.
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Affiliation(s)
- Takumi Habu
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Chiba, Japan
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shogo Kumagai
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Chiba, Japan
| | - Hideaki Bando
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Fujisawa
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Saori Mishima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Daisuke Kotani
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masaki Nakamura
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hidehiro Hojo
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shingo Sakashita
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shuichi Mitsunaga
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Hiroyoshi Nishikawa
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Chiba, Japan
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shohei Koyama
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Chiba, Japan.
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Takashi Kojima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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2
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Qureshi S, Khan S, Quraishy MS, Zaheer S. Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan. Pak J Med Sci 2024; 40:811-819. [PMID: 38827885 PMCID: PMC11140330 DOI: 10.12669/pjms.40.5.7582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Methods We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival. Results Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes. Conclusion Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.
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Affiliation(s)
- Sajida Qureshi
- Sajida Qureshi, FCPS, FRCS. Professor of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumayah Khan
- Sumayah Khan, FCPS. Fellow Upper GI Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Saeed Quraishy
- Sidra Zaheer, Senior Lecturer & Biostatistician School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- M Saeed Quraishy, FCPS, FRCS. Professor of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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3
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Eisner DC. Esophageal cancer: Treatment advances and need for screening. JAAPA 2024; 37:19-24. [PMID: 38484297 DOI: 10.1097/01.jaa.0001007328.84376.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
ABSTRACT Esophageal cancer is a challenging malignancy that often is diagnosed in advanced stages, resulting in a poor prognosis. This article provides a comprehensive review of the two main types of esophageal cancer, esophageal squamous cell carcinoma and esophageal adenocarcinoma, and reviews epidemiology, risk factors, pathogenesis, diagnostic modalities, staging systems, and established and emerging treatments. Recent advancements in treatment for resectable and unresectable esophageal cancer also are explored. These include immunotherapy, targeted therapy, sentinel lymph node mapping, radiogenomics, palliative measures, and screening measures.
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Affiliation(s)
- Daniel C Eisner
- Daniel C. Eisner is the owner of Systolica LLC, consulting and medical supplies, based in Bel Air, Md. The author has disclosed no potential conflicts of interest, financial or otherwise
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Lander S, Lander E, Gibson MK. Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise. Curr Gastroenterol Rep 2023; 25:275-279. [PMID: 37812328 DOI: 10.1007/s11894-023-00899-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE OF REVIEW Esophageal cancer (EC) is a common cancer affecting many regions of the world and carries significant morbidity and mortality. In this article, we review the key risk factors and their associated impact on the changing incidence and prevalence of EC subtypes within different global regions. We also highlight potential reasons for the ever-changing epidemiology of this prevalent cancer type. RECENT FINDINGS There has been a shift in incidence of Esophageal Adenocarcinoma (AC) and Squamous Cell Carcinoma (SCC) within certain populations primarily due to an increase prevalence of primary risk factors. In Western nations, more often the United States, there has been a shift from SCC predominance to the majority of new cases of EC being adenocarcinoma. This shift within the United States has largely correlated with a rise in obesity. The prevalence of AC in Asia is also starting to rise as more countries adopt a western diet. The pathophysiology, associated risk factors, and presentation of ESCC and AC are different. This difference is seen in varying lifestyles, population health, and certain genetic risks. With further development closer analysis of primary risk factors and implementation of policies and programs that promote public health literacy, there is a potential to decrease esophageal cancer's global disease burden.
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Affiliation(s)
- Steve Lander
- Department of Medicine, The University of Tennessee Health Sciences Center, Memphis, TN, USA.
| | - Eric Lander
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael K Gibson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Tu M, Yin X, Zhuang W, Lin X, Xia Y, Huang Z, Zheng Y, Huang Y. NSG1 promotes glycolytic metabolism to enhance Esophageal squamous cell carcinoma EMT process by upregulating TGF-β. Cell Death Discov 2023; 9:391. [PMID: 37872157 PMCID: PMC10593808 DOI: 10.1038/s41420-023-01694-6] [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: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
As a highly enriched endosomal protein within neuronal cells, NSG1 has been discovered to facilitate the process of epithelial-mesenchymal transition (EMT) in esophageal squamous cell carcinoma (ESCC). However, the precise mechanisms behind this phenomenon have yet to be elucidated. The pivotal role of transforming growth factor-β (TGF-β) in triggering the EMT and its significant contribution towards tumor metabolic reprogramming-responsible for EMT activation-has been robustly established. Nevertheless, the extent of TGF-β involvement in the NSG1-mediated EMT within ESCC and the processes through which metabolic reprogramming participates remain ambiguous. We accessed an array of extensive public genome databases to analyze NSG1 expression in ESCC. Regulation of TGF-β by NSG1 was analyzed by transcriptome sequencing, quantitative Real-Time PCR (qRT-PCR), co-immunoprecipitation (CO-IP), and immunofluorescence (IF). Additionally, cellular functional assays and western blot analyses were conducted to elucidate the effect of NSG1 on TGF-β/Smad signaling pathway, as well as its role in ESCC cell metastasis and proliferation. We validated the influence of the NSG1/TGF-β axis on metabolic reprogramming in ESCC by measuring extracellular acidification, glucose uptake, and lactate production. Our findings identify an oncogenic role for NSG1 in ESCC and show a correlation between high NSG1 expression and poor prognosis in ESCC patients. Additional research indicated TGF-β's involvement in the NSG1-induced EMT process. From a mechanistic perspective, NSG1 upregulates TGF-β, activating the TGF-β/Smad signaling pathway and subsequently fostering the EMT process by inducing cell metabolic reprogramming-evident from elevated glycolysis levels. In conclusion, our study highlights the NSG1/TGF-β axis as a promising therapeutic target for ESCC.
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Affiliation(s)
- Mingshu Tu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoqing Yin
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
- Integrated Chinese and Western Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Wanzhen Zhuang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoqing Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
| | - Yu Xia
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
- Integrated Chinese and Western Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhixin Huang
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
- Integrated Chinese and Western Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yue Zheng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China
| | - Yi Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China.
- Department of Clinical Laboratory, Fujian Provincial Hospital, Fuzhou, China.
- Central Laboratory, Center for Experimental Research in Clinical Medicine, Fujian Provincial Hospital, Fuzhou, China.
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, China.
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6
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Li P, Jing J, Liu W, Wang J, Qi X, Zhang G. Spatiotemporal Patterns of Esophageal Cancer Burden Attributable to Behavioral, Metabolic, and Dietary Risk Factors From 1990 to 2019: Longitudinal Observational Study. JMIR Public Health Surveill 2023; 9:e46051. [PMID: 37801354 PMCID: PMC10589835 DOI: 10.2196/46051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/16/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is the sixth leading cause of cancer-related burden with distinct regional variations globally. Although the burden of EC has decreased, the specific reasons for this decline are still unclear. OBJECTIVE This study aims to uncover the spatiotemporal patterns of EC risk-attributable burden in 204 countries and territories from 1990 to 2019 so that prevention and control strategies of EC can be prioritized worldwide. METHODS We extracted EC risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the global burden of disease (GBD) study from 1990 to 2019, in terms of behavioral, metabolic, and dietary factors by age, sex, and geographical location. Average annual percentage change (AAPC) was used to assess the long-term trends in the ASMRs and ASDRs of EC due to specific risk factors. RESULTS Between 1990 and 2019, the greatest decrease in EC burden was attributed to low intake of fruits and vegetables. An AAPC of -2.96 (95% CI -3.28 to -2.63) and -3.12 (95% CI -3.44 to -2.79) in ASMR and ASDR was attributable to a low-fruit diet, while an AAPC of -3.60 (95% CI -3.84 to -3.36) and -3.64 (95% CI -3.92 to -3.35) in ASMR and ASDR was attributed to a low-vegetable diet. However, the trends in ASMRs and ASDRs due to high BMI showed significant increases with an AAPC of 0.52 (95% CI 0.29-0.75) in ASMR and 0.42 (95% CI 0.18-0.66) in ASDR from 1990 to 2019 compared to significant decreases in other attributable risks with AAPC<0 (P<.05). East Asia had the largest decrease in EC burden due to low-vegetable diets, with an AAPC of -11.00 (95% CI -11.32 to -10.67) in ASMR and -11.81 (95% CI -12.21 to -11.41) in ASDR, followed by Central Asia, whereas Western Sub-Saharan Africa had the largest increase in ASMR and ASDR due to high BMI, with an AAPC of 3.28 (95% CI 3.14-3.42) and 3.09 (95% CI 2.96-3.22), respectively. China had the highest EC burden attributed to smoking, alcohol use, high BMI, and low-fruit diets. Between 1990 and 2019, there was a significant decrease in EC burden attributable to smoking, alcohol use, chewing tobacco, low-fruit diets, and low-vegetable diets in most countries, wherein a significant increase in the EC burden was due to high BMI. CONCLUSIONS Our study shows that smoking and alcohol consumption are still the leading risk factors of EC burden and that EC burden attributable to low intake of fruits and vegetables has shown the largest decline recently. The risks of ASMRs and ASDRs of EC showed distinct spatiotemporal patterns, and future studies should focus on the upward trend in the EC burden attributed to high BMI.
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Affiliation(s)
- Peng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jing Jing
- College of Geography and Environment, Baoji University of Arts and Sciences, Baoji, China
| | - Wenjun Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Jizhao Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Xin Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
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Pastrez PRA, Barbosa AM, Mariano VS, Causin RL, Castro AG, Torrado E, Longatto-Filho A. Interleukin-8 and Interleukin-6 Are Biomarkers of Poor Prognosis in Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15071997. [PMID: 37046658 PMCID: PMC10093339 DOI: 10.3390/cancers15071997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/30/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is a common type of cancer characterized by fast progression and high mortality rates, which generally implies a poor prognosis at time of diagnosis. Intricate interaction networks of cytokines produced by resident and inflammatory cells in the tumor microenvironment play crucial roles in ESCC development and metastasis, thus influencing therapy efficiency. As such, cytokines are the most prominent targets for specific therapies and prognostic parameters to predict tumor progression and aggressiveness. In this work, we examined the association between ESCC progression and the systemic levels of inflammatory cytokines to determine their usefulness as diagnostic biomarkers. We analyzed the levels of IL-1β, IL-6, IL-8, IL-10, TNF-α e IL-12p70 in a group of 70 ESCC patients and 70 healthy individuals using Cytometric Bead Array (CBA) technology. We detected increased levels of IL-1β, IL-6, IL-8, and IL-10 in ESCC patients compared to controls. However, multivariate analysis revealed that only IL8 was an independent prognostic factor for ESCC, as were the well-known risk factors: alcohol consumption, tobacco usage, and exposure to pesticides/insecticides. Importantly, patients with low IL-6, IL-8, TNM I/II, or those who underwent surgery had a significantly higher overall survival rate. We also studied cultured Kyse-30 and Kyse-410 cells in mice. We determined that the ESCC cell line Kyse-30 grew more aggressively than the Kyse-410 cell line. This enhanced growth was associated with the recruitment/accumulation of intratumoral polymorphonuclear leukocytes. In conclusion, our data suggest IL-8 as a valuable prognostic factor with potential as a biomarker for ESCC.
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8
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Jiang Y, Lin Y, Wen Y, Fu W, Wang R, He J, Zhang J, Wang Z, Ge F, Huo Z, Wang R, Peng H, Wu X, He J, Li S. Global trends in the burden of esophageal cancer, 1990-2019: results from the Global Burden of Disease Study 2019. J Thorac Dis 2023; 15:348-364. [PMID: 36910098 PMCID: PMC9992583 DOI: 10.21037/jtd-22-856] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/25/2022] [Indexed: 02/04/2023]
Abstract
Background Esophageal cancer is one of the leading causes of cancer death worldwide. A deeper understanding of the trends in annual incidence, mortality, and disability-adjusted life-years (DALYs) of esophageal cancer is critical for management and prevention. In this study, we report on the disease burden of esophageal cancer in 204 countries and territories between 1990 and 2019 by age, sex, and sociodemographic index (SDI). Methods Data on incidence, mortality, and DALYs were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The estimated numbers and age-standardized rates for esophageal cancer in 2019 are presented in this paper, as well as trends from 1990 to 2019. All estimates are presented as counts and age-standardized rates per 100,000 population, with 95% uncertainty intervals (UIs) for each estimate. Results In 2019, nearly 535,000 (95% UI: 467,000-595,000) new cases of esophageal cancer occurred globally. Esophageal cancer was responsible for more than 498,000 (95% UI: 438,000-551,000) deaths and 11.7 million (95% UI: 10.4-12.9 million) DALYs. Worldwide age-standardized rates of esophageal cancer, including incidence, deaths, and DALYs, have declined since 1990. However, the trends differ across countries and territories. Notably, there was a nonlinear but generally inverse correlation between age-standardized DALY rates and SDI. Higher age-standardized incidence and death rates were observed in males compared to females, and both increased with age. Regarding risk factors, smoking, alcohol use, and high body-mass index were 3 predominant contributors to esophageal cancer DALYs in 2019 for both sexes worldwide. Conclusions This study found a global reduction in the esophageal cancer burden, but substantial heterogeneity remains across regions and countries. Hence, the identification of high-risk groups and the exploration of specific local strategies and primary prevention efforts are required.
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Affiliation(s)
- Yu Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yuechun Lin
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yaokai Wen
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wenhai Fu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Rui Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianrong Zhang
- Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Zhufeng Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Fan Ge
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Huo
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Runchen Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Haoxin Peng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xiangrong Wu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
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9
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Wilson BF, Dang J, Masuda D, Cowler T. Esophageal Adenocarcinoma in an Active Duty Sailor: A Case Report. Mil Med 2023; 188:404-406. [PMID: 35355077 DOI: 10.1093/milmed/usac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 01/11/2023] Open
Abstract
Esophageal adenocarcinoma develops when normal squamous epithelia are replaced by dysplastic intestinal columnar cells in response to chronic gastroesophageal reflux disease (GERD). In addition to squamous cell carcinoma, the two malignancies account for over 95% of esophageal malignancies. This case describes a sailor deployed onboard an aircraft carrier who initially presented with typical GERD symptoms and later developed multifactorial weight loss confounded by the operational environment. Upon return to homeport, he was diagnosed with stage III gastroesophageal junction adenocarcinoma. This case emphasizes the difficulty in identifying and diagnosing a rare and dangerous pathology in the resource-limited, operational environment.
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Affiliation(s)
- Benjamin F Wilson
- Carrier Air Wing THREE, Naval Air Station Oceana, Virginia Beach, VA 23460, USA
| | - John Dang
- Carrier Air Wing THREE, Naval Air Station Oceana, Virginia Beach, VA 23460, USA
| | - Dane Masuda
- Carrier Air Wing THREE, Naval Air Station Oceana, Virginia Beach, VA 23460, USA
| | - Trevor Cowler
- Carrier Air Wing THREE, Naval Air Station Oceana, Virginia Beach, VA 23460, USA
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Sun HB, Jiang D, Liu XB, Xing WQ, Liu SL, Chen PN, Li P, Ma YX. Perioperative Outcomes and Learning Curve of Robot-Assisted McKeown Esophagectomy. J Gastrointest Surg 2023; 27:17-26. [PMID: 36261780 DOI: 10.1007/s11605-022-05484-w] [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: 05/26/2022] [Accepted: 10/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the perioperative outcomes of patients undergoing robot-assisted McKeown esophagectomy (RAME) and the learning curves of surgeons performing RAME at a single center. METHODS Perioperative outcomes of RAME and video-assisted McKeown esophagectomy (VAME) were compared after eliminating confounding factors by propensity score matching (PSM). The cumulative sum (CUSUM) method was used to evaluate the learning curves of RAME for a single surgical team. RESULTS In general, a total of 198 patients with esophageal cancer (RAME: 45 patients, VAME: 153 patients) were included in this study, and 43 pairs of patients receiving RAME or VAME were matched using 1:1 PSM analysis. Those in the RAME group had more lymph nodes dissected in the total lymph nodes (median 29.0 vs. 26.0, P = 0.011) and the upper mediastinum (median 8.0 vs. 6.0, P < 0.001), especially the left recurrent laryngeal nerve (RLN) lymph node (median 4.0 vs. 2.0, P = 0.001). According to the trend of the CUSUM plot, the learning curve was divided into two stages at the 20th RAME procedure. After mastering the learning curve, RAME harvested a significantly higher number of upper mediastinal lymph nodes (median 9.0 vs. 6.0, P = 0.001), left RLN lymph nodes (median 5.0 vs. 3.5, P = 0.003), and right RLN lymph nodes (median 4.0 vs. 2.0, P = 0.002). Meanwhile, the incidence of postoperative pneumonia in the proficiency phase was significantly lower than that in the learning phase (4.0% vs. 25.0%, P = 0.04). CONCLUSIONS RAME improved left RLN lymph node dissection. Surgeons with extensive VAME experience need at least 20 cases to achieve early proficiency in RAME.
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Affiliation(s)
- Hai-Bo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
| | - Duo Jiang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xian-Ben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wen-Qun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shi-Lei Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Pei-Nan Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Peng Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ya-Xing Ma
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
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Tsai MC, Chou YC, Lee YK, Hsu WL, Tang CS, Chen SY, Huang SP, Chen YC, Lee JM. Secular Trends in Incidence of Esophageal Cancer in Taiwan from 1985 to 2019: An Age-Period-Cohort Analysis. Cancers (Basel) 2022; 14:cancers14235844. [PMID: 36497327 PMCID: PMC9741308 DOI: 10.3390/cancers14235844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
In Taiwan, the age-standardized incidence of EC, especially esophageal squamous cell carcinoma (ESCC), has increased substantially during the past thirty years. We described the incidence trends of EC from 1985−2019 by an average annual percentage change (AAPC) and age-period-cohort model by using Taiwan Cancer Registry data. Age-period-cohort modeling was used to estimate the period and cohort effects of ESCC and esophageal adenocarcinoma (EAC). The Spearman’s correlation coefficient was used to analyze the correlation between age-adjusted incidence rates of EC and the prevalence of risk factors from national surveys. The results showed the incidence rate of ESCC in men (AAPC = 4.2, 95% CI = 3.1−5.4, p < 0.001) increased prominently from 1985−1989 to 2015−2019 while that of EAC in men (AAPC = 1.2, 95% CI = 0.9−1.5, p < 0.001) and ESCC in women (AAPC = 1.7, 95% CI = 1.4−2.1, p < 0.001) increased to a lesser degree. Increased period effects were observed in ESCC in men, ESCC in women, and EAC in men. High correlations were found between the risk factors and the increased birth-cohort effects of ESCC (p < 0.05). To conclude, the incidence of ESCC in both sex and EAC in men increased with statistical significance in recent decades. The increased prevalence of risk factors from approximately 1970−1995 could explain the increased cohort effects of ESCC.
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Affiliation(s)
- Min-Chen Tsai
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yu-Kwang Lee
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Wan-Lun Hsu
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
- Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
| | - Chin-Sheng Tang
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
| | - Shiow-Ying Chen
- Department of Medical Research, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
| | - Shih-Pei Huang
- Department of Medical Education & Bioethics, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei 10051, Taiwan
| | - Yong-Chen Chen
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
- Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
- Correspondence: ; Tel.: +886-2-29056221
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100225, Taiwan
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Efficacy of Digestive Endoscope Based on Artificial Intelligence System in Diagnosing Early Esophageal Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9018939. [PMID: 35761840 PMCID: PMC9233587 DOI: 10.1155/2022/9018939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022]
Abstract
Objective To explore the efficacy of digestive endoscopy (DEN) based on artificial intelligence (AI) system in diagnosing early esophageal carcinoma. Methods The clinical data of 300 patients with suspected esophageal carcinoma treated in our hospital from January 2018 to January 2020 were retrospectively analyzed; among them, 198 were diagnosed with esophageal carcinoma after pathological examination, and 102 had benign esophageal lesion. An AI system based on convolutional neural network (CNN) was adopted to assess the DEN images of patients with early esophageal carcinoma. A total of 200 patients (148 with early esophageal carcinoma and 52 with benign esophageal lesion) were selected as the learning group for the Inception V3 image classification system to learn; and the rest 100 patients (50 with early esophageal carcinoma and 50 with benign esophageal lesion) were included in the diagnosis group for the Inception V3 system to assist the narrow-band imaging (NBI) with diagnosis. The diagnosis results from Inception V3-assisted NBI were compared with those from imaging physicians, and the diagnostic efficacy diagram was drawn. Results The diagnosis rate of AI-NBI was significantly faster than that of physician diagnosis (0.02 ± 0.01 vs. 5.65 ± 0.32 s (mean rate of two physicians), P < 0.001); between AI-NBI diagnosis and physician diagnosis, no statistical differences in sensitivity (90.0% vs. 92.0%), specificity (92.0% vs. 94.0%), and accuracy (91.0% vs. 93.0%) were observed (P > 0.05); and according to the ROC curves, AUC (95% CI) of AI-NBI diagnosis = 0.910 (0.845-0.975), and AUC (95% CI) of physician diagnosis = 0.930 (0.872-0.988). Conclusion CNN-based AI system can assist NBI in screening early esophageal carcinoma, which has a good application prospect in the clinical diagnosis of early esophageal carcinoma.
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Yoo BS, Houston KV, D'Souza SM, Elmahdi A, Davis I, Vilela A, Parekh PJ, Johnson DA. Advances and horizons for artificial intelligence of endoscopic screening and surveillance of gastric and esophageal disease. Artif Intell Med Imaging 2022; 3:70-86. [DOI: 10.35711/aimi.v3.i3.70] [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: 01/28/2022] [Revised: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
The development of artificial intelligence in endoscopic assessment of the gastrointestinal tract has shown progressive enhancement in diagnostic acuity. This review discusses the expanding applications for gastric and esophageal diseases. The gastric section covers the utility of AI in detecting and characterizing gastric polyps and further explores prevention, detection, and classification of gastric cancer. The esophageal discussion highlights applications for use in screening and surveillance in Barrett's esophagus and in high-risk conditions for esophageal squamous cell carcinoma. Additionally, these discussions highlight applications for use in assessing eosinophilic esophagitis and future potential in assessing esophageal microbiome changes.
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Affiliation(s)
- Byung Soo Yoo
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Kevin V Houston
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, United States
| | - Steve M D'Souza
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Alsiddig Elmahdi
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Isaac Davis
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Ana Vilela
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - Parth J Parekh
- Division of Gastroenterology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
| | - David A Johnson
- Division of Gastroenterology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
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