[Mortality and survival analysis of esophageal cancer in China]

Combined Mean Corpuscular Hemoglobin, Fibrinogen, and Albumin (MF-A) Is a Novel Prognostic Marker in Patients with Resectable Esophageal Squamous Cell Carcinoma

BACKGROUND

The aim was to systematically select blood markers routinely tested in clinical settings, which are independently associated with overall survival (OS) and are able to stratify prognosis of esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy.

METHODS

We selected optimal blood markers for prognostic stratification from 60 candidates in a clinical cohort of 1819 consecutive patients with resectable ESCC in China. Selection was carried out using two-step multivariable Cox proportional hazards regression adjusted for multifaceted confounders. A composite index was developed by multiplying risk factors and dividing them by protective factors.

RESULTS

With a median follow-up of 48.07 months, 641 deaths occurred in the 1819 patients and the 5-year OS was 56.30%. Two risk factors (mean corpuscular hemoglobin, fibrinogen) and a protective factor (albumin), all dichotomized and assigned values 1 and 2, were used to construct the composite index marker "MF-A". Three risk groups were created based on the MF-A score including low- (0.5), moderate- (1), and high-risk groups (2 and 4). Compared with patients in the low-risk group (1184/1778, 66.59%), those in the moderate- (488, 27.45%), and high-risk (106, 5.96%) groups were at elevated risk of death (adjusted HR: 1.32, 95% CI: 1.11-1.57; adjusted HR: 2.08, 95% CI: 1.56-2.75; P_trend < 10^-7). Within each TNM stage grouping, OS also trended to be significantly worse as the MF-A score increased.

CONCLUSIONS

"MF-A" is a novel independent predictor which may be used to estimate and stratify prognosis for ESCC patients undergoing esophagectomy.

Solitary Celiac Lymph Node Metastasis Has a Better Long-Term Survival Compared With Solitary Mediastinal Lymph Node Metastasis in Esophagectomy of Esophageal Squamous Cell Cancer: A Propensity Score Matching Analysis

Background

The prognostic benefit of extensive lymphadenectomy remains controversial in esophageal squamous cell carcinoma (ESCC). The purpose of this retrospective study was to investigate the potential effect of solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) lymph node metastasis on the short- and long-term outcomes for patients who underwent minimally invasive McKeown esophagectomy.

Methods

From September 2009 to December 2020, a total of 934 cases were diagnosed with ESCC and underwent minimally invasive McKeown esophagectomy in our department; 223 cases met the inclusion and exclusion criteria. Propensity score matching (PSM) was utilized to contrast the postoperative results and long-term survival of Group 1 (SM) and Group 2 (SC). Univariate and multivariate Cox proportional hazards regression analyses were used on possible predictors of survival.

Results

One hundred forty-seven patients were available for outcome comparison after PSM. The postoperative results were not significantly different between the two groups. In terms of long-term survival, the 5-year disease-free survival (DFS) was 37.6% and 57.3% (p = 0.191) and 5-year disease-specific survival (DSS) was 39.7% and 68.4% (p = 0.028) for Group 1 (SM) and Group 2 (SC), respectively. Univariate and multivariate Cox proportional hazards regression analyses showed that body mass index (BMI), pathologic stage (pStage), and SC/SM grouping had significant hazard ratios (HRs), which suggested that SC is associated with better DSS.

Conclusion

This cohort study showed that SC lymph node metastasis has a better long-term survival compared with SM lymph node metastasis in esophagectomy of ESCC. The results challenge the current understanding and need confirmation in further research.

The Disease and Economic Burdens of Oesophageal Cancer in China from 2013 to 2030: A Dynamic Cohort Modelling Study

Background

Esophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control.

Objective

The aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030.

Methods

A dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time.

Results

From 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females.

Conclusions

EC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.

Associations of Porphyromonas gingivalis Infection and Low Beclin1 Expression With Clinicopathological Parameters and Survival of Esophageal Squamous Cell Carcinoma Patients

Purpose: The present study focused on exploring the associations of Porphyromonas gingivalis (P. gingivalis) infection and low Beclin1 expression with clinicopathological parameters and survival of esophageal squamous cell carcinoma (ESCC) patients, so as to illustrate its clinical significance and prognostic value. Methods: Immunohistochemistry (IHC) was used to detect P. gingivalis infection status and Beclin1 expression in 370 ESCC patients. The chi-square test was adopted to illustrate the relationship between categorical variables, and Cohen's kappa coefficient was used for correlation analysis. Kaplan-Meier survival curves with the log-rank test were used to analyse the correlation of P. gingivalis infection and low Beclin1 expression with survival time. The effects of P. gingivalis infection and Beclin1 downregulation on the proliferation, migration and antiapoptotic abilities of ESCC cells in vitro were detected by Cell Counting Kit-8, wound healing and flow cytometry assays. For P. gingivalis infection of ESCC cells, cell culture medium was replaced with antibiotic-free medium when the density of ESCC cells was 70-80%, cells were inoculated with P. gingivalis at a multiplicity of infection (MOI) of 10. Result: P. gingivalis infection was negatively correlated with Beclin1 expression in ESCC tissues, and P. gingivalis infection and low Beclin1 expression were associated with differentiation status, tumor invasion depth, lymph node metastasis, clinical stage and prognosis in ESCC patients. In vitro experiments confirmed that P. gingivalis infection and Beclin1 downregulation potentiate the proliferation, migration and antiapoptotic abilities of ESCC cells (KYSE150 and KYSE30). Our results provide evidence that P. gingivalis infection and low Beclin1 expression were associated with the development and progression of ESCC. Conclusion: Long-term smoking and alcohol consumption causes poor oral and esophageal microenvironments and ESCC patients with these features were more susceptible to P. gingivalis infection and persistent colonization, and exhibited lower Beclin1 expression, worse prognosis and more advanced clinicopathological features. Our findings indicate that effectively eliminating P. gingivalis colonization and restoring Beclin1 expression in ESCC patients may contribute to preventation and targeted treatment, and yield new insights into the aetiological research on ESCC.

LINC00261 Suppresses Cisplatin Resistance of Esophageal Squamous Cell Carcinoma Through miR-545-3p/MT1M Axis

To improve the survival rate and cure rate of patients, it is necessary to find a new treatment scheme according to the molecular composition of (ESCC) in esophageal squamous cell carcinoma. Long non-coding RNAs (lncRNAs) regulate the progression of ESCC by various pathophysiological pathways. We explored the possible function of the lncRNA LINC00261 (LINC00261) on cisplatin (DDP) resistance of ESCC and its relative molecular mechanisms. In the study, we found that LINC00261 was downregulated in ESCC tissues, cell lines, and DDP-resistant ESCC patients. Besides, overexpression of LINC00261 not only inhibited cell proliferation, and DDP resistance but also promotes cell apoptosis. Further mechanistic research showed that LINC00261 sponged miR-545-3p which was negatively correlated with the expression of LINC00261. In addition, functional experiments revealed that upregulation of miR-766-5p promoted proliferation and enhanced DDP resistance. Subsequently, MT1M was testified to be the downstream target gene of miR-545-3p. Rescue experiments revealed that overexpression of MT1M largely restores miR-545-3p mimics-mediated function on ESCC progression. Our results demonstrate that the LINC00261 suppressed the DDP resistance of ESCC through miR-545-3p/MT1M axis.

Exploration of the methods of establishing the minimum clinical important difference based on anchor and its application in the quality of life measurement scale QLICP-ES (V2.0) for esophageal cancer

Background

The development of the minimum clinical important difference (MCID) can make it easier for researchers or doctors to judge the significance of research results and the effect of intervention measures, and improve the evaluation system of efficacy. This paper is aimed to calculate the MCID based on anchor and to develop MCID for esophageal cancer scale (QLICP-ES).

Methods

The item Q29 (How do you evaluate your overall health in the past week with 7 grades answers from 1 very poor to 7 excellent)of EORTC QLQ-C30 was used as the subjective anchor to calculate the score difference between each domain at discharge and admission. MCID was established according to two standards, "one grade difference"(A) and "at least one grade difference"(B), and developed by three methods: anchor-based method, ROC curve method and multiple linear regression models. In terms of anchor-based method, the mean of the absolute value of the difference before and after treatments is MCID. The point with the best sensitivity and specificity-Yorden index at the ROC curve is MCID for ROC curve method. In contrast, the predicted mean value based on a multiple linear regression model and the parameters of each factor is MCID.

Results

Most of the correlation coefficients of Q29 and various domains of the QLICP-ES were higher than 0.30. The rank of MCID values determined by different methods and standards were as follows: standard B > standard A, anchor-based method > ROC curve method > multiple linear regression models. The recommended MCID values of physical domain, psychological domain, social domain, common symptom and side-effects domain, the specific domain and the overall of the QLICP-ES were 7.8, 9.7, 4.7, 3.6, 4.3, 2.3 and 2.9, respectively.

Conclusion

Different methods have their own advantages and disadvantages, and also different definitions and standards can be adopted according to research purposes and methods. A lot of different MCID values were presented in this paper so that it can be easy and convenient to select by users.

Identification of a PLCE1‑regulated competing endogenous RNA regulatory network for esophageal squamous cell carcinoma

Phospholipase C epsilon 1 (PLCE1) and the competing endogenous RNA (ceRNA) network are crucial for tumorigenesis and the progression of esophageal squamous cell carcinoma (ESCC). However, whether PLCE1 can regulate the ceRNA network in ESCC has not been clarified. In the present study, we aimed to identify the PLCE1-regulated ceRNA network and further elucidate the regulatory mechanisms by which ESCC is promoted. Microarray analysis was used to identify differentially expressed lncRNAs (DELs) and differentially expressed genes (DEGs) from three pairs of samples of PLCE-silenced Eca109 and control Eca109 cells. Next, the ceRNA regulatory network was established and visualized in Cytoscape, and functional enrichment analysis was performed to analyze DEGs from ceRNAs. Protein-protein interaction (PPI) networks among the DEGs were established by the STRING database to screen hub genes. Kaplan-Meier survival analysis was used to validate hub genes. Finally, PLCE1-related hub gene/lncRNA/miRNA axes were also constructed based on the ceRNA network. A total of 105 DELs and 346 DEGs were found to be dysregulated in the microarray data (|log2FC| >1.5, adjusted P<0.05). We constructed a PLCE1-regulated ceRNA network that incorporated 12 lncRNAs, 43 miRNAs, and 169 mRNAs. Functional enrichment analysis indicated that the DEGs might be associated with ESCC onset and development. A PPI network was established, and 9 hub genes [WD and tetratricopeptide repeats 1 (WDTC1), heat shock protein family A (Hsp70) member 5 (HSPA5), N-ethylmaleimide sensitive factor, vesicle fusing ATPase (NSF), fibroblast growth factor 2 (FGF2), cyclin dependent kinase inhibitor 1A (CDKN1A or P21), bone morphogenetic protein 2 (BMP2), complement C3 (C3), GM2 ganglioside activator (GM2A) and discs large MAGUK scaffold protein 4 (DLG4)] were determined from the network. Kaplan-Meier survival analysis validated four hub genes (BMP2, CDKN1A, GM2A, and DLG4) that were treated as prognostic factors. Ultimately, hub gene/lncRNA/miRNA subnetworks were obtained based on the 4 hub genes, 13 DEmiRNAs, and 10 DELs. In conclusion, the PLCE1-regulated ceRNA contributes to the onset and progression of ESCC and the underlying molecular mechanisms may provide insights into personalized prognosis and new therapies for ESCC patients.

Trends in incidence and mortality of esophageal cancer in Inner Mongolia, 2010-2015

Background

Esophageal cancer is among the leading cancer types in Inner Mongolia. This study aimed to investigate the incidence and mortality rates of esophageal cancer in 2015 and the trends in these rates in the 2010–2015 period in this region.

Methods

National Colorectal Cancer Roundtable (NCCR) screening methods and criteria were used to extract data from 10 cancer registries stratified by area (urban/rural), sex, and age group. The Chinese standard population in 2000 and Segi's world population were used to calculate age‐standardized rates. The annual percentage change (APC) in these rates was calculated using the Joinpoint Regression Program.

Results

In 2015, Inner Mongolia had 4324 new cases (4027 male vs. 297 female patients) and 3559 deaths (3300 male vs. 259 female patients) from esophageal cancer. The crude incidence, age‐standardized incidence by Chinese population, age‐standardized incidence by world population, and cumulative incidence were 13.45/100 000, 9.92/100 000, 10.18/100 000, and 1.30%, respectively. The corresponding figures for mortality were 11.32/100 000, 8.35/100 000, 8.53/100 000, and 1.04%. The incidence and mortality increased with age between 40 and 80 years. The rates in rural dwellers, especially men, showed negative APC (−13.25% vs. −11.08%; P < 0.05).

Conclusions

The incidence and mortality rates of esophageal cancer in Inner Mongolia increased between 2010 and 2015. The rates were higher in men in rural areas, middle‐aged and elderly individuals. Prevention and control programs focused on these groups, in addition to early diagnosis and treatment of esophageal cancer, are needed to reduce these rates.

Key points

Significant findings of the study: In Inner Mongolia, incidence and mortality rates of esophageal cancer were higher in urban areas than in rural areas and in men than in women between 2010 and 2015, and in middle‐aged and elderly than in younger people.

What this study adds: Prevention and control programs, in addition to early diagnosis and treatment of esophageal cancer, should be tailored to specifically target men in rural areas and middle‐aged and elderly individuals in order to reduce the incidence and mortality rates of this pathology.

Characterization of Esophageal Cancer and ItsAssociation with Influencing Factors in GuangzhouCity, China

Epidemiological features of esophageal cancer (EC), as well as their associations withpotential influencing factors in a city, have seldom been seldom explored on a fine scale. The ECdeath cases in Guangzhou city during 2012-2017 were collected to describe the epidemiologicalcharacteristics such as EC mortality rate (ECMR) and health-seeking behaviors of deaths. Potentialinfluencing factors, including socioeconomic conditions (population density, gross domesticproduct density), medical resources, and ageing degree were also gathered for exploring theirrelationships with the epidemiological characteristics of EC. A total of 2,409 EC deaths werereported during 2012-2017 in Guangzhou with an age-standardized ECMR of 3.18/105. Theprevalence of EC in Guangzhou was spatially featured and was divided into three regions withobvious differentiated ECMR (ECMR of 6.41/105 in region A, ECMR of 5.51/105 in region B, ECMRof 2.56/105 in region C). The street/town-level ECMR was spatially clustered in Guangzhou city,especially two clusters of streets/towns with high ECMR were highlighted in region A and Brespectively. Meanwhile, demographic features including gender gap, death age, temporal intervalbetween diagnosis and death, health-seeking behaviors were remarkably different among the threeregions. Moreover, health-seeking behaviors (e.g., the proportion of hospital deaths) of the ECdeaths were obviously influenced by medical institution occupancy rate and socioeconomicconditions at street/town level. In addition, the street/town-level ECMR was significantly associatedwith ageing degree across Guangzhou city (r = 0.466, p < 0.01), especially in region A (r = 0.565, p <0.01). In contrast, the ECMR in region B was closely related to population density (r = -0.524, p <0.01) and gross domestic product density (r = -0.511, p < 0.01) when the ageing degree was controlled,while these associations were weak in region C. The epidemiological characteristics of EC inGuangzhou city were spatially featured and potentially associated with socioeconomic conditions,medical resources and ageing degree on a fine scale across Guangzhou city. This study couldprovide scientific basis for local authorities to implement more targeted EC interventions.

Sulforaphene induces apoptosis and inhibits the invasion of esophageal cancer cells through MSK2/CREB/Bcl-2 and cadherin pathway in vivo and in vitro

Background

As a novel type of isothiocyanate derived from radish seeds from cruciferous vegetables, sulforaphene (SFE, 4-methylsufinyl-3-butenyl isothiocyanate) has various important biological effects, such as anti-oxidative and anti-bacterial effects. Recently, sulforaphene has attracted increasing attention for its anti-tumor effects and its ability to suppress the development of multiple tumors through different regulatory mechanisms. However, it has not yet been widely investigated for the treatment of esophageal cancer.

Methods

We observed an increased apoptosis in esophageal cancer cells on sulforaphene treatment through flow cytometry (FCM) analysis and transmission electron microscopy (TEM). Through mass spectrometry (MS) analysis, we further detected global changes in the proteomes and phosphoproteomes of esophageal cancer cells on sulforaphene treatment. The molecular mechanism of sulforaphene was verified by western blot,the effect and mechanism of SFE on esophageal cancer was further verified by patient-derived xenograft mouse model.

Results

We identified multiple cellular processes that were changed after sulforaphene treatment by proteomics. We found that sulforaphene could repress the phosphorylation of CREB through MSK2, leading to suppression of Bcl-2 and further promoted cell apoptosis. Additionally, we confirmed that sulforaphene induces tumor cell apoptosis in mice. Interestingly, we also observed the obvious inhibition of cell migration and invasion caused by sulforaphene treatment by inhibiting the expression of cadherin, indicating the complex effects of sulforaphene on the development of esophageal cancer.

Conclusions

Our data demonstrated that sulforaphene induced cell apoptosis and inhibits the invasion of esophageal cancer through a mechanism involving the inhibition of the MSK2–CREB–Bcl2 and cadherin pathway. Sulforaphene could therefore serve as a promising anti-tumor drug for the treatment of esophageal cancer.

Annotating Early Esophageal Cancers Based on Two Saliency Levels of Gastroscopic Images

Early diagnoses of esophageal cancer can greatly improve the survival rate of patients. At present, the lesion annotation of early esophageal cancers (EEC) in gastroscopic images is generally performed by medical personnel in a clinic. To reduce the effect of subjectivity and fatigue in manual annotation, computer-aided annotation is required. However, automated annotation of EEC lesions using images is a challenging task owing to the fine-grained variability in the appearance of EEC lesions. This study modifies the traditional EEC annotation framework and utilizes visual salient information to develop a two saliency levels-based lesion annotation (TSL-BLA) for EEC annotations on gastroscopic images. Unlike existing methods, the proposed framework has a strong ability of constraining false positive outputs. What is more, TSL-BLA is also placed an additional emphasis on the annotation of small EEC lesions. A total of 871 gastroscopic images from 231 patients were used to validate TSL-BLA. 365 of those images contain 434 EEC lesions and 506 images do not contain any lesions. 101 small lesion regions are extracted from the 434 lesions to further validate the performance of TSL-BLA. The experimental results show that the mean detection rate and Dice similarity coefficients of TSL-BLA were 97.24 and 75.15%, respectively. Compared with other state-of-the-art methods, TSL-BLA shows better performance. Moreover, it shows strong superiority when annotating small EEC lesions. It also produces fewer false positive outputs and has a fast running speed. Therefore, The proposed method has good application prospects in aiding clinical EEC diagnoses.

Characteristics of the local recurrence pattern after curative resection and values in target region delineation in postoperative radiotherapy for lower thoracic esophageal squamous cell cancer

Background

The aim of this study was to investigate the patterns and influencing factors of local‐regional recurrence of lower thoracic esophageal squamous cell carcinoma (TESCC) after curative resection and to delineate the clinical target volume (CTV) of postoperative radiotherapy (PORT).

Methods

From January 2009 to December 2013, the clinical data of patients who experienced local‐regional recurrence after curative esophagectomy were collected and analyzed to determine local‐regional recurrence patterns and to evaluate whether a proposed T‐shaped PORT CTV could cover regions of local‐regional failure.

Results

A total of 108 patients were eligible for this study. All patients experienced postoperative recurrence of lower TESCC. The time to local‐regional failure varied from one to 52 months (average 13.4 ± 11.0). Among the 108 patients, 127 recurrence sites were detected as the first recurrence event: 37 cases in the bilateral supraclavicular region, 56 in the upper mediastinum, 14 in the middle mediastinum, 15 in the upper abdominal lymph nodes, and five cases of anastomotic recurrence. The proposed PORT CTV could successfully cover 89 (82.4%) out of the 108 recurrences and 84.2% of the sites (107/127) of recurrence in our sample.

Conclusion

Local‐regional recurrence of lower TESCC is mainly distributed in the supraclavicular, upper‐middle mediastinum, anastomotic stoma, and upper abdominal lymph node regions. The proposed T‐shaped PORT CTV field could cover over 80% of local‐regional failure in our sample; therefore, we suggest that PORT should focus on this area.

A comparative study on the efficacy of fast-track surgery in the treatment of esophageal cancer patients combined with metabolic syndrome

The purpose of our study was to evaluate the clinical efficacy of fast-track surgery (FTS) in the treatment of esophageal cancer patients combined with metabolic syndrome. Ninety-four esophageal cancer patients with metabolic syndrome were selected in Affiliated Hospital of Jining Medical University from March, 2016 to February, 2017. Patients were randomly divided into control group and observation group with 47 cases in each group. Patients in observation group were treated with FTS, while patients in control group were treated with traditional method. Intraoperative blood loss, the number of dissected lymph nodes, operation time, postoperative hospital stay, the cost of hospitalization, postoperative readmission rate, and incidence of postoperative complications were compared between the groups. Levels of serum inflammatory cytokines (TNF-α and hs-CRP), fat cell factor chemerin and leptin (LP) were detected by enzyme-linked immunosorbent assay (ELISA) at 1 month after surgery. Levels of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) at 1 month after surgery were compared between groups. Levels of hemoglobin (Hb), albumin (Alb), prealbumin (PAB) and transferrin (TRF) at 1 month after surgery were also compared between the two groups. Treatment of cancer quality-of-life questionnaire-esophageal cancer (OES-18) module was used to evaluate the symptoms of patients at one month after surgery. It turned out that no significant differences in intraoperative blood loss, operation time and the number of dissected lymph nodes were found between groups (p>0.05). Postoperative hospital stay, the cost of hospitalization, postoperative readmission rate and the incidence of postoperative complications were significantly lower in observation group than in control group (p<0.05). Levels of TNF-α, hs-CRP, chemerin and LP in observation group were significantly lower than those in control group at one month after surgery (p<0.05). Levels of TC, TG and LDL-C were significantly lower and HDL-C level was significantly higher in observation group than in control group at one month after surgery (p<0.05). Levels of Hb and Alb were significantly lower and levels of PAB and TRF were significantly higher in observation group than in control group at one month after surgery (p<0.05). OES-18 score of observation group was significantly better than that of control group at one month after surgery (p<0.05). As a conclusion, FTS can promote postoperative rehabilitation, shorten hospital stay, reduce economic burden and reduce the rehospitalization rate of esophageal cancer patients. At the same time, FTS can also improve the lipid metabolism, nutritional status and regulate the differentiation of adipocytes, alleviate the low inflammatory response state, which in turn promotes metabolic syndrome.

Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China

Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results of the current study suggested that post-operative complications were more likely to occur in patients with diabetes, basic respiratory disease or lower serum albumin levels prior to surgery. Therefore, sufficient intensive peri-operative care, rigorous operative risk assessments, and the selection of the patients with early or mid-stage esophageal cancer, may decrease the risk of post-surgical complications in patients receiving radical resection of the esophagus. In addition, a high ratio of esophageal cancer stem-like cells was associated with cancer recurrence. These results suggest that an intensive surveillance strategy should be implemented in order to facilitate early detection of disease recurrence and improve the clinical management of these patients post-surgery.

High expression of Collagen Triple Helix Repeat Containing 1 (CTHRC1) facilitates progression of oesophageal squamous cell carcinoma through MAPK/MEK/ERK/FRA-1 activation

Background

Oesophageal cancer is one of the most common malignancies worldwide,and oesophageal squamous cell carcinoma (ESCC) is the predominant histological type both globally and in China. Collagen triple helix repeat containing 1 (CTHRC1) has been found to be upregulated in ESCC. However, its role in tumourigenesis and progression of ESCC remains unclear.

Methods

Using our previous ESCC mRNA profiling data, we screened upregulated genes to identify those required for proliferation. Immunohistochemistry was performed to determine the level of CTHRC1 protein expression in 204 ESCC patients. Correlations between CTHRC1 expression and clinicopathological characteristics were assessed. In addition, pyrosequencing and 5-aza-dC treatment were performed to evaluate methylation status of CTHRC1 promoter. In vitro and in vivo analyses were also conducted to determine the role of CTHRC1 in ESCC cell proliferation, migration and invasion, and RNA sequencing and molecular experiments were performed to study the underlying mechanisms.

Results

Based on mRNA profiling data, CTHRC1 was identified as one of the most significantly upregulated genes in ESCC tissues (n = 119, fold change = 20.5, P = 2.12E-66). RNA interference screening also showed that CTHRC1 was required for cell proliferation. Immunohistochemistry confirmed markedly high CTHRC1 protein expression in tumour tissues, and high CTHRC1 expression was positively correlated with advanced T stage (P = 0.043), lymph node metastasis (P = 0.023), TNM stage (P = 0.024) and poor overall survival (P = 0.020). Promoter hypomethylation at cg07757887 may contribute to increased CTHRC1 expression in ESCC cells and tumours. Forced overexpression of CTHRC1 significantly enhanced cell proliferation, migration and invasion, whereas depletion of CTHRC1 suppressed these cellular functions in three ESCC cell lines and xenografts. CTHRC1 was found to activate FRA-1 (Fos-related antigen 1, also known as FOSL1) through the MAPK/MEK/ERK cascade, which led to upregulation of cyclin D1 and thus promoted cell proliferation. FRA-1 also induced snail1-mediated MMP14 (matrix metallopeptidase 14, also known as MT1-MMP) expression to facilitate ESCC cell invasion, migration, and metastasis.

Conclusions

Our data suggest that CTHRC1 may act as an oncogenic driver in progression and metastasis of ESCC, and may serve as a potential biomarker for prognosis and personalized therapy.

Electronic supplementary material

The online version of this article (doi:10.1186/s13046-017-0555-8) contains supplementary material, which is available to authorized users.

Treatment of esophageal cancer with radiation therapy -a pan-Chinese survey of radiation oncologists

Lots of controversies were found about the treatment in relation to radiation therapy (RT) for esophageal squamous cell carcinoma (ESCC). We designed a questionnaire of these controversies to do a pan-Chinese survey of radiation oncologists (ROs). For operable ESCC, 53% ROs chose surgery plus postoperative chemoradiotherapy (CRT), while 40% chose preoperative CRT plus surgery. For target volume of postoperative RT, most ROs (92%) would delineate tumor bed plus involved lymph nodes region before surgery. For definitive RT, most ROs (81%) would give patients higher RT dose to 60-65Gy. For radiation target volume, most ROs would give patients prophylactic irradiation of the bilateral superclavicular-lymph nodes region for cervical ESCC (93%), and the left gastric lymph nodes region for lower thoracic ESCC (72%). For the treatment of mediastinal lymph nodes, 72% ROs preferred elective nodal irradiation, while 28% did the involved nodal irradiation. For concurrent chemotherapy regimen, PF (5-Fu + cisplatin) and TP (cisplatin + paclitaxel) were used widely (49% and 46%, respectively). During simulation, four-dimensional computer tomography (4D CT) was not widely used (48%), even for cervical or lower thoracic ESCC (52%). For daily RT delivery, only 66% ROs would perform imaging guidance RT daily. In summary, more controversies existed in the treatment of ESCC with RT in China, including treatment strategy, radiation dose and target contour. Future goals include standardization of treatment strategy, radiation dose, and target contour, and application of 4D CT and daily imaging guidance, and pursuit of randomized trials in Chinese population.