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Wang X, Zhang Z, Shi Y, Zhang W, Su C, Wang D. Construction of a Novel Mitochondria-Associated Gene Model for Assessing ESCC Immune Microenvironment and Predicting Survival. J Microbiol Biotechnol 2024; 34:1164-1177. [PMID: 38719775 PMCID: PMC11180922 DOI: 10.4014/jmb.2310.10052] [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: 11/09/2023] [Revised: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 05/29/2024]
Abstract
Esophageal squamous cell carcinoma (ESCC) is among the most common malignant tumors of the digestive tract, with the sixth highest fatality rate worldwide. The ESCC-related dataset, GSE20347, was downloaded from the Gene Expression Omnibus (GEO) database, and weighted gene co-expression network analysis was performed to identify genes that are highly correlated with ESCC. A total of 91 transcriptome expression profiles and their corresponding clinical information were obtained from The Cancer Genome Atlas database. A mitochondria-associated risk (MAR) model was constructed using the least absolute shrinkage and selection operator Cox regression analysis and validated using GSE161533. The tumor microenvironment and drug sensitivity were explored using the MAR model. Finally, in vitro experiments were performed to analyze the effects of hub genes on the proliferation and invasion abilities of ESCC cells. To confirm the predictive ability of the MAR model, we constructed a prognostic model and assessed its predictive accuracy. The MAR model revealed substantial differences in immune infiltration and tumor microenvironment characteristics between high- and low-risk populations and a substantial correlation between the risk scores and some common immunological checkpoints. AZD1332 and AZD7762 were more effective for patients in the low-risk group, whereas Entinostat, Nilotinib, Ruxolutinib, and Wnt.c59 were more effective for patients in the high-risk group. Knockdown of TYMS significantly inhibited the proliferation and invasive ability of ESCC cells in vitro. Overall, our MAR model provides stable and reliable results and may be used as a prognostic biomarker for personalized treatment of patients with ESCC.
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Affiliation(s)
- Xiu Wang
- Department of General Practice, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R. China
| | - Zhenhu Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R. China
| | - Yamin Shi
- School of Foreign Languages, Shandong University of Finance and Economics, Jinan 250014, P. R. China
| | - Wenjuan Zhang
- Department of Surgical, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R. China
| | - Chongyi Su
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, P.R. China
| | - Dong Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P.R. China
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2
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Xin G, Song N, Jiang K. Esophageal squamous cell carcinoma transformed into neuroendocrine carcinoma after neoadjuvant immunochemotherapy: A case report. Oncol Lett 2024; 27:184. [PMID: 38476207 PMCID: PMC10928968 DOI: 10.3892/ol.2024.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Immunotherapy provides durable responses for locally advanced esophageal carcinoma clinical therapy in numerous patients. However, the mechanisms of resistance to immunotherapy have not been elucidated. The phenomenon of the histological transformation of non-small cell lung cancer to small cell lung cancer resulting in resistance to immune checkpoint inhibitors (ICIs) has been reported. It remains unclear whether ICIs or chemotherapy could cause a similar transformation from esophageal squamous cell carcinoma (ESCC) to esophageal neuroendocrine carcinoma (ENEC). The present study report the case of a patient initially diagnosed with stage II ESCC who underwent radical surgery after three cycles of neoadjuvant therapy with cisplatin, albumin bound paclitaxel and ICIs. Immunohistochemical staining confirmed the absence of the SCC component and the presence of the NEC component, with negativity for CK5/6 and tumor protein p40, but positive expression of tumor protein p53, pan-cytokeratin, synaptophysin and CD56. The patient was followed up for 5 months with no treatment or postoperative complications. In conclusion, histological transformation to ENEC is a potential mechanism of acquired resistance to ICIs in ESCC. Prospective larger studies are warranted to further characterize ESCC-to-NEC transformation on use of ICIs.
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Affiliation(s)
- Gaojie Xin
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Naicheng Song
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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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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Zhao Q, Sun J, Zheng F, Dan Han, Fu C, Sun H, Liu C, Wang Z, Huang W, Wang R, Li B. Accurate location describe and management of lymph node recurrence after esophagectomy for thoracic esophageal squamous cell carcinoma:a retrospective cohort study. Int J Surg 2024; 110:01279778-990000000-01216. [PMID: 38498405 PMCID: PMC11175758 DOI: 10.1097/js9.0000000000001242] [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: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Describe the accurate locations of lymph node recurrence LNR of Chinese patients with postoperative thoracic esophageal squamous cell carcinoma (ESCC) is essential for determining the need for further surveillance protocols and treatments. We aimed to evaluate the patterns of postoperative ESCC and its current risk stratification with LNR. METHODS This population-based cohort study included a retrospective review of the medical records and image material of patients with ESCC who underwent LNR after radical surgery between January 2013 and September 2022, with a median follow-up time of 5.71 years. Clinical features were extracted from these records, and survival analysis was performed. The primary endpoint was the accurate location and range of LNR according to the nomenclature of the Japanese Society for Esophageal Diseases. The second endpoints was to explore the related factors of recurrence range (RR) and overall survival (OS) . RESULTS A total of 3268 lymph node regions were recurrence from 1129 patients, with a mean of 2.89 regions per patient. No.104, 106 and 107 was the most common recurrence of thoracic ESCC with an LNR rate higher than 15%. In upper thoracic ESCC, No.105 was a common recurrence site and abdominal lymph node recurrence was rare. In lower thoracic ESCC, retroperitoneal lymph node was a unique regions (15.4%). Anastomotic recurrence is an important recurrence pattern in patients with postoperative esophageal cancer, with an incidence of 24.5%. Rates of lymph node recurrence in range of lymph node dissection was low (13.9%). The median time of LRT was 20.0 (1.5-184.0) months. High range of recurrence was associated with significantly poorer OS in patients. Multiple linear regression analysis identified demonstrated N stage, tumor differentiation, adjuvant radiotherapy and total lymph nodes removed were association with recurrence range for patients. CONCLUSIONS Supraclavicular and upper mediastinums lymph nodes were common recurrence site for ESCC patients , and careful initial staging and surveillance are needed. Thorough lymph node dissection may reduce the range of regional recurrence.
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Affiliation(s)
- Qian Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Jinglong Sun
- Department of Rehabilitation, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan
| | - Feng Zheng
- Department of oncology, Linyi People’s Hospital, Linyi, Shandong
| | - Dan Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Chengrui Fu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Chengxin Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
| | - Ruozheng Wang
- The Third Affillated Teaching Hospital of Xinjiang Medical University/Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute/Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan
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Yoshida S, Fujii Y, Hoshino N, Tokoro Y, Tsunoda S, Obama K, Watanabe N. Anterior versus posterior mediastinal reconstruction after esophagectomy in esophageal cancer patients: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:88. [PMID: 38456948 DOI: 10.1007/s00423-024-03279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Esophagectomy is the primary surgical treatment for esophageal cancer, although other treatment approaches are often incorporated, including preoperative chemotherapy and chemoradiotherapy. The two major routes of esophageal reconstruction after esophagectomy are the anterior mediastinal (retrosternal, heterotopic) and posterior mediastinal (prevertebral, orthotopic) routes. However, which of these two routes of reconstruction is the most appropriate remains controversial. This systematic review aimed to compare the efficacy and safety of anterior mediastinal reconstruction with those of posterior mediastinal reconstruction after esophagectomy in esophageal cancer. METHODS In January 2022, a literature search of the CENTRAL, MEDLINE, and EMBASE databases was conducted to identify all published and unpublished randomized controlled trials, regardless of language. Eight studies were included for quantitative synthesis. RESULTS Postoperative death (9/129 and 4/125, risk ratio [RR]: 2.07, 95% confidence interval [CI]: 0.65-6.64) and incidence of anastomotic leak (24/208 and 26/208, RR: 0.95, 95% CI: 0.56-1.62) were not significantly different between the two mediastinal reconstructions. We could not perform a meta-analysis for quality of life, loss of body weight, or postoperative hospital stay due to data limitations. CONCLUSION Overall, there was low-quality evidence to suggest that the outcomes of the anterior and posterior mediastinal routes of reconstruction are not significantly different in patients with esophageal cancer.
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Affiliation(s)
- Shinya Yoshida
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yusuke Fujii
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yukinari Tokoro
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, 54, Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
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6
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Zhang J, Wu H, Wang R, Zhang M. Influencing factors of knowledge proficiency of general practitioners in rural China for esophageal cancer prevention and treatment: a cross-sectional study. Prim Health Care Res Dev 2024; 25:e9. [PMID: 38343367 PMCID: PMC10894722 DOI: 10.1017/s1463423623000701] [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: 12/13/2022] [Revised: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This study aims to investigate the knowledge of rural general practitioners (GPs) in esophageal cancer (EC) prevention and treatment in China and analyze relevant influencing factors, so as to improve the ability of rural GPs in EC prevention and treatment. METHODS This cross-sectional study was conducted from November 5, 2021, to November 20, 2021. A self-designed questionnaire was used to conduct an online survey. Multivariable logistic regression models were used to identify the influencing factors of knowledge proficiency of GPs in rural China for EC prevention and treatment. RESULTS This study included 348 participants from 12 rural areas in Hebei Province. The mean accuracy rate on all question items was 42.3% ± 10.67%. Sex (OR = 2.870, 95% CI: 1.519-5.423), educational level (OR = 3.256, 95% CI: 1.135-9.339), and comprehension of clinical practice guidelines for EC (OR = 4.305, 95% CI: 2.023-9.161) were significant predictors for GPs' knowledge proficiency of EC prevention and treatment (P < 0.05). CONCLUSIONS The study indicated that knowledge proficiency of rural GPs of EC prevention and control still awaits to be improved. Sex, educational level, and comprehension of clinical practice guidelines for EC were significant predictors for their proficiency.
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Affiliation(s)
- Jinjia Zhang
- Department of General Practice, The Second Hospital of Hebei Medical University, ShijiazhuangHebei, China
| | - Huadong Wu
- Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Rongying Wang
- Department of General Practice, The Second Hospital of Hebei Medical University, ShijiazhuangHebei, China
| | - Min Zhang
- Department of General Practice, The Second Hospital of Hebei Medical University, ShijiazhuangHebei, China
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7
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Gopakumar H, Khan H, Sharma N, Puli SR. Endoscopic spray cryotherapy for dysphagia palliation in esophageal cancer: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E211-E217. [PMID: 38348331 PMCID: PMC10861318 DOI: 10.1055/a-2231-7328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background and study aims Endoscopically delivered liquid nitrogen spray cryotherapy is reported to be a safe and possibly more effective strategy for dysphagia palliation in patients with advanced esophageal cancer. This systematic review and meta-analysis aimed to pool all available data to evaluate the impact of this treatment modality. Methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2005 through June 2023 were searched for studies evaluating endoscopically delivered liquid nitrogen spray cryotherapy for dysphagia palliation in patients with advanced esophageal cancer. Pooled proportions were calculated using random-effects (DerSimonian-Laird) model. Results From an initial 895 studies, data were extracted and analyzed from five studies comprising a total of 230 patients that met inclusion criteria. In this pooled analysis, dysphagia improved or did not deteriorate in 81.40% of patients (95% confidence interval [CI] 73.75-87.99). Significant improvement in dysphagia was reported by 55.19% of patients (95% CI 29.62-79.37). An alternate method of dysphagia palliation despite spray cryotherapy was required in 18.78% of patients (95% CI 8.09-32.63) with 10.56% (95% CI 2.53-23.18) requiring esophageal stents. The weighted mean number of spray cryotherapy sessions per patient was 3.37 (95% CI 2.55-4.18). The pooled major adverse event rate was 3.26% (95% CI 0.15-10.14). Conclusions Endoscopic liquid nitrogen spray cryotherapy can effectively and safely treat dysphagia in esophageal cancer. It can be considered an option for dysphagia palliation in centers with expertise and equipment.
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Affiliation(s)
- Harishankar Gopakumar
- Division of Gastroenterology and Hepatology, University of Illinois Chicago College of Medicine at Peoria, Peoria, United States
| | - Hamza Khan
- Mund-Lagowski Department of Chemistry and Biochemistry, Bradley University, Peoria, United States
| | - Neil Sharma
- Gastroenterology, Parkview Health, Fort Wayne, United States
| | - Srinivas Reddy Puli
- Division of Gastroenterology and Hepatology, University of Illinois Chicago College of Medicine at Peoria, Peoria, United States
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8
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Maramara T, Shridhar R, Blinn P, Huston J, Meredith K. Timing After Neoadjuvant Therapy Predicts Mortality in Patients Undergoing Esophagectomy: a Propensity Score-Matched Analysis. J Gastrointest Surg 2023; 27:2342-2351. [PMID: 37848687 DOI: 10.1007/s11605-023-05851-1] [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: 03/02/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Currently most surgeons allow 6-12 weeks after neoadjuvant therapy prior to recommending esophagectomy. Given that complete pathologic response correlates to improved survival, some have advocated a longer interval should be entertained to increase the pathologic response. The impact of an expanded neoadjuvant therapy-surgery timing is not currently well understood. METHODS Utilizing the National Cancer Database, we identified patients with esophageal cancer who underwent neoadjuvant therapy followed by esophagectomy. Patients were divided into 3-time intervals: < 6 weeks, 6-12 weeks, and > 3 months. RESULTS We identified 9256 patients who received neoadjuvant therapy followed by esophagectomy. There were 7858 (84.9%) males and 1398 (15.1%) females with a median age of 62. The median lymph nodes harvested decreased as timing increased (p < 0.001) and mean lymph nodes positive decreased as timing increased, p = 0.01. The complete response rate also increased as timing increased, p < 0.001. However, this improvement in pathologic complete response did not translate into an increase in median survival. Ninety-day mortality increased as the timing from neoadjuvant therapy increased: 6.4%, 7.9%, and 10.2%, respectively, p = 0.002. CONCLUSION Our data demonstrates that patients who have a prolonged neoadjuvant therapy- esophagectomy interval will have a substantial increase in 90-day mortality. While there was an increase in pathologic complete response rates, this did not translate into an improvement in survival. The current recommendations of a neoadjuvant therapy-surgery timing of 6-12 weeks should remain.
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Affiliation(s)
- Taylor Maramara
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA
| | | | - Paige Blinn
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA
| | - Jamie Huston
- Sarasota Memorial Hospital System, Sarasota Memorial Cancer Institute, Sarasota, FL, USA
| | - Kenneth Meredith
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA.
- Sarasota Memorial Hospital System, Sarasota Memorial Cancer Institute, Sarasota, FL, USA.
- Brian D. Jellison Cancer Institute, Sarasota, FL, USA.
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Pape M, Veen LM, Smit TM, Kuijper SC, Vissers PAJ, Geijsen ED, van Rossum PSN, Sprangers MAG, Derks S, Verhoeven RHA, van Laarhoven HWM. Late Toxicity and Health-Related Quality of Life Following Definitive Chemoradiotherapy for Esophageal Cancer: A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2023; 117:31-44. [PMID: 37224927 DOI: 10.1016/j.ijrobp.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/20/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Definitive chemoradiotherapy (dCRT) is a treatment option with curative intent for patients with esophageal cancer that could result in late toxicities and affect health-related quality of life (HRQoL). This study aimed to review the literature and perform a meta-analysis to investigate the effect of dCRT on late toxicities and HRQoL in esophageal cancer. METHODS AND MATERIALS A systematic search was performed in MEDLINE, EMBASE, and PsychINFO. Prospective phase II and III clinical trials, population-based studies, and retrospective chart reviews investigating late toxicity or HRQoL after dCRT (≥50 Gy) were included. The HRQoL outcomes were analyzed using linear mixed-effect models with restricted cubic spline transformation. Any HRQoL changes of ≥10 points were considered clinically relevant. The risk of toxicities was calculated using the number of events and the total study population. RESULTS Among 41 included studies, 10 assessed HRQoL and 31 late toxicity. Global health status remained stable over time and improved after 36 months compared with baseline (mean change, +11). Several tumor-specific symptoms, including dysphagia, eating restrictions, and pain, improved after 6 months compared with baseline. Compared with baseline, dyspnea worsened after 6 months (mean change, +16 points). The risk of any late toxicity was 48% (95% CI, 33%-64%). Late toxicity risk of any grade for the esophagus was 17% (95% CI, 12%-21%), pulmonary 21% (95% CI, 11%-31%), cardiac 12% (95% CI, 6%-17%), and any other organ 24% (95% CI, 2%-45%). CONCLUSIONS Global health status remained stable over time, and tumor-specific symptoms improved within 6 months after dCRT compared with baseline, with the exception of dyspnea. In addition, substantial risks of late toxicity were observed.
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Affiliation(s)
- Marieke Pape
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Linde M Veen
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Thom M Smit
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Steven C Kuijper
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Elisabeth D Geijsen
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Peter S N van Rossum
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Sarah Derks
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands
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10
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Böhme F, Racz K, Sebesta C, Sebesta C. [Esophageal Cancer]. Wien Med Wochenschr 2023; 173:209-215. [PMID: 36318394 DOI: 10.1007/s10354-022-00972-9] [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: 01/24/2022] [Accepted: 09/05/2022] [Indexed: 05/31/2023]
Abstract
Esophageal cancer has poor prognosis and high letality. With yearly 600,000 new cases worldwide it ist he sixt most common cancer worldwide and the eight most deadly. Squamous cell carcinoma is more common in Africa and Asia, whereas incidence of adenocarcinoma ist increasing in Norh America and Europe. Riskfactors include alcohol, smoking, obesity, esophageal stenosis or achalasia. Currently there are no recommendations for prevention strategies or cancer screening. Symptoms in early stages are unspecific, so diagnosis is made late. Diagnostics include gastroscopy, CT, PET and endosonography. Therapeutic approaches are depending on disease stage and patients general condition. In early stages endoscopic resection is the treatment of choice. In higher stages theraoy consists of surgical resection and radiochemotherapy. Generalised stade ist treated with palliative systemic therapy and local interventions.
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Affiliation(s)
- Felix Böhme
- 2. Medizinische Abteilung, Klinik Donaustadt, Langobardenstraße 122, 1220, Wien, Österreich.
| | - Krisztina Racz
- 2. Medizinische Abteilung, Klinik Donaustadt, Langobardenstraße 122, 1220, Wien, Österreich
| | - Christian Sebesta
- 2. Medizinische Abteilung, Klinik Donaustadt, Langobardenstraße 122, 1220, Wien, Österreich
| | - Christian Sebesta
- 2. Medizinische Abteilung, Klinik Donaustadt, Langobardenstraße 122, 1220, Wien, Österreich
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11
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Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma: An International Cohort Study From the Oesophagogastric Anastomosis Audit (OGAA). Ann Surg 2023; 277:e1026-e1034. [PMID: 35099168 DOI: 10.1097/sla.0000000000005394] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort. SUMMARY OF BACKGROUND DATA Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen. METHODS Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit. RESULTS The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, P = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI) 95% : 1.34-13.67]. Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18% vs 10%, P = 0.004) and margin-negative resections (93% vs 76%, P < 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI 95% : 1.26-3.34) and margin-negative resections (OR: 4.55, CI 95% : 2.70-7.69) compared to FLOT. CONCLUSIONS This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.
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Zhang G, Yuan J, Pan C, Xu Q, Cui X, Zhang J, Liu M, Song Z, Wu L, Wu D, Luo H, Hu Y, Jiao S, Yang B. Multi-omics analysis uncovers tumor ecosystem dynamics during neoadjuvant toripalimab plus nab-paclitaxel and S-1 for esophageal squamous cell carcinoma: a single-center, open-label, single-arm phase 2 trial. EBioMedicine 2023; 90:104515. [PMID: 36921563 PMCID: PMC10024111 DOI: 10.1016/j.ebiom.2023.104515] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors combined with chemotherapy as a neoadjuvant therapy have been applied to the treatment of esophageal squamous cell carcinoma (ESCC). However, the optimal regimen needs to be further explored, particularly for older patients, and the mechanisms by which the immune checkpoint inhibitor combined with chemotherapy modulates the evolution of ESCC are unknown. METHODS In this single-arm phase 2 trial, patients with resectable (stage II/III/IV without metastasis) ESCC were enrolled and received nanoparticle albumin-bound (nab) paclitaxel for two cycles and oral S-1 for 2 weeks, combined with intravenous toripalimab for two cycles before surgery. Combination postoperative adjuvant therapy was administered. The primary outcome was the major pathological response (MPR). Secondary outcomes included pathological complete response (pCR), overall response rate (ORR), disease control rate (DCR), disease-free survival (DFS), overall survival (OS), improvement in Stooler's dysphagia score and degree of daily living ability (dADL). Biopsies and plasma pre- and post-neoadjuvant therapy were performed using whole-exome sequencing, transcriptome sequencing, immunohistochemistry (IHC) for PD-L1, multiplex immunofluorescence (mIF) and proximity extension assay technology (PEA) for 92 proteins. FINDINGS From November 2019 to July 2021, 60 patients were enrolled. After neoadjuvant therapy, R0 resection was achieved in 55 (98.21%) patients. MPR was identified in 27 patients (49.09%), and 16 patients (29.09%) achieved pCR. Patients with PR, SD and PD were 37 (61.67%), 21 (35.00%) and 2 (3.33%), respectively. The overall staging, Stooler dysphagia scores and dADL were significantly decreased after treatment. 11 patients (18.3%) experienced grade ≥3 AEs. Compared to PD-L1-Low patients, PD-L1-High patients had a significantly higher ratio of PR. During therapy, the tumor mutation burden (TMB) and tumor neoantigen burden (TNB) were significantly decreased in patients with PR. Differential clonal evolution within tumors was demonstrated by analysis of intratumoral heterogeneity. Transcriptome analyses revealed that the infiltration of CD4+ T lymphocytes at baseline was associated with clinical outcome. During therapy, CD8+ T cells and CD4+ T cells were increased in all patients; however, exhausted cells, nTregs and iTregs were significantly increased in patients with non-MPR. Protein analyses revealed that the levels of IFN-γ, Gal.1 and LAMP3 can predict the clinical benefit. In addition, the expression of CD83, TNFRSF4, TNFSF14, VEGFR2, ADA, ARG1, and HO-1 was associated with serious AEs. More importantly, the integration of CD4+ T cells with plasma protein of IFN-γ, Gal.1 or LAMP3 could further distinguish responders from non-responders. INTERPRETATION In this study, neoadjuvant therapy with toripalimab, nab-paclitaxel and S-1 was less toxic and showed promising antitumor activity in patients with resectable ESCC. Changes in the genome, transcriptome, PD-L1 expression and serum proteins were comprehensively analyzed and correlated with clinical outcomes, which provides insight into the mechanism of action of toripalimab combined with nab-paclitaxel and S-1 in patients with ESCC. FUNDING This study was funded by Major projects of the ministry of science and technology of the 13th five-year plan of China [grant number: 2018ZX09201013].
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Affiliation(s)
- Guoqing Zhang
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Yuan
- Department of Pathology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chaohu Pan
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Qing Xu
- Department of Nutrition, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoli Cui
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Jing Zhang
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minglu Liu
- Outpatient Department, Jingnan Medical Area, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Song
- Department of Pathology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liangliang Wu
- Institute of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongfang Wu
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Haitao Luo
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China.
| | - Yi Hu
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Shunchang Jiao
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Bo Yang
- Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Li R, He Y, Sun X, Wang N, Zhang M, Wei K, Li H, Dong P, Du L, Chen W. The long-term survival of esophageal cancer in elderly patients: A multi-center, retrospective study from China. Cancer Med 2023; 12:4852-4863. [PMID: 36210795 PMCID: PMC9972158 DOI: 10.1002/cam4.5307] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Esophageal cancer (EC) often occurs in the elderly, and approximately 40% of patients are 70 years or older. To investigate the long-term survival of EC in elderly patients, to provide a theoretical direction for better management and predicting survival of EC based on the hospital-based multi-center study in China. METHODS The study was conducted in 18 hospitals including 6 provincial hospitals, 8 municipal hospitals, and 4 county hospitals. We extracted information from medical record homepage, records of admission and discharge, and pathological diagnosis reports from the medical record department of the elderly patients at 70-84 years old to obtain the 3-year and 5-year overall survival (OS), and main associated factors, and to analyze the current therapeutic effect of different treatment options for elderly patients. RESULTS The 3-year and 5-year OS rate of the 1013 elderly patients was 44.8% and 32.8%, respectively. Their median survival was 28.00 months. The median survival of patients with squamous cell carcinoma was longer than that of other pathological type (squamous vs. other types: 31.00 vs. 20.00 months, p = 0.018). The median survival of patients with surgery only or combined therapy was longer than that of radiotherapy, chemotherapy, and no therapy (surgery only vs. combined therapy vs. radiotherapy vs. chemotherapy vs. no therapy: 56.00 vs. 33.00 vs. 26.00 vs.18.00 vs. 16.00 months, p < 0.001). The 5-year OS rate of patients with highly differentiated cancer was higher than that of medium differentiated and poor differentiation/undifferentiated. In multivariate analysis, the older ages, pathological stage, were independent prognostic risk factors for poor EC survival. Treatment method was independent protective factors predictive of a good EC OS. CONCLUSIONS The survival rate of the elderly EC patients was still low in China. Age, therapy method, and pathological stage were mainly associated with the survival rate of EC in elderly patients.
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Affiliation(s)
- Runhua Li
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University/The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Xibin Sun
- Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Ning Wang
- Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Min Zhang
- Hubei Cancer Hospital, Wuhan, Hubei, China
| | - Kuangrong Wei
- Cancer Institute, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Huizhang Li
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Peng Dong
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Lingbin Du
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
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Yuan B, Lu H, Hu D, Xu K, Xiao S. Predictive models for the risk and prognosis of bone metastasis in patients with newly-diagnosed esophageal cancer: A retrospective cohort study. Front Surg 2023; 9:1014781. [PMID: 36713649 PMCID: PMC9879322 DOI: 10.3389/fsurg.2022.1014781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
Background Esophageal cancer (EC) is a common malignant tumor worldwide, and patients with both EC and bone metastasis (BM) have a poor prognosis. We aimed to determine the risk and prognostic factors for BM in patients with newly diagnosed EC and to conduct two nomograms to predict the probability of BM and overall survival after BM. Methods Data from patients with EC from 2010 to 2015 were reviewed in the Surveillance, Epidemiology, and End Results (SEER) database. We divided participants into training and validation cohorts using univariate and multivariate logistic regression analyses and Cox regression models to explore the risk and prognostic factors of BM, respectively. Moreover, two nomograms were developed for predicting the risk and prognosis of BM in patients with EC. Then we used receiver operating characteristic curves, decision curve analysis, and calibration curves to evaluate the nomogram models. The overall survival of patients with EC and BM was analyzed using the Kaplan-Meier method. Results A total of 10,730 patients with EC were involved, 735 of whom had BM at the time of diagnosis. Histologic type, sex, age, N stage, primary site, liver, lung, and brain metastases, and tumor differentiation grade were identified as independent BM risk factors. Histological type, chemotherapy, brain, liver, and lung metastases were identified as prognostic risk factors for patients with EC and BM. We developed diagnostic and prognostic nomograms according to the results. Receiver operating characteristic curves, calibration, and Kaplan-Meier curves, and decision curve analysis all indicated that both nomograms had great clinical predictive ability and good clinical application potential. Conclusions Two novel nomograms were constructed to predict the risk and prognosis of BM in patients with EC. These prediction models can effectively assist clinicians in clinical decision-making based on their good accuracy and reliability.
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Kamarajah SK, Evans RPT, Griffiths EA, Gossage JA, Pucher PH. Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma: meta-analysis. BJS Open 2022; 6:6880880. [PMID: 36477836 PMCID: PMC9728519 DOI: 10.1093/bjsopen/zrac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/27/2022] [Accepted: 09/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The literature lacks robust evidence comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy and surgery (nCRS) for oesophageal squamous cell carcinoma (ESCC). This study aimed to compare long-term survival of these approaches in patients with ESCC. METHODS A systematic review performed according to PRISMA guidelines included studies identified from PubMed, Scopus, and Cochrane CENTRAL databases up to July 2021 comparing outcomes between dCRT and nCRS for ESCC. The main outcome measure was overall survival (OS), secondary outcome was disease-free survival (DFS). A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs). RESULTS Ten studies including 14 092 patients were included, of which 30 per cent received nCRS. Three studies were randomized clinical trials (RCTs) and the remainder were retrospective cohort studies. dCRT and nCRS regimens were reported in six studies and surgical quality control was reported in two studies. Outcomes for OS and DFS were reported in eight and three studies respectively. Following meta-analysis, nCRS demonstrated significantly longer OS (HR 0.68, 95 per cent c.i. 0.54 to 0.87, P < 0.001) and DFS (HR 0.50, 95 per cent c.i. 0.36 to 0.70, P < 0.001) compared with dCRT. CONCLUSION Neoadjuvant chemoradiotherapy followed by oesophagectomy correlated with improved survival compared with definitive chemoradiation in the treatment of ESCC; however, there is a lack of literature on RCTs.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard P T Evans
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Philip H Pucher
- Correspondence to: Philip Pucher, Department of Surgery, Portsmouth University Hospitals NHS Trust, Cosham, Portsmouth, PO2 1LY, UK (e-mail: )
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Hsu C, Lin K, Shueng P, Wu Y, Tsai W, Chang C, Tien H, Wang S, Wu T, Mok GSP. Integrating 18 F-FDG PET/CT with lung dose-volume for assessing lung inflammatory changes after arc-based radiotherapy for esophageal cancer: A pilot study. Thorac Cancer 2022; 13:3114-3123. [PMID: 36163634 PMCID: PMC9663684 DOI: 10.1111/1759-7714.14661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The incidence of radiation pneumonitis (RP) has a highly linear relationship with low-dose lung volume. We previously established a volume-based algorithm (VBA) method to improve low-dose lung volume in radiotherapy (RT). This study assessed lung inflammatory changes by integrating fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) with VBA for esophageal cancer patients undergoing arc-based RT. METHODS Thirty esophageal cancer patients received 18 F-FDG PET/CT imaging pre-RT and post-RT were included in a retrospective pilot study. We fused lung doses and parameters of PET/CT in RT planning. Based on VBA, we used the 5Gy isodose curve to define high-dose (HD) and low-dose (LD) regions in the lung volume. We divided patients into non-RP (nRP) and RP groups. The maximum, mean standardized uptake value (SUVmax, SUVmean), global lung glycolysis (GLG), mean lung dose (MLD) and V5-30 in lungs were analyzed. Area under the curve values were utilized to identify optimal cut-off values for RP. RESULTS Eleven patients in the nRP group and 19 patients in the RP group were identified. In 30 RP lungs, post-RT SUVmax, SUVmean and GLG of HD regions showed significant increases compared to values for pre-RT lungs. There were no significant differences in values of 22 nRP lungs. Post-RT SUVmax and SUVmean of HD regions, MLD, and lung V5 and V10 in RP lungs were significantly higher than in nRP lungs. For detecting RP, the optimal cut-off values were post-RT SUVmax > 2.28 and lung V5 > 47.14%. CONCLUSION This study successfully integrated 18 F-FDG PET/CT with VBA to assess RP in esophageal cancer patients undergoing RT. Post-RT SUVmax > 2.28 and lung V5 > 47.14% might be potential indicators of RP.
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Affiliation(s)
- Chen‐Xiong Hsu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Kuan‐Heng Lin
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan,Industrial Ph.D. Program of Biomedical Science and EngineeringNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Pei‐Wei Shueng
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan,Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Yen‐Wen Wu
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Department of Nuclear Medicine, Division of CardiologyCardiovascular Medical Center, Far Eastern Memorial HospitalTaipei CityTaiwan
| | - Wei‐Ta Tsai
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Chiu‐Han Chang
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Hui‐Ju Tien
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Shan‐Ying Wang
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Department of Nuclear Medicine, Division of CardiologyCardiovascular Medical Center, Far Eastern Memorial HospitalTaipei CityTaiwan
| | - Tung‐Hsin Wu
- National Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Greta S. P. Mok
- Department of Electrical and Computer Engineering, Faculty of Science and TechnologyUniversity of MacauZhuhaiChina
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Zhu L, Zhao Z, Liu A, Wang X, Geng X, Nie Y, Zhao F, Li M. Lymph node metastasis is not associated with survival in patients with clinical stage T4 esophageal squamous cell carcinoma undergoing definitive radiotherapy or chemoradiotherapy. Front Oncol 2022; 12:774816. [PMID: 36185192 PMCID: PMC9516552 DOI: 10.3389/fonc.2022.774816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundClinical T4 stage (cT4) esophageal tumors are difficult to be surgically resected, and definitive radiotherapy (RT) or chemoradiotherapy (dCRT) remains the main treatment. The study aims to analyze the association between the status of lymph node (LN) metastasis and survival outcomes in the cT4 stage esophageal squamous cell carcinoma (ESCC) patients that underwent treatment with dCRT or RT.MethodsThis retrospective study analyzed the clinical data of 555 ESCC patients treated with dCRT or RT at the Shandong Cancer Hospital and the Liaocheng People’s Hospital from 2010 to 2017. Kaplan–Meier and Cox regression analyses was performed to determine the relationship between LN metastasis and survival outcomes of cT4 and non-cT4 ESCC patients. The chi-square test was used to evaluate the differences in the local and distal recurrence patterns in the ESCC patients belonging to various clinical T stages.ResultsThe 3-year survival rates for patients with non-cT4 ESCC and cT4 ESCC were 47.9% and 30.8%, respectively. The overall survival (OS) and progression-free survival (PFS) rates were strongly associated with the status of LN metastasis in the entire cohort (all P < 0.001) and the non-cT4 group (all P < 0.001) but not in the cT4 group. The local recurrence rates were 60.7% for the cT4 ESCC patients and 45.1% for the non-cT4 ESCC patients (P < 0.001). Multivariate analysis showed that clinical N stage (P = 0.002), LN size (P = 0.007), and abdominal LN involvement (P = 0.011) were independent predictors of favorable OS in the non-cT4 group. However, clinical N stage (P = 0.824), LN size (P = 0.383), and abdominal LN involvement (P = 0.337) did not show any significant correlation with OS in the cT4 ESCC patients.ConclusionsOur data demonstrated that the status of LN metastasis did not correlate with OS in the cT4 ESCC patients that received dCRT or RT. Furthermore, the prevalence of local recurrence was higher in the cT4 ESCC patients.
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Affiliation(s)
- Liqiong Zhu
- Department of Clinical Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Liaocheng People’s Hospital, Liaocheng, China
| | - Zongxing Zhao
- Department of Radiation Oncology, Liaocheng People’s Hospital, Liaocheng, China
| | - Ao Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- School of Medicine, Shandong University, Jinan, China
| | - Xin Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiaotao Geng
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yu Nie
- Department of Clinical Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Fen Zhao ; Minghuan Li,
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Fen Zhao ; Minghuan Li,
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The Biomarker Like the Correlation between Vasculogenic Mimicry, Vascular Endothelial Cadherin, Sex-DeterminingRegion on Y-Box Transcription Factor 17, and Cyclin D1 in Oesophageal Squamous Cell Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:8915503. [PMID: 36072972 PMCID: PMC9444392 DOI: 10.1155/2022/8915503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
Background This study aimed to explore the relationships between the sex-determining region on Y (SRY) box transcription factor 17 (SOX17), Cyclin D1, vascular endothelial cadherin (VE-cadherin), and vasculogenic mimicry (VM) in the occurrence and development of esophageal squamous cell carcinoma (ESCC). Methods The expressions of SOX17, Cyclin D1, and VE-cadherin, as well as VM, in tissues, were determined using immunohistochemistry. SOX17, Cyclin D1, and VE-cadherin mRNA in ESCC and their corresponding adjacent normal tissues were quantified using quantitative reverse transcription polymerase chain reaction analysis. Cell invasion, migration, and proliferation were determined after the silencing of VE-cadherin. SOX17, Cyclin D1, and VE-cadherin protein were quantified using Western blotting. Results The expression levels of SOX17, Cyclin D1, and VE-cadherin significantly correlated with the clinical characteristics of ESCC. After the VE-cadherin silencing, cell invasion, migration, and proliferation decreased, along with the Cyclin D1 levels, while the SOX17 levels increased. Conclusion SOX17, Cyclin D1, and VE-cadherin are involved in the development of ESCC.
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Survival after Multimodal Treatment Including Surgery for Metastatic Esophageal Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14163956. [PMID: 36010949 PMCID: PMC9405894 DOI: 10.3390/cancers14163956] [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: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The management of metastatic esophageal cancer is more often limited to palliative chemotherapy. Limited data are available regarding the role of surgery that remains controversial. The aim of this systematic review is to assess the survival outcome of surgically treated metastatic esophageal cancer patients. (2) Methods: The present systematic review is designed using the PRISMA guidelines and has been registered with PROSPERO (CRD42019140306). Two reviewers independently searched and identified studies dealing with surgery for stage IV esophageal cancer in the Medline and Google Scholar databases between January 2008 and December 2019. (3) Results: Seven retrospective nonrandomized studies, totaling 1756 patients with stage IV esophageal cancer who underwent curative surgery, were included. Our analysis demonstrates a three-year overall survival rate of 23% (CI 95% 17–31) among patients undergoing surgery. Because only two comparative studies were identified, data compilation and relative risk evaluation through meta-analysis were not possible. (4) Conclusions: Multimodality treatment, including surgery in curative intent, seems associated with a significant chance of three-year overall survival. A prospective evaluation of this approach and validation of adequate selection criteria are needed.
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Li X, Luan S, Yang Y, Zhou J, Shang Q, Fang P, Xiao X, Zhang H, Yuan Y. Trimodal Therapy in Esophageal Squamous Cell Carcinoma: Role of Adjuvant Therapy Following Neoadjuvant Chemoradiation and Surgery. Cancers (Basel) 2022; 14:cancers14153721. [PMID: 35954385 PMCID: PMC9367572 DOI: 10.3390/cancers14153721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to determine the role of adjuvant therapy after neoadjuvant chemoradiotherapy and esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: The study retrospectively reviewed 447 ESCC patients who underwent neoadjuvant chemoradiotherapy and esophagectomy. Patients were divided into an adjuvant therapy group and no adjuvant therapy group. Propensity score matching was used to adjust the confounding factors. Results: 447 patients with clinical positive lymph nodes and no distant metastasis treated with neoadjuvant chemoradiotherapy and esophagectomy were eligible for analysis. After propensity score matching, there were 120 patients remaining in each group. Patients receiving adjuvant therapy had a significantly shorter post-resection overall survival (OS) and disease-free survival (DFS) when compared to patients not receiving adjuvant therapy (log-rank, OS: p = 0.046, DFS: p < 0.001). Receiving adjuvant therapy is not an independently prognostic factor for OS (hazard ratio (HR): 1.270, HR: 0.846−1.906, p = 0.249) but a significantly unfavorable independent prognostic factor for DFS (HR: 2.061, HR: 1.436−2.958, p < 0.001). Conclusions: The results of our study indicate that adjuvant therapy after neoadjuvant chemoradiotherapy and surgery could reduce the OS and DFS in patients with ESCC. Therefore, adjuvant therapy is not recommended for ESCC patients after neoadjuvant chemoradiotherapy and esophagectomy, especially patients without nodal metastases after neoadjuvant therapy.
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Hu J, Chen Z, Lv J, Zheng Z, Bei Y, Chen X, Zheng L, Song W, Xu Y. The Application of Nimotuzumab Combined With Definitive Chemoradiotherapy Toward the Treatment of Locally Advanced Cervical Esophageal Carcinoma: A Retrospective Study. Front Oncol 2022; 12:905422. [PMID: 35898885 PMCID: PMC9310542 DOI: 10.3389/fonc.2022.905422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the safety and effectiveness of nimotuzumab in combination with chemoradiotherapy for locally advanced cervical esophageal squamous cell carcinoma. Methods Retrospective analysis was conducted from September 2012 to February 2017 among 50 locoregional-advanced cervical esophageal carcinoma (CEC) patients who received concurrent chemoradiotherapy (CRT) combined with or without nimotuzumab at Ningbo Medical Center Lihuili Hospital. Intensity-modulated radiotherapy (IMRT) was administrated on all patients. All patients were divided into two groups, of which 26 (Group A) received 200 mg (22 of 50) or 400 mg (4 of 50) of nimotuzumab per week with CRT and 24 (Group B) received definitive CRT. Results The median follow-up time was 23 months. The median overall survival (OS) and progression-free survival (PFS) were 40.6 and 21.1 months for all, respectively. The 1-, 2-, and 3-year OS rates on the whole were 79.6%, 62.1%, and 47.8%. There was no statistical difference in overall response rate and disease control rate between the two groups. Patients treated with nimotuzumab (group A) had better PFS than the definitive CRT group (group B) (P < 0.05). However, the median OS was 41.4 months in group A and 32.4 months in group B, respectively (P = 0.517). Multivariate analysis showed that PFS among those with lower Eastern Cooperative Oncology Group (ECOG) score (HR = 5.11; P < 0.01), stage II (HR = 9.52; P < 0.01) and the application of nimotuzumab combined with CRT (HR = 0.16; P < 0.01) was much longer. Furthermore, ECOG, stage, C-reactive protein (CRP) baseline, and histological grade can also be used as independent predictors of OS. Grade >3 adverse reactions were not observed. The most common adverse event related to nimotuzumab was mild fever and the occurrence rate was 19% (5 of 26). The incidence of anemia was 65.4% in group A and 87.5% in group B (P < 0.05). Conclusions For locoregional-advanced CEC, nimotuzumab combined with IMRT and concomitant chemotherapy was tolerated and effective. In addition, patients with a normal pretherapeutic serum CRP level (CRP < 10 mg/L) can achieve better OS.
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Affiliation(s)
- Jing Hu
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Zhe Chen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jiaming Lv
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Zhen Zheng
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yanping Bei
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Xue Chen
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Lu Zheng
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Wenjie Song
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yunbao Xu
- Department of Radiotherapy and Chemotherapy, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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22
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Liu X, Guan HY, Zhu Q, Tang C, Cheng F, Zeng C, Chen Y. Endoscopic Submucosal Dissection Versus Radical Surgery for T1 Superficial Esophageal Cell Carcinoma: a Subgroup Survival Analysis. J Gastrointest Cancer 2022; 54:155-164. [PMID: 35192141 DOI: 10.1007/s12029-021-00739-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous advent of magnifying endoscopy, endoscopic submucosal dissection (ESD) has gradually become the mainstream treatment for early esophageal cancer. We aimed to compare the outcomes of patients with T1 superficial esophageal cell carcinoma treated with ESD vs. esophagectomy. METHODS We retrospectively analyzed patients who underwent ESD or radical surgery at the First Affiliated Hospital of Nanchang University from January 1, 2010, to December 31, 2018. The purpose of propensity score matching is to reduce selection bias. Precise subgroup analysis according to depth of invasion was performed to reduce the influence of confounding factors. RESULT We reviewed patients who underwent ESD (n = 117) or radical surgery (n = 217) at the First Affiliated Hospital of Nanchang University from 2010 to 2018. The OS rate and progression-free survival rate in the ESD group were better than those in the surgery group (OS, P = 0.002. PFS, P = 0.004). The ESD group had a lower early adverse event rate (74.6% vs. 91%, P = 0.012), shorter hospital stays (median 10 days vs. 18 days, P < 0.001), and lower hospitalization costs (median 15,455 vs. 62,376 RMB, P < 0.001). Multivariate Cox regression analysis found that the treatment method was an independent risk factor affecting the prognosis of patients with superficial esophageal cancer, and the death risk of patients in the ESD group was 0.377 times that of the radical surgery group (HR = 0.377, P = 0.023). We conducted a subgroup analysis of patients again according to the depth of invasion; 37 pairs of patients were included in the T1a stage, and 19 pairs of patients were included in the T1b stage. In T1a and T1b patients, the difference in OS rate and PFS rate between the two treatments was statistically significant (T1a, OS, P = 0.002, PFS, P = 0.004; T1b, OS, P = 0.019, PFS, P = 0.022), and the OS rates in the ESD group were better than those in the radical surgery group. CONCLUSION For patients with T1b superficial esophageal cancer, ESD has a longer overall survival and progression-free survival compared with radical surgery. These results support ESD as the preferred treatment for stage T1b superficial esophageal cancer.
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23
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Hang TVP, Spiritos Z, Gamboa AM, Chen Z, Force S, Patel V, Chawla S, Keilin S, Saba NF, El-Rayes B, Cai Q, Willingham FF. Epidemiology of Early Esophageal Adenocarcinoma. Clin Endosc 2022; 55:372-380. [PMID: 35144364 PMCID: PMC9178140 DOI: 10.5946/ce.2021.152] [Citation(s) in RCA: 7] [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: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined. Methods Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available. Results The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval 4.66, 5.56). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%. Conclusions There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.
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Affiliation(s)
- Thuy-Van P Hang
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Zachary Spiritos
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC, USA
| | - Anthony M Gamboa
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN, USA
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Seth Force
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Vaishali Patel
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Saurabh Chawla
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Steven Keilin
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Nabil F Saba
- Emory Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Bassel El-Rayes
- Emory Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Qiang Cai
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Field F Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA, USA
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24
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Lei LL, Song X, Zhao XK, Xu RH, Wei MX, Sun L, Wang PP, Yang MM, Hu JF, Zhong K, Han WL, Han XN, Fan ZM, Wang R, Li B, Zhou FY, Wang XZ, Zhang LG, Bao QD, Qin YR, Chang ZW, Ku JW, Yang HJ, Yuan L, Ren JL, Li XM, Wang LD. Long-term effect of hospital volume on the postoperative prognosis of 158,618 patients with esophageal squamous cell carcinoma in China. Front Oncol 2022; 12:1056086. [PMID: 36873301 PMCID: PMC9978392 DOI: 10.3389/fonc.2022.1056086] [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: 09/28/2022] [Accepted: 12/16/2022] [Indexed: 02/18/2023] Open
Abstract
Background The impact of hospital volume on the long-term survival of esophageal squamous cell carcinoma (ESCC) has not been well assessed in China, especially for stage I-III stage ESCC. We performed a large sample size study to assess the relationships between hospital volume and the effectiveness of ESCC treatment and the hospital volume value at the lowest risk of all-cause mortality after esophagectomy in China. Aim To investigate the prognostic value of hospital volume for assessing postoperative long-term survival of ESCC patients in China. Methods The date of 158,618 patients with ESCC were collected from a database (1973-2020) established by the State Key Laboratory for Esophageal Cancer Prevention and Treatment, the database includes 500,000 patients with detailed clinical information of pathological diagnosis and staging, treatment approaches and survival follow-up for esophageal and gastric cardia cancers. Intergroup comparisons of patient and treatment characteristics were conducted with the X2 test and analysis of variance. The Kaplan-Meier method with the log-rank test was used to draw the survival curves for the variables tested. A Multivariate Cox proportional hazards regression model was used to analyze the independent prognostic factors for overall survival. The relationship between hospital volume and all-cause mortality was assessed using restricted cubic splines from Cox proportional hazards models. The primary outcome was all-cause mortality. Results In both 1973-1996 and 1997-2020, patients with stage I-III stage ESCC who underwent surgery in high volume hospitals had better survival than those who underwent surgery in low volume hospitals (both P<0.05). And high volume hospital was an independent factor for better prognosis in ESCC patients. The relationship between hospital volume and the risk of all-cause mortality was half-U-shaped, but overall, hospital volume was a protective factor for esophageal cancer patients after surgery (HR<1). The concentration of hospital volume associated with the lowest risk of all-cause mortality was 1027 cases/year in the overall enrolled patients. Conclusion Hospital volume can be used as an indicator to predict the postoperative survival of ESCC patients. Our results suggest that the centralized management of esophageal cancer surgery is meaningful to improve the survival of ESCC patients in China, but the hospital volume should preferably not be higher than 1027 cases/year. Core tip Hospital volume is considered to be a prognostic factor for many complex diseases. However, the impact of hospital volume on long-term survival after esophagectomy has not been well evaluated in China. Based on a large sample size of 158,618 ESCC patients in China spanning 47 years (1973-2020), We found that hospital volume can be used as a predictor of postoperative survival in patients with ESCC, and identified hospital volume thresholds with the lowest risk of death from all causes. This may provide an important basis for patients to choose hospitals and have a significant impact on the centralized management of hospital surgery.
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Affiliation(s)
- Ling-Ling Lei
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Song
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xue-Ke Zhao
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Rui-Hua Xu
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Meng-Xia Wei
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Lin Sun
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Pan-Pan Wang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Miao-Miao Yang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Jing-Feng Hu
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Kan Zhong
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Wen-Li Han
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xue-Na Han
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Zong-Min Fan
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Ran Wang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Bei Li
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Fu-You Zhou
- Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, Henan, China
| | - Xian-Zeng Wang
- Department of Thoracic Surgery, Linzhou People's Hospital, Linzhou, Henan, China
| | - Li-Guo Zhang
- Department of Thoracic Surgery, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - Qi-De Bao
- Department of Oncology, Anyang District Hospital, Anyang, Henan, China
| | - Yan-Ru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Wei Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Wei Ku
- Department of Gastroenterology, The Second Affiliated Hospital of Nanyang Medical College, Nanyang, Henan, China
| | - Hai-Jun Yang
- Department of Pathology, Anyang Tumor Hospital, Anyang, Henan, China
| | - Ling Yuan
- Department of Radiotherapy, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China
| | - Jing-Li Ren
- Department of Pathology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xue-Min Li
- Department of Pathology, Hebei Provincial Cixian People's Hospital, Cixian, Hebei, China
| | - Li-Dong Wang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
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25
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Yajima S, Sugawara K, Iwai M, Tanaka M, Seto Y, Todo T. Efficacy and safety of a third-generation oncolytic herpes virus G47Δ in models of human esophageal carcinoma. Mol Ther Oncolytics 2021; 23:402-411. [PMID: 34853811 PMCID: PMC8605086 DOI: 10.1016/j.omto.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022] Open
Abstract
Treatment options are limited for esophageal carcinoma (EC). G47Δ, a triple-mutated, conditionally replicating herpes simplex virus type 1 (HSV-1), exhibits enhanced killing of tumor cells with high safety features. Here, we studied the efficacy of G47Δ using preclinical models of human EC. In vitro, G47Δ showed efficient cytopathic effects and replication capabilities in all eight human esophageal cancer cell lines tested. In athymic mice harboring subcutaneous tumors of human EC (KYSE180, TE8, and OE19), two intratumoral injections with G47Δ significantly inhibited the tumor growth. To mimic the clinical treatment situations, we established an orthotopic EC model using luciferase-expressing TE8 cells (TE8-luc). An intratumoral injection with G47Δ markedly inhibited the growth of orthotopic TE8-luc tumors in athymic mice. Furthermore, we evaluated the safety of applying G47Δ to the esophagus in mice. A/J mice inoculated intraesophageally or administered orally with G47Δ (107 plaque-forming units [pfu]) survived for more than 2 months without remarkable symptoms, whereas the majority with wild-type HSV-1 (106 pfu) deteriorated within 10 days. PCR analyses showed that the G47Δ DNA was confined to the esophagus after intraesophageal inoculation and was not detected in major organs after oral administration. Our results provide a rationale for the clinical use of G47Δ for treating EC.
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Affiliation(s)
- Shoh Yajima
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kotaro Sugawara
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwako Iwai
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Minoru Tanaka
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoki Todo
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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26
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Yoshida S, Hoshino N, Hida K, Tsunoda S, Obama K, Watanabe N, Sakai Y. Anterior versus posterior mediastinal reconstruction after esophagectomy for patients with esophageal cancer. Hippokratia 2021. [DOI: 10.1002/14651858.cd014607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shinya Yoshida
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
| | - Nobuaki Hoshino
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
| | - Koya Hida
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
| | - Shigeru Tsunoda
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
| | - Kazutaka Obama
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior; Kyoto University School of Public Health; Kyoto Japan
| | - Yoshiharu Sakai
- Department of Surgery; Kyoto University Hospital; Kyoto Japan
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27
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Song S, Chen Q, Li Y, Lei G, Scott AW, Huo L, Li CY, Estrella JS, Correa AM, Pizzi M, Ma L, Jin J, Liu B, Wang Y, Xiao L, Hofstetter WL, Lee JH, Weston B, Bhutani MS, Shanbhag ND, Johnson RL, Gan B, Wei S, Ajani JA. Targeting cancer stem cells with a pan-BCL-2 inhibitor in preclinical and clinical settings in patients with gastroesophageal carcinoma. Gut 2021; 70:2238-2248. [PMID: 33487592 PMCID: PMC9720890 DOI: 10.1136/gutjnl-2020-321175] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Gastro-oesophageal cancers (GEC) are resistant to therapy and lead to poor prognosis. The cancer stem cells (CSCs) and antiapoptotic pathways often confer therapy resistance. We sought to elucidate the antitumour action of a BCL-2 inhibitor, AT101 in GEC in vitro, in vivo and in a clinical trial. METHODS Extensive preclinical studies in vitro and in vivo were carried out to establish the mechanism action of AT101 on targeting CSCs and antiapoptotic proteins. A pilot clinical trial in patients with GEC was completed with AT-101 added to standard chemoradiation. RESULTS Overexpression of BCL-2 and MCL-1 was noted in gastric cancer tissues (GC). AT-101 induced apoptosis, reduced proliferation and tumour sphere formation in MCL-1/BCL-2 high GC cells. Interestingly, AT101 dramatically downregulated genes (YAP-1/Sox9) that control CSCs in GEC cell lines regardless of BCL-2/MCL-1 expression. Addition of docetaxel to AT-101 amplified its antiproliferation and induced apoptosis effects. In vivo studies confirmed the combination of AT101 and docetaxel demonstrated stronger antitumour activity accompanied with significant decrease of CSCs biomarkers (YAP1/SOX9). In a pilot clinical trial, 13 patients with oesophageal cancer (EC) received AT101 orally concurrently with chemoradiation. We observed dramatic clinical complete responses and encouraging overall survival in these patients. Clinical specimen analyses revealed that AT-101 dramatically reduced the expression of CSCs genes in treated EC specimens indicating antitumour activity of AT101 relies more on its anti-CSCs activity. CONCLUSIONS Our preclinical and clinical data suggest that AT-101 overcomes resistance by targeting CSCs pathways suggesting a novel mechanism of action of AT101 in patients with GEC.
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Affiliation(s)
- Shumei Song
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiongrong Chen
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030;,Department of Pathology & Surgical Oncology, Hubei Cancer Hospital, Wuhan, Hubei, CN, 430079
| | - Yuan Li
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Guang Lei
- Department of Experimental Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Ailing W Scott
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Longfei Huo
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Cordelia Y. Li
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Jeannelyn S. Estrella
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Arlene M. Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Melissa Pizzi
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Lang Ma
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Jiankang Jin
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Bin Liu
- Department of Epigenetic&Molecular Carcinogenesis, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Ying Wang
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Lianchun Xiao
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Wayne L. Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Jeffrey H. Lee
- Department of Gastroenterology Hepat&Nutr, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Brian Weston
- Department of Gastroenterology Hepat&Nutr, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepat&Nutr, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Namita D. Shanbhag
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Randy L. Johnson
- Department of Cancer Biology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Boyi Gan
- Department of Experimental Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030
| | - Shaozhong Wei
- Department of Pathology & Surgical Oncology, Hubei Cancer Hospital, Wuhan, Hubei, CN, 430079
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030;,Corresponding Authors: Shumei Song, Tel: 713-834-6144; or Jaffer A. Ajani, Tel: 713-792-3685; ; Department of Gastrointestinal Medical Oncology, Unit 426, The University of Texas, M.D. Anderson Cancer Center; 1515 Holcombe Blvd., Houston, TX, 77030
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The Prognostic Impact of Histology in Esophageal and Esophago-Gastric Junction Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13205211. [PMID: 34680360 PMCID: PMC8533974 DOI: 10.3390/cancers13205211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Stage significantly affects survival of esophageal and esophago-gastric junction adenocarcinomas (EA/EGJAs), however, limited evidence for the prognostic role of histologic subtypes is available. The aim of the study was to describe a morphologic approach to EA/EGJAs and assess its discriminating prognostic power. Histologic slides from 299 neoadjuvant treatment-naïve EA/EGJAs, resected in five European Centers, were retrospectively reviewed. Morphologic features were re-assessed and correlated with survival. In glandular adenocarcinomas (240/299 cases-80%), WHO grade and tumors with a poorly differentiated component ≥6% were the most discriminant factors for survival (both p < 0.0001), distinguishing glandular well-differentiated from poorly differentiated adenocarcinomas. Two prognostically different histologic groups were identified: the lower risk group, comprising glandular well-differentiated (34.4%) and rare variants, such as mucinous muconodular carcinoma (2.7%) and diffuse desmoplastic carcinoma (1.7%), versus the higher risk group, comprising the glandular poorly differentiated subtype (45.8%), including invasive mucinous carcinoma (5.7%), diffuse anaplastic carcinoma (3%), mixed carcinoma (6.7%) (CSS p < 0.0001, DFS p = 0.001). Stage (p < 0.0001), histologic groups (p = 0.001), age >72 years (p = 0.008), and vascular invasion (p = 0.015) were prognostically significant in the multivariate analysis. The combined evaluation of stage/histologic group identified 5-year cancer-specific survival ranging from 87.6% (stage II, lower risk) to 14% (stage IVA, higher risk). Detailed characterization of histologic subtypes contributes to EA/EGJA prognostic prediction.
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29
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Martínez A, Infante JR, Quirós J, Rayo JI, Serrano J, Moreno M, Jiménez P, Cobo A, Baena A. Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer. Rev Esp Med Nucl Imagen Mol 2021; 41:164-170. [PMID: 34452867 DOI: 10.1016/j.remnie.2021.07.006] [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: 01/14/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Abstract
AIM To determine the utility of [18F]FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). MATERIAL AND METHODS Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. RESULTS The average follow-up was 22.4 months, with 22 recurrence-progressions and 25 deaths. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. CONCLUSION Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment.
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Affiliation(s)
- A Martínez
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain.
| | - J R Infante
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - J Quirós
- Servicio de Oncología Radioterápica, Hospital Universitario de Badajoz, Badajoz, Spain
| | - J I Rayo
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - J Serrano
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M Moreno
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - P Jiménez
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Cobo
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
| | - A Baena
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, Spain
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30
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Lorenzen S, Reinacher-Schick A, Masetti M. [Modern concepts of systemic treatment for adjuvant and palliative treatment of locally advanced or metastasized esophageal cancer]. Chirurg 2021; 92:1085-1093. [PMID: 34387700 DOI: 10.1007/s00104-021-01476-9] [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] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The approval of a wide variety of PD-1/PD-L1 and CTLA‑4 inhibitors has sustainably influenced the treatment landscape in many tumor entities and established immunotherapy as a new oncological treatment strategy. OBJECTIVE This article summarizes the current clinical state of treatment for locally advanced and metastatic esophageal cancer and assesses the running and future developmental program and the implementation in the clinical routine. MATERIAL AND METHODS Publications from Medline, ASCO and ESMO were systematically collected and evaluated. RESULTS Many phase I-III trials focusing on immunotherapy for gastrointestinal tumors were carried out in recent years but were however without comparable success to other tumor entities and with only moderate response rates between 10% and 25% in monotherapy. Subgroups such as microsatellite instability (MSI) cancers and tumors overexpressing PD-L1 seem to particularly benefit from treatment with immune checkpoint inhibitors. Routine testing for known molecular alterations should therefore be carried out with all advanced esophageal cancers. Initial promising approaches with a combination of chemotherapy and immunotherapy were recently published and could become new treatment standards for esophageal cancer. CONCLUSION Due to the survival advantage with a combination of chemotherapy and immunotherapy for untreated advanced stage esophageal cancer, it seems likely that this treatment strategy will become established as a new standard of care, assuming approval is granted. Immunotherapy might also become important in the adjuvant treatment of esophageal cancer.
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Affiliation(s)
- Sylvie Lorenzen
- Klinik und Poliklinik für Innere Medizin III, Abteilung für Hämatologie und Onkologie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Anke Reinacher-Schick
- Medizinische Klinik V, Klinik für Hämatologie und Onkologie mit Palliativmedizin, St. Josef-Hospital, Ruhr-Universität, Bochum, Deutschland
| | - Michael Masetti
- Abteilung für Hämatologie und Onkologie, Klinikum rechts der Isar, TU München, München, Deutschland
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31
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Kamarajah SK, Phillips AW, Ferri L, Hofstetter WL, Markar SR. Neoadjuvant chemoradiotherapy or chemotherapy alone for oesophageal cancer: population-based cohort study. Br J Surg 2021; 108:403-411. [PMID: 33755097 DOI: 10.1093/bjs/znaa121] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although both neoadjuvant chemoradiotherapy (nCRT) and chemotherapy (nCT) are used as neoadjuvant treatment for oesophageal cancer, it is unknown whether one provides a survival advantage over the other, particularly with respect to histological subtype. This study aimed to compare prognosis after nCRT and nCT in patients undergoing oesophagectomy for oesophageal adenocarcinoma (OAC) or squamous cell carcinoma (OSCC). METHODS Data from the National Cancer Database (2006-2015) were used to identify patients with OAC and OSCC. Propensity score matching and Cox multivariable analyses were used to account for treatment selection biases. RESULTS The study included 11 167 patients with OAC (nCRT 9972, 89.3 per cent; nCT 1195, 10.7 per cent) and 2367 with OSCC (nCRT 2155, 91.0 per cent; nCT 212, 9.0 per cent). In the matched OAC cohort, nCRT provided higher rates of complete pathological response (35.1 versus 21.0 per cent; P < 0.001) and margin-negative resections (90.1 versus 85.9 per cent; P < 0.001). However, patients who had nCRT had similar survival to those who received nCT (hazard ratio (HR) 1.04, 95 per cent c.i. 0.95 to 1.14). Five-year survival rates for patients who had nCRT and nCT were 36 and 37 per cent respectively (P = 0.123). For OSCC, nCRT had higher rates of complete pathological response (50.9 versus 30.4 per cent; P < 0.001) and margin-negative resections (92.8 versus 82.4 per cent; P < 0.001). A statistically significant overall survival benefit was evident for nCRT (HR 0.78, 0.62 to 0.97). Five-year survival rates for patients who had nCRT and nCT were 45.0 and 38.0 per cent respectively (P = 0.026). CONCLUSION Despite pathological benefits, including primary tumour response to nCRT, there was no prognostic benefit of nCRT compared with nCT for OAC suggesting that these two modalities are equally acceptable. However, for OSCC, nCRT followed by surgery appears to remain the optimal treatment approach.
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Affiliation(s)
- S K Kamarajah
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - A W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.,School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - L Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - W L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
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32
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Zhang W, Bhagwath AS, Ramzan Z, Williams TA, Subramaniyan I, Edpuganti V, Kallem RR, Dunbar KB, Ding P, Gong K, Geurkink SA, Beg MS, Kim J, Zhang Q, Habib AA, Choi SH, Lapsiwala R, Bhagwath G, Dowell JE, Melton SD, Jie C, Putnam WC, Pham TH, Wang DH. Itraconazole Exerts Its Antitumor Effect in Esophageal Cancer By Suppressing the HER2/AKT Signaling Pathway. Mol Cancer Ther 2021; 20:1904-1915. [PMID: 34376577 DOI: 10.1158/1535-7163.mct-20-0638] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/11/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
Itraconazole, an FDA-approved antifungal, has antitumor activity against a variety of cancers. We sought to determine the effects of itraconazole on esophageal cancer and elucidate its mechanism of action. Itraconazole inhibited cell proliferation and induced G1-phase cell-cycle arrest in esophageal squamous cell carcinoma and adenocarcinoma cell lines. Using an unbiased kinase array, we found that itraconazole downregulated protein kinase AKT phosphorylation in OE33 esophageal adenocarcinoma cells. Itraconazole also decreased phosphorylation of downstream ribosomal protein S6, transcriptional expression of the upstream receptor tyrosine kinase HER2, and phosphorylation of upstream PI3K in esophageal cancer cells. Lapatinib, a tyrosine kinase inhibitor that targets HER2, and siRNA-mediated knockdown of HER2 similarly suppressed cancer cell growth in vitro. Itraconazole significantly inhibited growth of OE33-derived flank xenografts in mice with detectable levels of itraconazole and its primary metabolite, hydroxyitraconazole, in esophagi and tumors. HER2 total protein and phosphorylation of AKT and S6 proteins were decreased in xenografts from itraconazole-treated mice compared to xenografts from placebo-treated mice. In an early phase I clinical trial (NCT02749513) in patients with esophageal cancer, itraconazole decreased HER2 total protein expression and phosphorylation of AKT and S6 proteins in tumors. These data demonstrate that itraconazole has potent antitumor properties in esophageal cancer, partially through blockade of HER2/AKT signaling.
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Affiliation(s)
- Wei Zhang
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ankur S Bhagwath
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
| | - Zeeshan Ramzan
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas.,Division of Gastroenterology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, TCU and University of North Texas Health Science Center School of Medicine and Texas Health Harris Methodist Hospital, Fort Worth, Texas
| | - Taylor A Williams
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Indhumathy Subramaniyan
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, Texas.,Clinical Pharmacology and Experimental Therapeutics Center, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, Texas
| | - Vindhya Edpuganti
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, Texas.,Clinical Pharmacology and Experimental Therapeutics Center, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, Texas
| | - Raja Reddy Kallem
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, Texas.,Clinical Pharmacology and Experimental Therapeutics Center, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, Texas
| | - Kerry B Dunbar
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas.,Division of Gastroenterology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Peiguo Ding
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ke Gong
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samuel A Geurkink
- Department of Internal Medicine, Methodist Dallas Medical Center, Dallas, Texas
| | - Muhammad S Beg
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James Kim
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qiuyang Zhang
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas
| | - Amyn A Habib
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sung-Hee Choi
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
| | - Ritu Lapsiwala
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
| | - Gayathri Bhagwath
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
| | - Jonathan E Dowell
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
| | - Shelby D Melton
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chunfa Jie
- Department of Biochemistry and Nutrition, Des Moines University, Des Moines, Iowa
| | - William C Putnam
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, Texas.,Clinical Pharmacology and Experimental Therapeutics Center, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, Texas.,Department of Pharmaceutical Science, Texas Tech University Health Sciences Center, Dallas, Texas
| | - Thai H Pham
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David H Wang
- Esophageal Diseases Center, University of Texas Southwestern Medical Center, Dallas, Texas. .,Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,VA North Texas Health Care System, Dallas, Texas
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33
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Zhang W, Chen H, Zhang G, Jin G. A nomogram for predicting lymph node metastasis in superficial esophageal squamous cell carcinoma. J Biomed Res 2021; 35:361-370. [PMID: 34628403 PMCID: PMC8502689 DOI: 10.7555/jbr.35.20210034] [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: 11/04/2022] Open
Abstract
Superficial esophageal squamous cell carcinoma (SESCC) is defined as carcinoma with mucosal or submucosal invasion, regardless of regional lymph node metastasis (LNM). The lymph node status is not only a key factor to determine the training strategy, but also the most important prognostic factor in esophageal cancer. In this study, we establish a clinical nomogram for predicting LNM in patients with SESCC. A predictive model was established based on the training cohort composed of 711 patients who underwent esophagectomy for SESCC from December 2009 to June 2018. A prospective cohort of 203 patients from June 2018 to January 2019 was used for validation. Favorable calibration and well-fitted decision curve analysis were conducted and good discrimination was observed (concordance index [C-index], 0.860; 95% confidence interval [CI], 0.825–0.894) through internal validation. The external validation cohort presented good discrimination (C-index, 0.916; 95% CI, 0.860–0.971). This model may facilitate the prediction of LNM in patients with SESCCs.
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Affiliation(s)
- Weifeng Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China.,The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Han Chen
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China.,The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Guoxin Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China.,The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Guangfu Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
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34
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Suzuki S, Kanaji S, Urakawa N, Takiguchi G, Hasegawa H, Matsuda Y, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Kakeji Y. Survival Benefit of Neoadjuvant Chemotherapy for Locally Advanced Adenocarcinoma of Esophagogastric Junction. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:185-191. [PMID: 35399316 PMCID: PMC8962799 DOI: 10.21873/cdp.10025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Adenocarcinoma of the esophagogastric junction (AEG) is refractory even when curative resection is followed by adjuvant chemotherapy. This study evaluated the efficacy of neoadjuvant chemotherapy (NAC) using an oral fluoropyrimidine-platinum regimen for AEG. PATIENTS AND METHODS Out of 35 patients with locally advanced AEG who underwent curative resection, 21 who underwent surgery first and 14 who received NAC were retrospectively compared in terms of survival. RESULTS The NAC regimens comprised of S-1 or capecitabine plus oxaliplatin or cisplatin; trastuzumab was added to six borderline resectable cases. The downstaging rate was 50% and the pathological response rate including complete response (29%) was 50%. The three-year relapse-free survival in the NAC group was significantly superior than the surgery-first group (78% vs. 22%, p=0.011). The NAC group had a significantly longer median survival time than the surgery-first group (NR vs. 29 months, p=0.032). CONCLUSION NAC using an oral fluoropyrimidine-platinum regimen may provide survival benefit in AEG.
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Affiliation(s)
- Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeru Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery,Graduate School of Medicine, Kobe University, Kobe, Japan
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Yee EK, Coburn NG, Zuk V, Davis LE, Mahar AL, Liu Y, Gupta V, Darling G, Hallet J. Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study. Gastric Cancer 2021; 24:790-799. [PMID: 33550518 DOI: 10.1007/s10120-021-01157-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. METHODS We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. RESULTS Of 10,228 patients surviving a median 5.1 months (IQR: 2.0-12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63-0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53-0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02-1.13) for 11-50 km, hazard ratio 1.13 (95% CI 1.04-1.23) for 51-100 km]. CONCLUSION A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.
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Affiliation(s)
- Elliott K Yee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Natalie G Coburn
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Victoria Zuk
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Laura E Davis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ying Liu
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Vaibhav Gupta
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gail Darling
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Julie Hallet
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
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36
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Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, Lee SH, Bae JH, Chung H, Choi KD, Park JC, Lee H, Kwak MS, Kim B, Lee HJ, Lee HS, Choi M, Park DA, Lee JY, Byeon JS, Park CG, Cho JY, Lee ST, Chun HJ. [Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:264-291. [PMID: 32448858 DOI: 10.4166/kjg.2020.75.5.264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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Affiliation(s)
- Chan Hyuk Park
- Department of Gastroenterology, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jie-Hyun Kim
- Department of Gastroenterology, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Inje University Busan Paik Hospital, Busan, Korea
| | - Yang Won Min
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Si Hyung Lee
- Department of Gastroenterology, Yeungnam University Medical Center, Daegu, Korea
| | - Jung Ho Bae
- Department of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hyunsoo Chung
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Jun Chul Park
- Department of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyuk Lee
- Department of Gastroenterology, Samsung Medical Center, Seoul, Korea
| | - Min-Seob Kwak
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Bun Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jung Lee
- Department of Gastroenterology, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong-Ah Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Chan Guk Park
- Department of Gastroenterology, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha University Bundang Medical Center, Seongnam, Korea
| | - Soo Teik Lee
- Department of Gastroenterology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hoon Jai Chun
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
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Martínez A, Infante JR, Quirós J, Rayo JI, Serrano J, Moreno M, Jiménez P, Cobo A, Baena A. Baseline 18F-FDG PET/CT quantitative parameters as prognostic factors in esophageal squamous cell cancer. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00107-4. [PMID: 34088649 DOI: 10.1016/j.remn.2021.03.016] [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: 01/14/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022]
Abstract
AIM To determine the utility of 18F-FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). MATERIAL AND METHODS Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test. ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. RESULTS The average follow-up was 22.4months, with 22 recurrence-progressions and 25 deads. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. CONCLUSION Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment.
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Affiliation(s)
- A Martínez
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España.
| | - J R Infante
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - J Quirós
- Servicio de Oncología Radioterápica, Hospital Universitario de Badajoz, Badajoz, España
| | - J I Rayo
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - J Serrano
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - M Moreno
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - P Jiménez
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - A Cobo
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
| | - A Baena
- Servicio de Medicina Nuclear, Hospital Universitario de Badajoz, Badajoz, España
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38
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Onitilo AA, Stankowski-Drengler TJ, Shiyanbola O, Engel J, Tanimu S, Fagbemi SO, Li YH. Modified Docetaxel, Cisplatin, and Fluorouracil (mDCF) as a Neoadjuvant Chemotherapy for Non-metastatic Esophageal Cancer (nMEC). Clin Med Res 2021; 19:64-71. [PMID: 33789952 PMCID: PMC8231693 DOI: 10.3121/cmr.2021.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
Objective: Perioperative chemotherapy can potentially downstage esophageal cancer, reducing the risk of early systemic dissemination. One recommended neoadjuvant regimen for managing gastroesophageal junction and esophageal cancer is docetaxel, cisplatin, and 5-fluorouracil (DCF). To address the high toxicity profile of DCF, modifications in dosages and treatment intervals have been studied. We integrated a modified DCF regimen (mDCF) into a multimodal treatment approach for non-metastatic esophageal cancer (nMEC). Retrospectively, we sought to describe our community experience of administrating neoadjuvant mDCF to patients with nMEC.Design: Patients diagnosed with nMEC between August 2008 and November 2017 and prescribed mDCF were identified for retrospective review. Outcomes of interest included disease-free survival (DFS), overall survival (OS), and hematologic toxicities. Analyses were performed using SAS 9.4.Results: Thirty patients met inclusion criteria with a median age of 64.9 years; 90% were male. The 2-year and 5-year DFS was 60.8% and 41.7%, respectively, for adenocarcinoma and 71.4% and 71.4% for squamous cell carcinoma (SCC). The 2-year and 5-year OS was 64.9% and 44.5%, respectively, for adenocarcinoma and 71.4% and 71.4% for SCC. Both DFS and OS decreased with increasing disease stage, histology (adenocarcinoma versus squamous), esophageal compared to esophagogastric-junction involvement, and without surgical intervention. Frequent toxicity grades for leukopenia and thrombocytopenia were Grades I and II.Conclusion: Using an mDCF regimen in combination with chemoradiation +/- surgical resection in a community setting appears to have an acceptable toxicity profile as well as DFS and OS outcomes compared to chemotherapeutic regimens reported in other similar studies.
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Affiliation(s)
- Adedayo A Onitilo
- Department of Hematology/Oncology, Marshfield Clinic-Weston Center, Weston, Wisconsin
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Trista J Stankowski-Drengler
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Oyewale Shiyanbola
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jessica Engel
- Department of Hematology/Oncology, Marshfield Clinic-Weston Center, Weston, Wisconsin
| | - Sabo Tanimu
- Department of Gastroenterology, Marshfield Clinic-Weston Center, Weston, Wisconsin
| | - Seth O Fagbemi
- Department of Hematology/Oncology, Marshfield Clinic-Weston Center, Weston, Wisconsin
| | - Ya-Huei Li
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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CEP55 Positively Affects Tumorigenesis of Esophageal Squamous Cell Carcinoma and Is Correlated with Poor Prognosis. JOURNAL OF ONCOLOGY 2021; 2021:8890715. [PMID: 34104194 PMCID: PMC8159646 DOI: 10.1155/2021/8890715] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/16/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023]
Abstract
Centrosomal protein 55 (CEP55) is a centrosome- and midbody-associated protein that is overexpressed in several cancers. However, the underlying molecular mechanism of CEP55-mediated progression and metastasis of esophageal squamous cell carcinoma (ESCC) is not clear. In the current study, we detected CEP55 mRNA by qRT-PCR while protein expression was detected by western blot analysis and immunohistochemistry (IHC). In addition, we knocked down CEP55 and investigated the ability of CEP55 to affect colony formation and migration. Here, we report that CEP55 mRNA and protein expression was significantly increased in ESCC. IHC staining showed that CEP55 expression correlated with TNM stage (p=0.046) and lymph node metastases (p=0.024). According to overall survival (OS) and disease-free survival (DFS), patients whose tumors expressed a higher level of CEP55 had a poorer prognosis than those with low expression level of CEP55. A multivariate analysis revealed that CEP55 expression was an independent prognostic indicator for patients with ESCC. Knockdown of CEP55 decreased the colony formation ability and migration of ESCC cells and also reduced the phosphorylation of Src, FAK, and ERK. Therefore, our study implied that CEP55 may be a valuable biomarker and a potential target in the treatment of patients with ESCC.
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40
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Duan Q, Tang C, Ma Z, Chen C, Shang X, Yue J, Jiang H, Gao Y, Xu B. Genomic Heterogeneity and Clonal Evolution in Gastroesophageal Junction Cancer Revealed by Single Cell DNA Sequencing. Front Oncol 2021; 11:672020. [PMID: 34046362 PMCID: PMC8144650 DOI: 10.3389/fonc.2021.672020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
Gastroesophageal junction (GEJ) cancer is a tumor that occurs at the junction of stomach and esophagus anatomically. GEJ cancer frequently metastasizes to lymph nodes, however the heterogeneity and clonal evolution process are unclear. This study is the first of this kind to use single cell DNA sequencing to determine genomic variations and clonal evolution related to lymph node metastasis. Multiple Annealing and Looping Based Amplification Cycles (MALBAC) and bulk exome sequencing were performed to detect single cell copy number variations (CNVs) and single nucleotide variations (SNVs) respectively. Four GEJ cancer patients were enrolled with two (Pt.3, Pt.4) having metastatic lymph nodes. The most common mutation we found happened in the TTN gene, which was reported to be related with the tumor mutation burden in cancers. Significant intra-patient heterogeneity in SNVs and CNVs were found. We identified the SNV subclonal architecture in each tumor. To study the heterogeneity of CNVs, the single cells were sequenced. The number of subclones in the primary tumor was larger than that in lymph nodes, indicating the heterogeneity of primary site was higher. We observed two patterns of multi-station lymph node metastasis: one was skip metastasis and the other was to follow the lymphatic drainage. Taken together, our single cell genomic analysis has revealed the heterogeneity and clonal evolution in GEJ cancer.
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Affiliation(s)
- Qingke Duan
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Chao Tang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhao Ma
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chuangui Chen
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaobin Shang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jie Yue
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yan Gao
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Bo Xu
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Center for Intelligent Oncology, Chongqing University Cancer Hospital, Chongqing University School of Medicine, Chongqing, China
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41
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Wu J, Yang J, Lin X, Lin L, Jiang W, Xie C. Survival outcomes for patients with four treatments in stages I-III esophageal squamous cell carcinoma: a SEER analysis. Transl Cancer Res 2021; 10:2144-2152. [PMID: 35116534 PMCID: PMC8798536 DOI: 10.21037/tcr-20-2995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/26/2021] [Indexed: 12/23/2022]
Abstract
Background Esophageal cancer (EC) is globally acknowledged as one of the most common malignancies among all gastrointestinal cancers. Furthermore, in Eastern Asia, squamous cell carcinoma is the main pathological type of EC. There are different treatments for esophageal squamous cell carcinoma (ESCC), but there is still a lack of large-sample analysis of prognosis among different treatments, especially for different tumor stages. The analysis of the prognosis of ESCC patients with different treatments may be helpful to choose the treatment methods for different stages ESCC. Methods A total of 3,346 patients with pathological ESCC between 1976 and 2016 were derived from the Surveillance, Epidemiology, and End Results (SEER) database. All clinical factors associated with prognosis were collected and analyzed to achieve the difference of prognosis among different treatments in ESCC patients, such as ages, sex, race, tumor grade, anatomic location and so on. Kaplan-Meier and Cox proportional hazard analysis were used to compare survival of different treatments in ESCC patients with stage I–III. Results The overall survival (OS) in all ESCC patients who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that had not received any treatments and radiation therapy or/and chemotherapy. The OS in ESCC patients with stage I who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that had not received any treatments and radiation therapy or/and chemotherapy. The OS in ESCC patients with stage II/III who had received surgery and surgery plus radiation therapy or/and chemotherapy are superior than that in other groups. Age, race and grade as an independent predictive factor for survival (P<0.05). A nomogram model was constructed to show surgery group had better 1-, 3- and 5-year OS than radiation therapy or/and chemotherapy group (OS: 78.5% vs. 59.2%, 37.9% vs. 18.4%, 16.9% vs. 6.1%). Conclusions Surgery is still the first choice for all ESCC patients with stage I–III. Radiotherapy and chemotherapy could improve the survival rate in ESCC patients with stage II–III who have received surgery.
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Affiliation(s)
- Jingyang Wu
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jiansheng Yang
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xianbin Lin
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Liang'an Lin
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Wentan Jiang
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Chengke Xie
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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42
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Harada K, Hwang H, Wang X, Abdelhakeem A, Iwatsuki M, Blum Murphy MA, Maru DM, Weston B, Lee JH, Rogers JE, Thomas I, Shanbhag N, Zhao M, Bhutani MS, Nguyen QN, Swisher SG, Ikoma N, Badgwell BD, Hofstetter WL, Ajani JA. Frequency and Implications of Paratracheal Lymph Node Metastases in Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma. Ann Surg 2021; 273:751-757. [PMID: 31188215 DOI: 10.1097/sla.0000000000003383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We aimed to evaluate the frequency of paratracheal lymph nodes (LN) metastases and their prognostic influence. SUMMARY BACKGROUND DATA Paratracheal LNs are considered regional nodes in the esophageal cancer classification, but their metastatic rate and influence on survival remain unclear. METHODS One thousand one hundred ninety-nine patients with resectable esophageal or gastroesophageal junction adenocarcinoma (EAC) (January 2002 and December 2016) in our Gastrointestinal Medical Oncology Database were analyzed. Paratracheal LNs were defined as1R, 1L, 2R, 2L, 4R, and 4L, according to the 8th American Joint Committee on Cancer classification. RESULTS Of 1199 patients, 73 (6.1%) had positive paratracheal LNs at diagnosis. The median overall survival (OS) of 73 patients with initial paratracheal LN involvement was 2.10 years (range 0.01-10.1, 5-yrs OS 24.2%). Of 1071 patients who were eligible for recurrence evaluation, 70 patients (6.5%) developed paratracheal LN metastases as the first recurrence. The median time to recurrence was 1.28 years (range 0.28-5.96 yrs) and the median OS following recurrence was only 0.95 year (range 0.03-7.88). OS in 35 patients who had only paratracheal LN recurrence was significantly longer than in patients who had other recurrences (median OS 2.26 vs 0.51 yrs, 5-yrs OS; 26.8% vs 0%, P < 0.0001). Higher T stage (T3/T4) was an independently risk factor for paratracheal LN recurrence (odds ratio 5.10, 95% confidence interval 1.46-17.89). We segregated patients in 3 groups based on the distance of tumor's proximal edge to esophagogastric junction (low; ≤2 cm, medium; 2.0-7.0 cm, and high; >7.0 cm). Paratracheal LN metastases were more frequent with the proximal tumors (low, 4.2%; medium, 12.0%; high, 30.3%; Cochran-Armitage Trend test, P < 0.001). CONCLUSION Paratracheal LN metastases were associated with a shorter survival in resectable EAC patients. Alternate approaches to prolong survival of this group of patients are warranted.
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Affiliation(s)
- Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hyunsoo Hwang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Abdelhakeem
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Masaaki Iwatsuki
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Mariela A Blum Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dipen M Maru
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Weston
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey H Lee
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irene Thomas
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Namita Shanbhag
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meina Zhao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manoop S Bhutani
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Al-Kaabi A, Schoon EJ, Deprez PH, Seewald S, Groth S, Giovannini M, Braden B, Berr F, Lemmers A, Hoare J, Bhandari P, van der Post RS, Verhoeven RHA, Siersema PD. Salvage endoscopic resection after definitive chemoradiotherapy for esophageal cancer: a Western experience. Gastrointest Endosc 2021; 93:888-898.e1. [PMID: 32763242 DOI: 10.1016/j.gie.2020.07.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Definitive chemoradiotherapy (CRT) is increasingly used as a nonsurgical treatment for esophageal cancer. In Japanese studies, salvage endoscopic resection (ER) has emerged as a promising strategy for local failure after definitive CRT. We aimed to evaluate the safety and efficacy of salvage ER in a Western setting. METHODS Gastroenterologists from Europe and the United States were invited to submit their experience with salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) after definitive CRT. Participating gastroenterologists completed an anonymized database, including patient demographics, clinicopathologic variables, and follow-up on survival and recurrence. RESULTS Gastroenterologists from 10 endoscopic units in 6 European countries submitted information on 25 patients. A total of 35 salvage ER procedures were performed, of which 69% were ESD and 31% EMR. Most patients had squamous cell carcinoma (64%) of the middle or lower esophagus (68%) staged as cT2-3 (68%) and cN+ (52%) before definitive CRT. The median time from end of definitive CRT to ER was 22 months (interquartile range, 6-47). The en-bloc resection rate was 92% for ESD and 46% for EMR. During a median of 24 months (interquartile range, 12-59) of follow-up after salvage ER, 52% developed a recurrence (11 locoregional, 2 distant). The 5-year recurrence-free survival, overall survival, and disease-specific survival were 36%, 52%, and 79%, respectively. No major intra- or postprocedural adverse events, such as bleeding or perforation, were reported. CONCLUSIONS In carefully selected esophageal cancer patients, salvage ER is technically feasible after definitive CRT. Further prospective research is recommended to validate the safety and effectivity of salvage ER for the management of local failure.
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Affiliation(s)
- Ali Al-Kaabi
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pierre H Deprez
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Stefan Seewald
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Stefan Groth
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Frieder Berr
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan Hoare
- Department of Gastroenterology, Imperial College NHS Trust, London, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Das PK, Islam F, Smith RA, Lam AK. Therapeutic Strategies Against Cancer Stem Cells in Esophageal Carcinomas. Front Oncol 2021; 10:598957. [PMID: 33665161 PMCID: PMC7921694 DOI: 10.3389/fonc.2020.598957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
Cancer stem cells (CSCs) in esophageal cancer have a key role in tumor initiation, progression and therapy resistance. Novel therapeutic strategies to target CSCs are being tested, however, more in-depth research is necessary. Eradication of CSCs can result in successful therapeutic approaches against esophageal cancer. Recent evidence suggests that targeting signaling pathways, miRNA expression profiles and other properties of CSCs are important strategies for cancer therapy. Wnt/β-catenin, Notch, Hedgehog, Hippo and other pathways play crucial roles in proliferation, differentiation, and self-renewal of stem cells as well as of CSCs. All of these pathways have been implicated in the regulation of esophageal CSCs and are potential therapeutic targets. Interference with these pathways or their components using small molecules could have therapeutic benefits. Similarly, miRNAs are able to regulate gene expression in esophageal CSCs, so targeting self-renewal pathways with miRNA could be utilized to as a potential therapeutic option. Moreover, hypoxia plays critical roles in esophageal cancer metabolism, stem cell proliferation, maintaining aggressiveness and in regulating the metastatic potential of cancer cells, therefore, targeting hypoxia factors could also provide effective therapeutic modalities against esophageal CSCs. To conclude, additional study of CSCs in esophageal carcinoma could open promising therapeutic options in esophageal carcinomas by targeting hyper-activated signaling pathways, manipulating miRNA expression and hypoxia mechanisms in esophageal CSCs.
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Affiliation(s)
- Plabon Kumar Das
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Farhadul Islam
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh.,Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Robert A Smith
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,Cancer Molecular Pathology, School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Alfred K Lam
- Cancer Molecular Pathology, School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Sawyer WP, Luo X, Welch AM, Bolton NM, Brown R, Bolton JS. 15-Year Experience with Multimodality Therapy Including Esophagectomy for Elderly Patients with Locoregional Esophageal Cancer. J Am Coll Surg 2021; 232:580-588. [PMID: 33549634 DOI: 10.1016/j.jamcollsurg.2020.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optimal curative therapy for locally advanced esophageal and esophagogastric junction (EGJ) cancer might not be offered to elderly patients due to patient and treating physician perception of the high risk of therapy. To understand the risk of multimodality curative therapy, including surgical resection in the elderly population, we studied our experience with curative therapy in this patient population and compared the risks and outcomes with those in a younger population. STUDY DESIGN Between January 1, 2004 and December 31, 2019, four hundred and five consecutive patients with esophageal or EGJ cancer underwent primary treatment at our institution, including esophagectomy. Data collected included demographic information, tumor stage, preoperative Charlson Comorbidity Index scores, treatment variables, and short- and long-term outcomes. Patients who were 70 years or older were classified as the "older" group and patients younger than 70 years were "younger." RESULTS One hundred and eighty-eight younger (mean age 59 years) and 94 older (mean age 74 years) patients received neoadjuvant chemoradiotherapy and surgical resection for stage II and higher cancer. Preoperative American Society of Anesthesiologist and Charlson Comorbidity Index scores were significantly worse in the older group. Postoperative atrial fibrillation and urinary retention developed more often in the older group. Despite this, the rate of postoperative Clavien-Dindo complication severity scores of 3 or higher, perioperative mortality rates, and lengths of stay were similar. Long-term age-adjusted survival rate was 44.8% at 5 years for the group 70 years or older and 39% for the group younger than 70 years (NS). CONCLUSIONS Patients 70 years and older with locally advanced esophageal or EGJ cancer should be evaluated for optimal curative therapy including neoadjuvant chemoradiotherapy and surgical resection. Although preoperative risk scoring and postoperative atrial arrythmias are higher in the older group, short- and long-term outcomes are not inferior in these patients.
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Affiliation(s)
- W Peter Sawyer
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Xinyi Luo
- The University of Queensland-Ochsner Clinical School, New Orleans, LA
| | - Andrew M Welch
- The University of Queensland-Ochsner Clinical School, New Orleans, LA
| | - Nathan M Bolton
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Russell Brown
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - John S Bolton
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
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46
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Reinert CP, Sekler J, Gani C, Nikolaou K, la Fougère C, Pfannenberg C, Gatidis S. Impact of PET/CT on management of patients with esophageal cancer - results from a PET/CT registry study. Eur J Radiol 2021; 136:109524. [PMID: 33434862 DOI: 10.1016/j.ejrad.2021.109524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the impact of positron emission tomography/computed tomography (PET/CT) on clinical management in patients with esophageal cancer and its link to overall survival (OS) in a real-world setting. METHODS A patient cohort with advanced esophageal cancer undergoing PET/CT was prospectively enrolled in a registry study between 04/2013 and 06/2019. Intended patient management prior and after PET/CT was documented based on standardized questionnaire data. Management changes after PET/CT were recorded including major changes concerning the treatment goal (curative vs. palliative) and minor changes (therapy adjustments). OS was analyzed for subgroups with squamous cell carcinomas (SCC) or adenocarcinomas (AC) and stratified for extent of metastatic disease and treatment goals. RESULTS 257 patients (53 female;65.5 ± 10.0 yr.) were included. After PET/CT, major changes of intended therapy were observed in 34/257 patients (13.2%), from curative to palliative (8.2%), palliative to curative (1.9%) and from "not finally determined" to a curative (1.9%) or palliative (1.2%) concept. Minor changes were found in 62/257 patients (24.1%). Invasive procedures and additional imaging were intended in 70/257 (27.2%) and 94/257 (36.6%) patients before PET/CT and 20/257 (7.8%) and 8/257 (3.1%) patients after PET/CT. Curative therapy concepts based on PET/CT were associated with a longer OS (3.5 yr.[95%CI 3.1-3.8 yr.]) as compared to palliative concepts (0.9 yr.[95%CI 0.6-1.2 yr.];p < 0.0001). Patients with SCC had a worse prognosis (2.4 yr.[95%CI 2.0-2.9 yr.]) as compared to patients with AC (3.2 yr.[95%CI 2.7-3.7 yr.];p = 0.01). CONCLUSIONS In patients with advanced esophageal cancer, PET/CT has a significant impact on clinical management by improving the selection of individualized treatment strategies and avoiding additional diagnostic procedures.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - Julia Sekler
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
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47
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Fukahori M, Kato K, Taniguchi H, Ohtomo R, Takahashi N, Shoji H, Iwasa S, Honma Y, Takashima A, Hamaguchi T, Yamada Y, Shimada Y, Ito Y, Itami J, Hokamura N, Igaki H, Tachimori Y, Miwa K, Torimura T, Boku N. Relationship between cervical esophageal squamous cell carcinoma and human papilloma virus infection and gene mutations. Mol Clin Oncol 2020; 14:41. [PMID: 33437479 PMCID: PMC7788557 DOI: 10.3892/mco.2020.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022] Open
Abstract
Cervical esophageal squamous cell carcinoma (CESCC) is rare, accounting for 5% of all esophageal carcinomas. Several diagnostic and predictive markers have been studied. However, to the best of our knowledge, no biomarker is known to determine patient management except the clinical stage. The present study aimed to evaluate whether human papilloma virus (HPV) infection, epidermal growth factor receptor (EGFR) and its pathway-related gene mutations, known to be sensitive biomarkers of oropharyngeal carcinomas, could be used as biomarkers for the prediction of the prognosis of patients with CESCC. The present retrospective study included patients with CESCC who received chemoradiotherapy or surgery. HPV infection and the genomic status of EGFR, KRAS, BRAF, NRAS and PIK3CA of each tumor sample from patients with CESCC were analyzed by in situ hybridizations (ISH) and PCR methods, respectively. The present study included 33 patients with CESCC (male/female, 29/4; median age, 62 years; age range, 41-86 years; clinical stage I/II/III/IV, 2/6/10/15). The present study detected HPV in one patient (3.0%) by ISH and PCR. Concerning the investigation of EGFR and its pathway-related gene mutations, the present study detected 15.1% of EGFR, 6.0% of NRAS, 3.5% of BRAF, 3.0% of KRAS and 3.0% for PIK3CA mutations, with no significant relationship between any gene mutations and the clinical prognostic factors. The HPV-infected patient did not exhibit any gene mutations. The present study indicated that HPV infection, EGFR and its pathway-related gene mutations rarely exist in patients with CESCC. The relationship between these biomarkers and the prognosis in patients with CESCC is still unclear.
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Affiliation(s)
- Masaru Fukahori
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.,Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan.,Division of Gastroenterology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Hirokazu Taniguchi
- Department of Clinical Laboratory, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Rie Ohtomo
- Department of Clinical Laboratory, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.,Department of Clinical Laboratory, JR Tokyo General Hospital, Shibuya, Tokyo 151-8528, Japan
| | - Naoki Takahashi
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Hirokazu Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Satoru Iwasa
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Yoshitaka Honma
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Tetsuya Hamaguchi
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Yasuhide Yamada
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Yasuhiro Shimada
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Nobukazu Hokamura
- Department of Esophageal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Hiroyasu Igaki
- Department of Esophageal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Yuji Tachimori
- Department of Esophageal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan
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48
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Depypere L, De Hertogh G, Moons J, Provoost AL, Lerut T, Sagaert X, Coosemans W, Van Veer H, Nafteux P. Importance of Lymph Node Response After Neoadjuvant Chemoradiotherapy for Esophageal Adenocarcinoma. Ann Thorac Surg 2020; 112:1847-1854. [PMID: 33352178 DOI: 10.1016/j.athoracsur.2020.09.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Tumor response and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiotherapy (nCRT). We hypothesize that lymph node response (LNR) is also a valuable prognosticator in these patients, potentially revealing the added effect of nCRT. METHODS Hematoxylin and eosin slides of 193 esophageal adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with nCRT between 2008 and 2015 were assessed. Lymph nodes containing viable tumor cells were considered ypN+, and those negative for viable tumor were ypN0. LNR was also described according to an earlier defined method. Three groups were obtained: ypN0/LNR-, ypN0/LNR+, and ypN+. They were compared with 188 cN+ patients being pN0 (n = 45) or pN+ (n = 143) after upfront esophageal resection. RESULTS Forty-four patients were ypN0/LNR-, 55 were ypN0/LNR+, and 94 were ypN+. Median overall survival was 96.4, 31.2, and 20.6 months, respectively, and was significantly different between ypN0/LNR- and ypN0/LNR+ groups (P = .020). Survival was comparable between ypN0/LNR- and pN0 (104.2 months) groups (P = .519) and between ypN+ and pN+ (21.6 months) groups (P = .966). In ypN0 patients, risk of death in LNR+ patients was tripled compared with LNR- patients. CONCLUSIONS In cN+ esophageal adenocarcinoma patients treated with nCRT with postoperative final pathology being ypN0, median overall survival is tripled when no signs of LNR were found and comparable to cN+/pN0 upfront esophagectomy patients, suggesting that 23% of patients treated with nCRT were in fact true N0 and overtreated by nCRT. ypN+ patients have no survival benefit compared with pN+ patients.
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Affiliation(s)
- Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - An-Lies Provoost
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Xavier Sagaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism (CROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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49
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Kidane B, Higgins S, Hirpara DH, Kaaki S, Shen YC, Allison F, Waddell TK, Darling GE. From Emergency Department Visit to Readmission After Esophagectomy: Analysis of Burden and Risk Factors. Ann Thorac Surg 2020; 112:379-386. [PMID: 33310147 DOI: 10.1016/j.athoracsur.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Frequent emergency department (ED) visits occur after esophagectomy. We aimed to identify the incidence of and risk factors for conversion from ED visit to inpatient admission. METHODS A retrospective cohort study was performed of consecutive esophagectomies at a tertiary Canadian center (1999 to 2014). Multivariable regression analyses identified factors associated with conversion from ED visit to admission. RESULTS There were 520 esophagectomies with 6% inhospital mortality (n = 31). Of those discharged, 29.7% (n = 145) had one or more emergency visit and 43.4% (n = 63) of these patients were readmitted to the hospital. First-time ED visits resulted in inpatient conversion 23.4% of the time (n = 34); successive ED visits resulted in increasing conversion. On multivariable analysis, anastomotic leak (adjusted odds ratio 2.45; 95% confidence interval, 1 to 6.01; P = .05) was independently associated with higher odds of conversion to admission. Sensitivity analysis using Poisson regression to model conversion as a rate identified that living in regions further away was associated with lower conversion rate to admission (risk ratio 0.35; 95% confidence interval, 0.13 to 0.94; P = .04). CONCLUSIONS Although postesophagectomy ED utilization is high, the majority of visits do not convert to admission. With each increasing ED visit, likelihood of converting to admission increases. Anastomotic leakage was associated with higher odds of conversion to admission, possibly related to development of strictures. Access to urgent outpatient endoscopy may help reduce the incidence of ED visits and admission. Although living in regions further away is associated with lower conversion rates to admission at the index hospital, that may be due to patients utilizing closer local hospitals.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Sean Higgins
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dhruvin H Hirpara
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Suha Kaaki
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yu Cindy Shen
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Frances Allison
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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50
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Liu Y, Baba Y, Ishimoto T, Tsutsuki H, Zhang T, Nomoto D, Okadome K, Yamamura K, Harada K, Eto K, Hiyoshi Y, Iwatsuki M, Nagai Y, Iwagami S, Miyamoto Y, Yoshida N, Komohara Y, Ohmuraya M, Wang X, Ajani JA, Sawa T, Baba H. Fusobacterium nucleatum confers chemoresistance by modulating autophagy in oesophageal squamous cell carcinoma. Br J Cancer 2020; 124:963-974. [PMID: 33299132 PMCID: PMC7921654 DOI: 10.1038/s41416-020-01198-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 09/23/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Fusobacterium nucleatum (F. nucleatum) is a gut microbe implicated in gastrointestinal tumorigenesis. Predicting the chemotherapeutic response is critical to developing personalised therapeutic strategies for oesophageal cancer patients. The present study investigated the relationship between F. nucleatum and chemotherapeutic resistance in oesophageal squamous cell carcinoma (ESCC). Methods We examined the relationship between F. nucleatum and chemotherapy response in 120 ESCC resected specimens and 30 pre-treatment biopsy specimens. In vitro studies using ESCC cell lines and co-culture assays further uncovered the mechanism underlying chemotherapeutic resistance. Results ESCC patients with F. nucleatum infection displayed lesser chemotherapeutic response. The infiltration and subsistence of F. nucleatum in the ESCC cells were observed by transmission electron microscopy and laser scanning confocal microscopy. We also observed that F. nucleatum modulates the endogenous LC3 and ATG7 expression, as well as autophagosome formation to induce chemoresistance against 5-FU, CDDP, and Docetaxel. ATG7 knockdown resulted in reversal of F. nucleatum-induced chemoresistance. In addition, immunohistochemical studies confirmed the correlation between F. nucleatum infection and ATG7 expression in 284 ESCC specimens. Conclusions F. nucleatum confers chemoresistance to ESCC cells by modulating autophagy. These findings suggest that targeting F. nucleatum, during chemotherapy, could result in variable therapeutic outcomes for ESCC patients.
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Affiliation(s)
- Yang Liu
- Second Oncology Department, Shengjing Hospital affiliated of China Medical University, Shenyang, Liaoning, China.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Next-Generation Surgical Therapy Development, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyasu Tsutsuki
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tianli Zhang
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daichi Nomoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuo Okadome
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kensuke Yamamura
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuto Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yohei Nagai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Ohmuraya
- Department of Genetics, Hyogo College of Medicine, Hyogo, Japan
| | - Xiaoming Wang
- Radiology Department, Shengjing Hospital affiliated of China Medical University, Shenyang, Liaoning, China
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tomohiro Sawa
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. .,Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto, Japan.
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