ObjectiveTo compare the short-term and long-term effects of minimally invasive esophagectomy (MIE) and traditional open esophagectomy (OE) in patients with stage T1b esophageal squamous cell carcinoma (ESCC).MethodsWe retrospectively analyzed the clinical pathology data of 162 patients undergoing thoracic surgery at Northern Jiangsu People's Hospital from 2015 to 2018 whose pathological diagnosis was stage pT1b ESCC. According to the surgical approach, they were divided into MIE group and OE group. There were 55 males and 21 females in the OE group, with an average age of 63.3±5.6 years, and 60 males and 26 females in the MIE group, with an average age of 64.7±6.1 years. The preoperative, intraoperative and postoperative data of the two groups were compared and followed up. Survival data were compared using Kaplan-Meier and log-rank tests between the two groups, and Cox proportional hazard regression models were used to analyze prognostic factors.ResultsCompared with the OE group, the intraoperative bleeding volume of the MIE group was less (119.8±70.0 mL vs. 210.5±136.2 mL, P<0.001), and the lymph nodes dissected during the operation were more (19.1±7.4 vs. 13.8±5.9, P<0.001), the rate of postoperative pulmonary infections was lower (9.3% vs. 21.1%, P=0.036), but the operation time was longer (240.0±52.4 min vs. 179.5±35.7 min, P<0.001). Twenty-one patients had lymph node metastasis, and the lymph node metastasis rate was 13.0%. At the end of the follow-up, 19 patients died, and the overall survival (OS) at 1 year, 3 years, and 5 years after operation were 97.5%, 88.8% and 82.9%, respectively; 31 patients had recurrence and metastasis, and the disease-free survival (DFS) rate at 1 year, 3 years, and 5 years after operation was 95.1%, 80.9% and 75.6%. There was no significant difference in OS and DFS between the two groups. Multivariate Cox regression analysis of OS found that lymph node metastasis, anastomotic fistula and chylothorax were independent risk factors for OS. Multivariate Cox regression analysis of DFS found that lymph node metastasis, anastomotic fistula, chylothorax, and vascular cancer thrombus were independent risk factors for OS.ConclusionMIE can achieve the same long-term effects as OE, with less intraoperative bleeding, more lymph nodes dissected, and lower incidence of postoperative pulmonary infections, but it takes longer operation time.
Objective To investigate the prognostic value of preoperative inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and fibrinogen-to-prealbumin ratio (FPR), for postoperative survival in patients with resectable esophageal squamous cell carcinoma (ESCC). Additionally, to construct and validate a prognostic model for ESCC based on these inflammatory markers combined with TNM staging. Methods We retrospectively analyzed the clinical data of patients with histologically confirmed ESCC who underwent surgical resection at the First Affiliated Hospital of the University of Science and Technology of China during 2017. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for preoperative NLR, PLR, SII, and FPR. Clinicopathological characteristics were compared between patient groups with different levels of these markers. Survival analysis was performed using the Kaplan-Meier method, and univariate and multivariate regression analyses were conducted using the Cox proportional hazards model to identify prognostic factors. Nomograms for predicting overall survival (OS) and disease-free survival (DFS) were constructed using R software. The model's discrimination was assessed with ROC curves, its calibration was evaluated with calibration curves, and its clinical utility was determined by decision curve analysis (DCA). Results A total of 224 patients who underwent surgery for ESCC were included, comprising 180 males and 44 females. The optimal preoperative cut-off values of NLR, PLR, SII, and FPR for predicting postoperative OS were 2.70, 140.34, 360.73, and 0.015, respectively. The 5-year OS and DFS rates in the high-NLR group were lower than in the low-NLR group (both P<0.001). Similarly, patients in the high-PLR group (P=0.005 and P=0.009, respectively), high-SII group (P=0.008 and P=0.018, respectively), and high-FPR group (both P<0.001) had lower 5-year OS and DFS rates compared to their low-level counterparts. Multivariate Cox regression analysis revealed that patient age, T stage, N stage, tumor differentiation, and NLR>2.70 et al were independent prognostic factors for both OS and DFS. Based on these factors, nomograms for OS and DFS were constructed. The area under the ROC curve (AUC) for 3- and 5-year OS were 0.966 and 0.907, respectively, and for 3- and 5-year DFS were 0.960 and 0.919, respectively. The calibration curves showed good agreement between predicted and actual outcomes. DCA demonstrated that the models provided a positive net benefit for all patients under intervention. Conclusion Preoperative levels of NLR, PLR, SII, and FPR are associated with the prognosis of patients with ESCC, with NLR being an independent prognostic predictor. The nomogram models, constructed based on patient age, tumor differentiation, T stage, N stage, and preoperative NLR level, can accurately predict the prognosis of patients with ESCC. These models may help guide preoperative clinical decision-making and tailor treatment and follow-up strategies.
ObjectiveTo investigate the expression of MicroRNA 155 (miR-155) in esophageal squamous cell carcinoma (ESCC) and analyze its correlation with clinicopathological features of ESCC.
MethodsThis study included 54 patients with primary ESCC who underwent radical esophagectomy in Department of Thoracic Surgery, Henan Cancer Hospital of Zhengzhou University between January 2010 and November 2012. There were 47 males and 7 females with median age of 61 years (range, 45 to 82 years). Forty patients were in stage Ⅰ or Ⅱ and 14 patients in stage Ⅲ a+b. Expression of miR-155 was determined by SYBR Green qRT-PCR in ESCC tissue and corresponding adjacent normal mucosa in surgical samples from the 54 patients, and its correlation with clinicopathological features was analyzed.
ResultsExpression of miR-155 was significantly lower in ESCC tissue than that in adjacent normal mucosa (Z=-4.258, P=0.000).Expression level of miR-155 was significantly correlated with lymph node metastasis (P=0.040), but not significantly correlated with smoking (P=0.430), drinking (P=0.429), age (P=0.769), gender (P=0.671), depth of invasion (P=0.230), differentiation degree (P=0.896) or pTNM (P=0.407) of ESCC.
ConclusionUnder-regulation of miR- 155 expression in ESCC tissue may lead to disorders of inflammation response, immune response and relevant tumor suppressor, and may play a significant role in carcinogenesis and progression of ESCC.
ObjectiveTo evaluate the safety and necessity of recurrent laryngeal lymph node resection by comparing the complications and prognosis of patients with recurrent laryngeal nerve injury receiving different recurrent laryngeal lymph node resections.MethodsWe reviewed the clinical data of 153 patients with stage T1N0M0 esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at the Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2014 to May 2016. Among them, 125 were male and 28 were female, at an average age of 62 years. All patients underwent bilateral recurrent laryngeal nodes sampling. They were divided into 3 groups according to the dissection situation: patients with only one recurrent laryngeal lymph node resection on both sides during the operation were treated as a sampling group (n=49); patients with only one recurrent laryngeal lymph node resection on one side and more than one recurrent laryngeal lymph nodes resection on the other side were treated as a unilateral dissection group (n=49); patients with more than one recurrent laryngeal lymph nodes resection on both sides were treated as a bilateral dissection group (n=55). Follow-up was performed to compare the prognostic differences among the three groups. Seven days after the operation, the vocal cords of the patients were examined with an electronic laryngoscope and classified using the Clavien-Dindo system. The differences in complications related to recurrent laryngeal nerve injury among the three groups were compared.ResultsThe 5-year overall survival (OS) rate of the patients in the sampling group, unilateral dissection group and bilateral dissection group was 66.8%, 88.5%, 93.8%, respectively. There was statistical difference between the sampling group and the unilateral dissection group or the bilateral dissection group (P<0.05), and no statistical difference between the unilateral dissection group and the bilateral dissection group (P>0.05). The incidence of complications among the three groups was not statistically different (P>0.05).ConclusionFor patients with esophageal squamous cell carcinoma of stage T1N0M0, the lymph nodes of the bilateral recurrent laryngeal nerves should be removed during the operation as many as possible, which will help improve the 5-year survival rate of the patients.
ObjectiveTo investigate misdiagnosis of primary squamous cell carcinoma of liver (PSCCL) as cholangiocarcinoma before operation and its clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis, so as to improve understanding and reasonable diagnosis and treatment of disease.MethodThe clinicopathologic data of a case of PSCCL misdiagnosed as cholangiocarcinoma in the West China Hospital of Sichuan University were analyzed retrospectively.ResultsThe patient was admitted to the West China Hospital of Sichuan University with the right hepatic space occupying. The preoperative imaging examination showed that the patient had the imaging characteristics of hepatic cholangiocarcinoma, then the right hemihepatectomy was performed. The postoperative pathological diagnosis was the PSCCL.ConclusionsPreoperative diagnosis of PSCCL is extremely difficult and it is difficult to differentiate it from primary liver cancer, and it is easy to overlook liver metastasis’s occurrence in other parts of the squamous cell carcinoma, which leads to liver metastasis. It is usually diagnosed by pathological diagnosis after operation, and then original lesions in other parts are excluded by various examinations. PSCCL is treated in a variety of ways, but it’s prognosis is not good. At present, there is no unified treatment principle, most of which are surgery, followed by postoperative radiotherapy and chemotherapy. In most cases, because PSCCL’s etiology is unknown and mechanism is not clear, clinicians can only implement individualized treatment according to patient’s condition.
Increasing evidence suggests that many types of cancers contain a population of cells that display stem cell properties. These cells are called cancer stem cells （CSCs），which are closely related to tumor initiation，growth，metastasis and chemoresistance. CSCs are also found in esophageal squamous cell carcinoma （ESCC）. These cells are characterized by potential of self-renewal and differentiation，tumor formation in nude mice and chemotherapy resistance，and thus may play an important role in targeted cancer therapies. Current methods for culturing and sorting CSCs in ESCC mainly include fluorescence activated cell sorting （FACS），magnetic activated cell sorting （MACS），suspension culture，and side population （SP） cell sorting. In this review，we focus on current research methods for CSCs in ESCC，their biological characteristics and areas for improvement. We believe that a combination of multiple cell-surface makers is needed for research of CSCs in ESCC.
Objective
To evaluate the security and outcomes of thoracolaparoscopic esophagectomy (TLE) versus open approach (OA) for thoracic esophageal squamous cell carcinoma.
Methods
From June 2014 to June 2015, 125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through McKeown approach, including TLE (a TLE group, 107 patients, 77 males and 30 females) and OA (an OA group, 18 patients, 13 males and 5 females). The data of operation and postoperative complications of the two groups were analyzed retrospectively.
Results
There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group (333.58±72.84 min vs. 369.17±91.24 min, P=0.067; 2.84±1.44 d vs. 6.44±13.46 d, P=0.272; 4.71±3.87 vs. 3.89±3.97, P=0.408) . There was a statistical difference in blood loss, total resected lymph nodes and resected lymph nodes groups between TLE group and OA group (222.62±139.77 ml vs. 427.78±276.65, P=0.006; 19.62±9.61 vs. 14.61±8.07, P=0.038; 3.70±0.99 vs. 3.11±1.13, P=0.024). The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group (P=0.608). There was a statistical difference (P=0.011) in incidence of pulmonary infection (2.8% in the TLE group and 16.7% in the OA group). Incidences of complications, such as anastomotic leakage, cardiac complications, left-side hydrothorax, right-side pneumothorax, voice hoarse and incision infection, showed no statistical difference between two groups.
Conclusion
For patients with thoracic esophageal squamous cell carcinoma, TLE possesses advantages of more harvested lymph nodes, less blood loss and less pulmonary infection comparing with open approach, and is complied with the principles of security and oncological radicality of surgery.
ObjectiveTo explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. ResultsA total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557).ConclusionThere is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.
Objective To summarize the progress and trend on clinical drug trials of esophageal squamous cell carcinoma in China. Methods Based on the clinical drug trial registration and information disclosure platform and the drug data query system of the National Medical Products Administration, the characteristics of clinical trials, investigational drugs and listed drugs of esophageal squamous cell carcinoma in China from 2012 to 2021 were analyzed. Results From 2012 to 2021, a total of 49 clinical drug trials of esophageal squamous cell carcinoma were registered in China, accounting for 1.6% of all clinical trials of anticancer drugs. Among them, there were 39 (79.6%) trials initiated by domestic pharmaceutical enterprises, 6 (12.2%) for adjuvant and neoadjuvant treatment, and 9 (18.4%) for local treatment. There were differences in the treatment line distribution between global and domestic enterprise-initiated trials (P=0.032). The above trials covered 29 investigational drugs, including 23 (79.3%) targeted drugs, most of which targeted programmed death-1, programmed death-ligand 1 and epidermal growth factor receptor. From 2012 to 2021, there were 2 drugs for esophageal squamous cell carcinoma listed in China, both of which were approved for the first-line and second- line treatment. Conclusion Great achievements have been made in the clinical development of esophageal squamous cell carcinoma drugs in China. It is suggested that domestic enterprises increase the investment of esophageal squamous cell carcinoma, pay attention to adjuvant and local treatment, explore novel targets and drug categories, and focus on the details of pivotal trials.
ObjectiveTo evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC.MethodsRetrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival.ResultsIn total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively.ConclusionLarynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.
