The Impact of Anastomosis Location in Patients with Lower Thoracic Esophageal Squamous Cell Carcinoma: A Retrospective Observational Study

Abstract BackgroundSeveral kinds of anastomoses with varying locations that can be performed after the surgical resection of lower thoracic esophageal squamous cell carcinoma. In this study, we evaluated the prognostic impact of anastomosis locations in these patients who underwent radical esophagectomy.MethodsLower thoracic esophageal squamous cell carcinoma patients which underwent radical esophagectomy and confirmed as microscopically complete resection were retrospectively enrolled. Anastomoses below the aortic arch or below the azygos arch were defined as low anastomosis. Other anastomoses were defined as high anastomosis. Overall survival of these two kinds of anastomoses were analyzed using the log-rank test and Cox regression model.ResultsOf the 781 patients enrolled, 196 and 585 were classified as the low anastomosis and high anastomosis groups, respectively. Overall, the survival time in low anastomosis group (median OS, 36.1 versus 65.4; P=0.01) was shorter than high anastomosis group but no statistical difference was observed in multivariate analysis (P=0.195). Again, no significant difference in survival between low anastomosis and high anastomosis group (median OS, 140.9 versus 124.8; P=0.345) were observed in pT1-T2 subgroup. In pT3-T4 subgroups, patients with low anastomosis group had significantly poorer survival that those with high anastomosis (median OS, 27.1 versus 42.9, P=0.003), even after controlling for other confounders (P=0.026). Notably, the impact of anastomosis location on long-term survival in pT3-4 patients was not significantly modified by nodal status. The internal validation of patients undergoing Sweet approach shown that pT3-T4 patients with high anastomosis had survival advantages (adjusted HR=0.711, 95%CI, 0.601 0.990, P=0.041)ConclusionsFor lower thoracic esophageal squamous cell carcinoma with declared T3-4 status, low anastomosis is associated with worse prognosis and should be avoided.

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Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma

10.21203/rs.3.rs-72203/v1 ◽

2020 ◽

Author(s):

Ryoma Haneda ◽

Eisuke Booka ◽

Kenjiro Ishii ◽

Hirotoshi Kikuchi ◽

Yoshihiro Hiramatsu ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Local Recurrence ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Definitive Chemoradiotherapy ◽

Radical Esophagectomy ◽

Term Survival ◽

Promising Alternative ◽

Significant Difference

Abstract Background: The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and good clinical outcome of this treatment has been reported. This study compared the efficacy of definitive chemoradiotherapy with radical esophagectomy.Methods: From January 2011 to December 2019, this study enrolled 68 consecutive patients. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcome were compared and subsequent therapies after recurrence were also investigated.Results: Surgery was performed to 39 patients, and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between two groups. However, the rate of 5-year recurrence free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1% vs. 62.7%, Hazard ratio 3.976, 95% Confidence interval 1.076-14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, and resulted in no disease progression and a good prognosis.Conclusions: Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.

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Prognostic impact of lymph node metastasis along the left gastric artery in esophageal squamous cell carcinoma

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01466-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xuan Liu ◽

Leilei Wu ◽

Dongkun Zhang ◽

Peng Lin ◽

Hao Long ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cox Regression ◽

Left Gastric Artery ◽

Prognostic Impact ◽

Gastric Artery ◽

Term Survival

Abstract Background Although the incidence of lymph node (LN) metastasis (LNM) along the left gastric artery is high, its relationship with the prognosis in postoperative patients with esophageal squamous cell carcinoma (ESCC) is rarely reported. This study clarified the prognostic impact of LNM along the left gastric artery in postoperative patients with ESCC. Methods This study assessed data of 1521 patients with ESCC who underwent esophagectomy at the Sun Yat-sen University Cancer Center between March 1992 and March 2012. A chi-squared test and Mann-Whitney U test were used to explore the preliminary correlation between clinical factors and LNM along the left gastric artery. Univariate and multivariate Cox regression analyses were used to assess whether LNM along the left gastric artery was an independent predictor of overall survival. Kaplan–Meier analysis and the log-rank test were used to present a classifying effect based on LN status. Results LNM was observed in 598 patients (39.3%) and was found along the branches of the left gastric artery in 256 patients (16.8%). The patients were classified into two groups based on the presence of LNM along the left gastric artery. Patients without LNM along the left gastric artery had better cancer-specific survival than those with positive LNs (P < 0.001). Conclusions This study indicated that LNM along the left gastric artery was an important independent prognostic factor for long-term survival among ESCC patients (P = 0.011).

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Increased dose of re-irradiation therapy improves the survival of patients with local recurrent esophageal squamous cell carcinoma after radiotherapy

10.21203/rs.3.rs-56036/v2 ◽

2020 ◽

Author(s):

Xun Wu ◽

Xingsheng Hu ◽

Junru Chen ◽

Lang He

Keyword(s):

Squamous Cell Carcinoma ◽

Survival Rate ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Irradiation Dose ◽

Term Survival ◽

Irradiation Therapy ◽

Radiotherapy Alone ◽

The Impact

Abstract Introduction: Local recurrence (LR) threatens the treatment of esophageal squamous cell carcinoma (ESCC). This study interrogated the optimal re-irradiation dose for the LRESCC following radical (chemo) radiotherapy.Methods: We retrospectively analyzed a total of 125 patients with LRESCC after initial radiotherapy. For the radiotherapy dose, 58 patients were assigned to low-dose (LD) group (50–54 Gy) while the remaining 67 were classified into the high-dose (HD) group (55–60 Gy). We recorded the response rate (complete + partial response), 1-, 2- and 3-year survival rate, and toxicity. We then analyzed the impact of the different radiotherapy doses, and combination chemotherapy on the survival of the LRESCC patients.Results: After re-irradiation, the 1-, 2- and 3-year survival rates were 48.3%, 24.1% and 10.3% in the LD group, and 61.2%, 34.3% and 19.4% in the HD group (P<0.05), respectively. The median survival time of patients receiving radiotherapy alone was 9 months in the LD group and 15 months in the HD group (P<0.05). Whereas the survival rate of patients treated with chemoradiotherapy was higher than that of patients treated with radiotherapy alone in the LD group, chemoradiotherapy showed no advantage over radiotherapy alone in the HD group. In addition, the incidence of esophagitis, the most common toxicity, was higher in the HD group compared to the LD group (68.7% vs 58.6%, P<0.05). Our multivariate analysis demonstrated that re-irradiation dose was an independent favorable prognostic factor in patients with LRESCC.Conclusion: Taken together, our data shows that, increasing the re-irradiation therapy dose (55-60Gy) improves the long-term survival of patients with LRESCC after radiotherapy, with tolerable toxicity.

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Nomogram predicting long-term survival probability of thoracic esophageal squamous cell carcinoma after radical esophagectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4094 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4094-4094

Author(s):

Weimin Mao ◽

Xinming Zhou ◽

Qixun Chen ◽

Youhua Jiang ◽

Xun Yang ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Regression Model ◽

Cell Carcinoma ◽

Squamous Cell ◽

Radical Esophagectomy ◽

Term Survival

4094 Background: Nomograms have been widely and successfully used for numerous cancers to obtain reliable prognostic information for each individual patient.To date, however, no studies have conducted survival estimates using nomograms for esophageal squamous-cell carcinoma (ESCC) in Chinese population.The purpose of this study is to develop a nomogram to predict the long-term survival probabilities in patients diagnosed with ESCC after radical esophagectomy. Methods: This study involves a dataset containing 1923 patients who underwent radical esophagectomy for ESCC at Zhejiang Cancer Hospital in Hangzhou, China. Among them, 1,578 patients with no missing data were used to build a prognostic nomogram based on Cox proportional hazard regression model. A multivariate survival analysis using Cox regression model was applied to identify significant variables with P-values <0.05. On the basis of the predictive model with the identified variables, a nomogram was constructed for predicting five-year and ten-year overall survival probabilities. The prediction model was internally validated using bootstrap resampling, assessing its optimism-corrected discrimination and calibration. Results: The median of overall survival times of 1578 ESCC patients was 35.6 months, and the 5-year and 10-year survival rate was 32% and 20%, respectively. The multivariate Cox model identified alcohol, tumor length, surgical approach, number of surgical removed lymph node, ratio of metastatic lymph nodes, region of lymph nodes dissection, depth of invasion, differentiation of tumor, postoperative complications as covariates significantly associated with survival. Across the 100 bootstrap replicates, the median optimism-corrected summary C-index for predicting survival was 0.713 (SE=0.011). Conclusions: A nomogram predicting 5- and 10-year overall survival after radical esophagectomy for ESCC in Chinese population was constructed and validated based on nine significant variables. The nomogram can be applied in daily clinical practice for individualized survival prediction of ESCC patients after potentially curative esophagectomy.

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A re-irradiation dose of 55–60 Gy improves the survival rate of patients with local recurrent esophageal squamous cell carcinoma after radiotherapy

Radiation Oncology ◽

10.1186/s13014-021-01828-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xun Wu ◽

Xingsheng Hu ◽

Junru Chen ◽

Lang He

Keyword(s):

Squamous Cell Carcinoma ◽

Survival Rate ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Irradiation Dose ◽

High Dose ◽

Term Survival ◽

Radiotherapy Alone ◽

The Impact

Abstract Introduction Local recurrence (LR) is clinical challenge in the treatment of esophageal squamous cell carcinoma (ESCC). The current study aimed to determine the optimal re-irradiation dose for local recurrent esophageal squamous cell carcinoma (LRESCC) following radical (chemo) radiotherapy. Methods We retrospectively analyzed 125 patients with LRESCC after receiving initial radiotherapy. For radiotherapy treatment, 58 patients were assigned to low-dose (LD) group (50–54 Gy) and 67 were assigned to the high-dose (HD) group (55–60 Gy). The response rate (complete + partial response), 1-, 2- and 3-year survival rate, and toxicity were recorded. We then analyzed the impact of different radiotherapy doses and combination chemotherapy on the survival of patients with LRESCC. Results After re-irradiation, the 1-, 2- and 3-year survival rates in the LD and HD groups were 48.3%, 24.1% and 10.3% and 61.2%, 34.3% and 19.4% in the HD group, respectively, and the difference in overall survival rate between the two groups were significant (P < 0.05). The median survival time of patients receiving radiotherapy alone was 9 months in the LD group and 15 months in the HD group (P < 0.05). The survival rate of patients treated with chemoradiotherapy was higher than that of patients treated with radiotherapy alone in the LD group. However, chemoradiotherapy showed no advantage over radiotherapy alone in the HD group. In addition, the incidence of radiation esophagitis, the most common toxicity, was higher in the HD group compared to the LD group (68.7% vs 58.6%). Multivariate analysis demonstrated that re-irradiation dose was an independent favorable prognostic factor in patients with LRESCC. Conclusion Higher re-irradiation dose (55–60 Gy) can improve the long-term survival of patients with LRESCC after radiotherapy, with tolerable toxicity.

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Inhibited MicroRNA-301 Restrains Angiogenesis and Cell Growth in Esophageal Squamous Cell Carcinoma by Elevating PTEN

Nanoscale Research Letters ◽

10.1186/s11671-020-03452-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Bin Wang ◽

Peiyan Hua ◽

Ruimin Wang ◽

Jindong Li ◽

Guangxin Zhang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Growth ◽

Esophageal Squamous Cell Carcinoma ◽

Tumor Growth ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cell Cycle Distribution ◽

Pten Inhibition ◽

The Impact

Abstract Objective Esophageal squamous cell carcinoma (ESCC) is featured by early metastasis and late diagnosis. MicroRNA-301 (miR-301) is known to participate in diverse cancers. Nevertheless, effects of miR-301 on ESCC remain unexplored. Thus, we aim to explore the role of miR-301 in ESCC progression. Methods Expression of miR-301 and phosphatase and tensin homologue (PTEN) in ESCC tissues and cell lines was assessed. Next, the screened cells were treated with altered miR-301 or PTEN oligonucleotide and plasmid, and then, the colony formation ability, cell viability, migration, invasion, cell cycle distribution and apoptosis of ESCC cells were assessed. Moreover, tumor growth and microvessel density (MVD) were also assessed, and the targeting relationship between miR-301 and PTEN was affirmed. Results MiR-301 was upregulated, and PTEN was downregulated in ESCC tissues and cells. KYSE30 cells and Eca109 cells were selected for functional assays. In KYSE30 cells, inhibited miR-301 or overexpressed PTEN suppressed cell malignant behaviors, and silenced PTEN eliminated the impact of miR-301 inhibition on ESCC progression. In Eca109 cells, miR-301 overexpression or PTEN inhibition promoted cell malignant behaviors, and PTEN overexpression reversed the effects of miR-301 elevation on ESCC progression. The in vivo assay revealed that miR-301 inhibition or PTEN overexpression repressed ESCC tumor growth and MVD, and miR-301 elevation or PTEN reduction had contrary effects. Moreover, PTEN was targeted by miR-301. Conclusion Taken together, results in our study revealed that miR-301 affected cell growth, metastasis and angiogenesis via regulating PTEN expression in ESCC.

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