scholarly journals Unresected Small Lymph Nodes Assessment Predict Prognosis For Patients With pT3N0M0 Thoracic Esophageal Squamous Cell Carcinoma

Author(s):  
Yi Wang ◽  
Ping Xiao ◽  
Ningjing Yang ◽  
Xiang Wang ◽  
Ke Ma ◽  
...  

Abstract Background: The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients.Methods: Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence. Results: Eighty-four patients (42.5%) were classified as CT-suspect group according to the diagnostic criteria, survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR: P<0.000; LR: P<0.000). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.000).Conclusions: Unresected small lymph nodes assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi Wang ◽  
Ping Xiao ◽  
Ningjing Yang ◽  
Xiang Wang ◽  
Ke Ma ◽  
...  

Abstract Background The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients. Methods Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence. Results Eighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001). Conclusions Unresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.


Author(s):  
Nattinee Charoen ◽  
Kitti Jantharapattana ◽  
Paramee Thongsuksai

Objective: Programmed cell death ligand 1 (PD-L1) and mammalian target of rapamycin (mTOR) are key players in host immune evasion and oncogenic activation, respectively. Evidence of the prognostic role in oral squamous cell carcinoma (OSCC) is conflicting. This study examined the associations of PD-L1 and mTOR expression with 5-year overall survival in OSCC patients. Material and Methods: The expressions of PD-L1 and mTOR proteins were immunohistochemically evaluated on tissue microarrays of 191 patients with OSCC who were treated by surgery at Songklanagarind Hospital, Thailand from 2008 to 2011. Cox regression analysis was used to determine independent prognostic factors. Results: PD-L1 expression was observed in 14.1% of cases while mTOR expression was present in 74.3% of cases. Females were more likely to have tumors with PD-L1 (p-value=0.007) and mTOR expressions (p-value=0.003) than males. In addition, lower clinical stage and well differentiated tumor are more likely to have mTOR expression (p-value= 0.038 and p-value<0.001, respectively). Cox regression analysis showed that age, tumor stage, nodal stage, combined surgical treatment with radiation or chemoradiation therapy, surgical margin status, PD-L1 expression and mTOR expression are independent prognostic factors. High PD-L1 expression (hazard ratio (HR) 3.14, 95% confidence interval (CI), 1.26–7.79) and high mTOR expression (HR 1.69, 95% CI, 1.00–2.84) are strong predictors of poor outcome. Conclusion: A proportion of OSCC expressed PD-L1 and mTOR proteins. Expression of PD-L1 and mTOR proteins are strong prognostic factors of OSCC.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15545-e15545
Author(s):  
Jinling Zhang ◽  
Xueyuan Heng ◽  
Fengyuan Che

e15545 Background: It was reported that the number of positive lymph nodes (PLN) and negative lymph nodes (NLN) resected in lymphadenectomy were both independent prognostic factors in esophageal squamous cell carcinoma (ESCC). However, it is unclear which kind of combination of them would have a stronger impact on the prognosis of the ESCC patients. Methods: A total of 229 patients with ESCC were retrospectively investigated. The Cox Proportional Hazards Model was used to investigate the relationship between the PLN or NLN and the overall survival of patients. Survival analysis was performed using the Kaplan-Meier method, and the survival difference between sub-groups were explored with log-rank tests. The cut-off number of the ratio of NLN count to PLN count resulted in an improved outcome for patients was investigated by a series of log-rank tests. Results: The numbers of PLN and NLN were both independent prognostic factors, supported by the results of Cox regression model analysis (hazard ratio [HR], 1.12, P < 0.001 and HR, 0.97, P = 0.024, respectively).The survival differences among sub-groups from N0 to N3 stage were statistically significant (P < 0.001). Analysis using a Cox regression model revealed that the number of NLN inside the thoracic cavity had a stronger impact on the prognosis compared to the number of NLN outside the thoracic cavity (HR,0.959, P = 0.042 vs.HR, 0.973, P = 0.179). As a combination analysis consisting of the number of PLN and NLN, the log-rank test result demonstrated that patients with the ratio of NLN count inside thoracic cavity to the PLN count less than 8 could achieve a better survival. Conclusions: The ratio of NLN count inside thoracic cavity to the PLN count was a independent prognostic factor.


2021 ◽  
Vol 12 ◽  
Author(s):  
Jiecheng Ye ◽  
Yining Wu ◽  
Heyuan Cai ◽  
Li Sun ◽  
Wanying Deng ◽  
...  

Esophageal squamous cell carcinoma (ESCC) is a common malignant tumor with high mortality and poor prognosis. Ferroptosis is a newly discovered form of cell death induced by iron-catalyzed excessive peroxidation of polyunsaturated fatty acids (PUFAs). However, the prognostic value of ferroptosis-related genes (FRGs) for ESCC remains unclear. Based on the ESCC dataset from the Gene Expression Omnibus (GEO) database, we identified 39 prognostic FRGs through univariate Cox regression analysis. After LASSO regression and multivariate Cox regression analyses, a multigene signature based on 10 prognostic FRGs was constructed and successfully divided ESCC patients into two risk groups. Patients in the low-risk group showed a significantly better prognosis than patients in the high-risk group. In addition, we combined the risk score with clinical predictors to construct a nomogram for ESCC. The predictive ability of the nomogram was further verified by ROC curves and calibration plots in both the training and validation sets. The predictive power of the nomogram was demonstrated to be better than that of either the risk score or clinical variable alone. Furthermore, functional analysis revealed that the 10-FRG signature was mainly associated with ferroptosis, differentiation and immune response. Connectivity map analysis identified potential compounds capable of targeting FRGs in ESCC. Finally, we demonstrated the prognostic value of SRC gene in ESCC using the clinical samples and found that SRC inhibition sensitized ESCC cells to ferroptosis inducers by in vitro experiments. In conclusion, we identified and verified a 10-FRG prognostic signature and a nomogram, which provide individualized prognosis prediction and provide insight into potential therapeutic targets for ESCC.


2021 ◽  
Vol 11 ◽  
Author(s):  
Heyang Cui ◽  
Yongjia Weng ◽  
Ning Ding ◽  
Chen Cheng ◽  
Longlong Wang ◽  
...  

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignant tumors in China, and its prognosis remains poor. Autophagy is an evolutionarily conserved catabolic process involved in the occurrence and development of ESCC. In this study, we described the expression profile of autophagy-related genes (ARGs) in ESCC and developed a prognostic prediction model for ESCC patients based on the expression pattern of ARGs. We used four ESCC cohorts, GSE53624 (119 samples) set as the discovery cohort, The Cancer Genome Atlas (TCGA) ESCC set (95 samples) as the validation cohort, 155 ESCC cohort, and Oncomine cohort were used to screen and verify differentially expressed ARGs. We identified 34 differentially expressed genes out of 222 ARGs. In the discovery cohort, we divided ESCC patients into three groups that showed significant differences in prognosis. Then, we analyzed the prognosis of 34 differentially expressed ARGs. Three genes [poly (ADP-ribose) polymerase 1 (PARP1), integrin alpha-6 (ITGA6), and Fas-associated death domain (FADD)] were ultimately obtained through random forest feature selection and were constructed as an ARG-related prognostic model. This model was further validated in TCGA ESCC set. Cox regression analysis confirmed that the three-gene signature was an independent prognostic factor for ESCC patients. This signature effectively stratified patients in both discovery and validation cohorts by overall survival (P = 5.162E-8 and P = 0.052, respectively). We also constructed a clinical nomogram with a concordance index of 0.713 to predict the survival possibility of ESCC patients by integrating clinical characteristics and the ARG signature. The calibration curves substantiated fine concordance between nomogram prediction and actual observation. In conclusion, we constructed a new ARG-related prognostic model, which shows the potential to improve the ability of individualized prognosis prediction in ESCC.


2021 ◽  
Author(s):  
Xiang Lv ◽  
Songtao Han ◽  
Bin Xu ◽  
Yuqin Deng ◽  
Feng Yangchun

Abstract Objective To investigate the value of complete blood count in predicting the survival rate of patients with esophageal squamous cell carcinoma. Methods A total of 3587 patients with esophageal squamous cell carcinoma who were initially admitted to the Affiliated Cancer Hospital of Xinjiang Medical University from January 2010 to December 2017 were collected by retrospective study. The relevant clinical data were collected by the medical record system, and the patients were followed up by the hospital medical record follow-up system. The follow-up outcome was death. The survival time of all patients was obtained. The survival curve was established using the cut-off value of each index obtained by ROC curve. The Cox proportional hazards regression analysis model and nomogram were established to predict the survival prognosis of esophageal squamous cell carcinoma. The role of each index in the prognosis of patients with esophageal squamous cell carcinoma was studied Results The cut-off values of NLR, NMR, LMR, RDW and PDW in blood routine were 3.52, 10.22, 2.25, 13.85% and 12.05%, respectively. Survival curve analysis showed that patients aged < 60 years and NLR < 3.52 had survival. All indicators were divided into high and low groups according to ROC curve. Univariate Cox regression analysis model showed that RDW (≥ 13.85) and NLR (≥ 3.52) groups were risk factors for the prognosis of ESCC, with HR values of 1.099 (1.015–1.191; p = 0.020) and 1.340 (1.231–1.458; p < 0.001) compared with RDW (< 13.85) and NLR (< 3.52), respectively; multivariate Cox regression analysis model showed that NLR was significantly associated with the prognosis of ESCC, with HR of 1.342 (1.232–1.461; p < 0.001) for NLR (≥ 3.52) NLR (< 3.52). Conclusion NLR results in blood count can be used to predict the survival of patients with esophageal squamous cell carcinoma.


2020 ◽  
Author(s):  
Qun Zhang ◽  
Feng Li ◽  
Peng Cai ◽  
Hongwei Li ◽  
Hongmei Yin ◽  
...  

Abstract Background To investigate the expression of PD-L1(programmed death-ligand 1)in patients with esophageal squamous cell carcinoma (ESCC) and its clinical significance. Methods The tissue expression of PD-L1 protein in 139 cases of ESCC and 50 adjacent non-malignant epithelial tissues (> 5 cm from the tumor resection margins) were identified by immunohistochemical staining. Subsequently, the relationship between expression and the observed clinical characteristics was analyzed. Results The positive expression rate of PD-L1 protein was increased in tumor tissues compared to that of adjacent noncancerous mucosa tissues (40.3% vs. 22.0%, P < 0.05). The findings also indicated that PD-L1 protein expression had no significant correlation with age, gender, tumor location, differentiation and lymph node (N) status (P > 0.05). The 91 months follow-up Kaplan-Meier survival analysis showed that patients in positively expressed PD-L1 group experienced a lower survival rate compared to their negatively expressed PD-L1 counterparts (32.1% vs. 48.2%, P < 0.05). The COX regression analysis results suggested that PD-L1 represented an independent prognosis factor for ESCC. Conclusions The findings indicated that PD-L1 plays an important role in the progression of ESCC and might represent a potential therapeutic and prognostic target for ESCC patients.


2018 ◽  
Vol 48 (1) ◽  
pp. 251-262 ◽  
Author(s):  
Xian-Zi Yang ◽  
Qing-Jun He ◽  
Tian-Tian Cheng ◽  
Jun Chi ◽  
Zi-Ying Lei ◽  
...  

Background/Aims: Considerable evidence indicates that long noncoding RNAs (lncRNAs) exert importantly regulatory functions during human cancer initiation and progression and are promising biotargets in the flight against cancer. Methods: In this study, we evaluated the role of the lncRNA LINC01133 in esophageal squamous cell carcinoma (ESCC). LINC01133 expression in ESCC was examined by quantitative real-time PCR. The correlations between LINC01133 expression and clinicopathological variables and survival were examined by the χ2 test, Kaplan–Meier method, log-rank test, and univariate Cox regression analysis. Results: LINC01133 expression levels were frequently lower in ESCC tissues and cell lines than in paired normal tissues and an immortalized esophageal epithelial cell line, respectively. The expression of LINC01133 decreased in a TNM stage- and lifestyle-independent manner. LINC01133 was an independent protective factor and had an anti-tumor effect in the early stage of ESCC development. More importantly, we discovered that drinking status in our cohort impaired the predictive accuracy of LINC01133 for patients with ESCC. Furthermore, a new risk model combining LINC01133 expression, drinking status, and TNM stage provided better survival discrimination compared with three other predictors. Conclusions: Our data indicate that a loss of LINC01133 expression is a potential poor prognostic biomarker and therapeutic target for ESCC and provide additional prognostic information to improve the outcomes of ESCC patients.


2021 ◽  
Author(s):  
Yushi Nagaki ◽  
Satoru Motoyama ◽  
Yusuke Sato ◽  
Akiyuki Wakita ◽  
Hiromu Fujita ◽  
...  

Abstract Background: A pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) ensures long-term survival in esophageal squamous cell carcinoma (ESCC) patients following esophagectomy, but pCR patients are a minority. The aim here was to identify prognostic factors in patients with non-pCR ESCC after NACRT. Methods: This is a retrospective study. Investigated were 5-year overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) among non-pCR ESCC patients divided into pT0N0, primary site pCR (pT0N+), lymph node pCR (pT+N0), and non-pCR in both the tumor and lymph nodes (pT+N+) subgroups after NACRT and esophagectomy. Focusing on the SUVmax reduction rate in the primary tumor in 88 patients who underwent FDG-PET before and after NACRT, we used univariate and multivariate Cox proportional hazard models to identify prognostic factors.Results: Although there were no significant survival differences among non-pCR ESCC patients with pT0N+, pT+N0, or pT+N+, and survival rate among pT+N+ patients was the poorest. After setting a 60% cutoff for the SUVmax reduction rate in the tumor, RFS curves for non-pCR patients significantly differed between patients above the cutoff and those below it. For pT+N+ patients, the SUVmax reduction rate (<60% vs ≥60%) was an independent prognostic factor of OS, DSS, and RFS.Conclusion: Because ESCC patients with SUVmax reduction rates of <60% in the tumor after NACRT and categorized as pT+N+ after NACRT had significantly poorer prognoses, even after esophagectomy, a change in treatment strategy may be an option to improve survival.


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