Detection of lymph node involvement by cytokeratin immunohistochemistry is an independent prognostic factor after curative resection of esophageal cancer

Sex differences in survival following surgery for esophageal cancer: A systematic review and meta-analysis

The impact of sex on the prognosis of patients with esophageal cancer remains unclear. Evidence supports that sex- based disparities in esophageal cancer survival could be attributed to sex- specific risk exposures, such as age at diagnosis, race, socioeconomic status, smoking, drinking, and histological type. The aim of our study is to investigate the role of sex disparities in survival of patients who underwent surgery for esophageal cancer. A systematic review and meta-analysis of the existing literature in PubMed, EMBASE, and CENTRAL from December 1966 to February 2023, was held. Studies that reported sex-related differences in survival outcomes of patients who underwent esophagectomy for esophageal cancer were identified. A total of 314 studies were included in the quantitative analysis. Statistically significant results derived from 1-year and 2-year overall survival pooled analysis with Relative Risk (RR) 0.93 (95% Confidence Interval (CI): 0.90-0.97, I2 = 52.00) and 0.90 (95% CI: 0.85-0.95, I2 = 0.00), respectively (RR < 1 = favorable for men). In the postoperative complications analysis, statistically significant results concerned anastomotic leak and heart complications, RR: 1.08 (95% CI: 1.01-1.16) and 0.62 (95% CI: 0.52-0.75), respectively. Subgroup analysis was performed among studies with <200 and > 200 patients, histology types, study continent and publication year. Overall, sex tends to be an independent prognostic factor for esophageal carcinoma. However, unanimous results seem rather obscure when multivariable analysis and subgroup analysis occurred. More prospective studies and gender-specific protocols should be conducted to better understand the modifying role of sex in esophageal cancer prognosis.

Prognostic value of occult lymph node metastases in patients with completely resected esophageal squamous cell carcinoma

To investigate the prognostic value of occult lymph node metastases (OLNMs) in patients with pathologically lymph node negative (pN0) esophageal squamous cell carcinoma (ESCC). OLNMs were detected in 516 pN0 ESCC patients by immunohistochemical staining. The correlation between the clinicopathological features and OLNM, and the prognostic value of OLNM was explored. Eighty-eight patients (17.1%) had OLNMs, including 37 patients with isolated tumor cells (ITCs), 49 patients with micrometastases, and 2 patients with macrometastases (> 2 mm). The OLNM-positive group had poorer differentiation and a more advanced pT category. The 5-year overall survival and disease-free survival for patients with OLNMs were significantly worse than those of IHC-negative patients (P < 0.001), but similar to those of the pN1 patients (P > 0.05). The multivariate analysis showed that OLNM was an independent prognostic factor. In subgroup analyses, the IHC-negative patients had significant survival advantages compared with the ITC group and the micrometastasis group, whereas the survival for the ITC group was similar to that of the micrometastasis group. IHC staining in pN0 ESCC patients might help to identify patients at high risk of death after resection, and ITCs in the lymph nodes appear to have a prognostic value equal to that of micrometastases.

Meta-analysis of prognostic factors of overall survival in patients undergoing oesophagectomy for oesophageal cancer

INTRODUCTION

Currently, the American Joint Commission on Cancer (AJCC) staging system is used for prognostication for oesophageal cancer. However, several prognostically important factors have been reported but not incorporated. This meta-analysis aimed to characterize the impact of preoperative, operative, and oncological factors on the prognosis of patients undergoing curative resection for oesophageal cancer.

METHODS

This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling to determine pooled univariable hazard ratios (HRs). The study was prospectively registered with the PROSPERO database (Registration: CRD42018157966).

RESULTS

One-hundred and seventy-one articles including 73,629 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these. the strongly associated prognostic factors were 'pathological' T stage (HR: 2.07, CI95%: 1.77-2.43, P < 0.001), 'pathological' N stage (HR: 2.24, CI95%: 1.95-2.59, P < 0.001), perineural invasion (HR: 1.54, CI95%: 1.36-1.74, P < 0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82-2.59, P < 0.001), poor tumor grade (HR: 1.53, CI95%: 1.34-1.74, P < 0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30-1.66, P < 0.001).

CONCLUSION

Several tumor biological variables not included in the AJCC 8th edition classification can impact on overall survival. Incorporation and validation of these factors into prognostic models and next edition of the AJCC system will enable personalized approach to prognostication and treatment.

The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review

Lymph nodal metastasis is one of the most important prognostic factors determining survival in patients with carcinoma esophagus. Radical esophagectomy, with the resection of surrounding lymph nodes, is considered the prime treatment of carcinoma esophagus. An extensive lymphadenectomy improves the accuracy of staging and betters locoregional control, but its effect on survival is still not apparent and carries the disadvantage of increased morbidity. The extent of lymphadenectomy during esophagectomy also remains debatable, with many studies revealing contradictory results, especially in the era of neoadjuvant therapy. The pattern of distribution and the number of nodal metastasis are modified by neoadjuvant therapy. The paper reviews the existing evidence to determine whether increased lymph node yield improves oncological outcomes in patients undergoing esophagectomy with particular attention to those patients receiving neoadjuvant therapy.

Sterilization of tumor-positive lymph nodes of esophageal cancer by neo-adjuvant treatment is associated with worse survival compared to tumor-negative lymph nodes treated with surgery first

BACKGROUND AND OBJECTIVES

Lymph node (LN) involvement by esophageal cancer is associated with compromised long-term prognosis. This study assessed whether LN downstaging by neoadjuvant treatment (NAT) might offer a survival benefit compared to patients with a priori negative LN.

METHODS

Patients undergoing esophagectomy for cancer between 2005 and 2014 were screened for inclusion. Group 1 included cN0 patients confirmed as pN0 who were treated with surgery first, whereas group 2 included patients initially cN+ and down-staged to ypN0 after NAT. Survival analysis was performed with the Kaplan-Meier and Cox regression methods.

RESULTS

Fifty-seven patients were included in our study, 24 in group 1 and 33 in group 2. Group 2 patients had more locally advanced lesions compared to a priori negative patients, and despite complete LN sterilization by NAT they still had worse long-term survival. Overall 3-year survival was 86.8% for a priori LN negative versus 63.3% for downstaged patients (P = 0.013), while disease-free survival was 79.6% and 57.9%, respectively (P = 0.021). Tumor recurrence was also earlier and more disseminated for the down-staged group.

CONCLUSIONS

Downstaged LN, despite the systemic effect of NAT, still inherit an increased risk for early tumor recurrence and worse long-term survival compared to a priori negative LN.

UBE2D3 is a positive prognostic factor and is negatively correlated with hTERT expression in esophageal cancer

Human telomerase reverse transcriptase (hTERT) is a critical factor in unlimited cell proliferation and immortalization, with numerous studies demonstrating that high expression of hTERT is a poor prognostic factor in various types of cancer. Ubiquitin-conjugating enzyme E2D 3 (UBE2D3) is a member of the E2 family, and participates in the ubiquitin proteasome pathway to regulate basic cellular activities, such as cell cycle control, the DNA damage response, apoptosis, and tumorigenesis. Our previous study initially determined that downregulation of UBE2D3 expression increases hTERT expression and cell proliferation, however, the association between the expression of these two proteins and their functions in cancer tissues remains unknown. Therefore, the protein expression levels of hTERT and UBE2D3 were evaluated in 150 esophageal cancer and 30 adjacent healthy tissue samples by performing immunohistochemical analysis. Concurrently, the clinicopathological data of the enrolled patients were obtained to allow correlation analysis. It was identified that the expression of hTERT in the esophageal cancer tissues was significantly higher compared with that of the adjacent tissues (P=0.015), however, the expression of UBE2D3 was significantly lower in esophageal cancer tissues than the adjacent tissues (P=0.001). Additionally, the study demonstrated that hTERT was significantly upregulated in poorly-differentiated, advanced tumor-node-metastasis (TNM) stage cancer tissues (P<0.05 for all), however, UBE2D3 expression was downregulated in poorly-differentiated, lymph node invaded cancer tissues and recurrent cases. It was also identified that traditional factors, including tumor location, T stage, lymph node status, TNM stage, and molecular factors of hTERT and UBE2D3, were significantly associated with overall survival time (P<0.05 for all). Furthermore, UBE2D3, lymph node status and tumor location were independent prognostic factors for esophageal cancer in multivariate analysis. Most notably, hTERT and UBE2D3 expression were negatively correlated with each other. In conclusion, the findings of the present study indicated that hTERT and UBE2D3 proteins appear to be involved in the development of esophageal cancer, that UBE2D3 may a positive prognostic factor for esophageal cancer, and that UBE2D3 and hTERT expression levels are inversely correlated.

The impact of the number of occult metastatic lymph nodes on postoperative relapse of resectable esophageal cancer

Clinical stage II/III esophageal cancer (EC), as defined by the Japanese Classification, relapses at a moderately high rate even after curative resection. The number of lymph node metastases is known to be associated with tumor relapse. Recently, the prognostic significance of occult metastatic lymph nodes (MLNs), as well as that of overt MLNs, has been reported. The aim of this study was to investigate the impact of the total number of MLNs including occult MLNs on postoperative relapse in clinical stage II/III EC. One hundred and five patients with clinical stage II/III EC who underwent esophagectomy accompanied by radical lymphadenectomy at the Department of Surgical Oncology in Osaka City University Hospital between January 2000 and October 2008 were included in this study. Occult MLNs, metastases not detected by hematoxylin-eosin staining, were identified by immunohistochemistry (IHC) using antipancytokeratin antibody AE1/AE3. The clinicopathological features of occult MLNs were compared between the relapse and no relapse groups. A total of 6558 lymph nodes (1357 from two-field dissection and 5201 from three-field dissection) were examined by IHC staining; 362 overt MLNs and 143 occult MLNs were detected. The number of occult MLNs increased in proportion to the International Union Against Cancer pathological (p)N-status and pStage. When the number of occult MLNs was added to the number of pNs, the number of total MLNs was associated with postoperative relapse. With respect to tumor, node, metastasis stage, 6 of 22 patients (27%) who were pathological node-negative converted to node-positive by considering total MLNs. The number of N3 patients with relapse increased markedly with restaging by total MLNs. The number of total MLNs, but not overt MLNs, was an independent prognostic factor on multivariate analysis. These results suggest that occult MLNs were often found, and they were associated with postoperative relapse of resectable esophageal cancer. The total number of MLNs including occult MLNs could contribute to evaluating the precise stage of patients with esophageal cancer.

Clinical significance of micrometastases in lymph nodes from laryngeal squamous cell carcinoma

OBJECTIVE

To assess the role of lymph nodes micrometastases in laryngeal squamous cell carcinoma and correlate the results with survival.

METHODS

We performed immunohistochemical analyses of lymph nodes after the resection of 126 patients for detection of micrometastasis. The lymph nodes were examined with hematoxylin and eosin (HE)-stained and cytokeratin (CK) antibodies AE1/AE3 stained. Recurrences and metastases were recorded during follow-up. The Kaplan-Meier method was used for survival analysis.

RESULTS

In total, 126 patients underwent neck dissection. Forty-one patients were HE positive (group 1), while 85 were HE negative. Thirty-three of these HE negative patients were CK positive (group 2), while 52 were CK negative (group 3). Patients in groups 2 and 3 had a different outcome (P < .001). Survival was worse in patients in group 2 (10-year survival of 52.12% vs 81.16% in group 3, P < .01).

CONCLUSION

Immunohistochemical analysis is an efficient way to detect micrometastasis in lymph nodes after the resection of conventionally node-negative patients. The detection of CK-positive cells is an independent prognostic factor, and more aggressive treatment should be indicated in these patients.

Molybdenum increases chemosensitivity of ECA-109 cells to cisplatin and cisplatin-induced inhibition of p75NTR expression in esophageal stem cells

AIM: To investigate the effect of molybdenum on the chemosensitivity of esophageal cancer ECA-109 cells to cisplatin and expression of p75^NTR in esophageal stem cells.

METHODS: ECA-109 cells were divided into four groups: blank control group, cisplatin group, molybdenum group, cisplatin plus molybdenum group. Cell proliferation was measured by methyl thiazolyl tetrazolium (MTT) assay. The expression of p75^NTR in human esophageal stem cells was examined by flow cytometry.

RESULTS: Cisplatin reduced the percentage of p75^NTR-positive cells and the proliferation of ECA-109 cells in a dose-dependent manner. Treatment with molybdenum alone had no significant influence on the proliferation of ECA-109 cells and the percentage of p75^NTR-positive cells. However, treatment with molybdenum significantly enhanced the chemosensitivity of esophageal cancer ECA-109 cells to cisplatin and cisplatin-induced inhibition of p75^NTR expression in esophageal stem cells when compared to cells incubated with cisplatin alone or blank control cells (all P < 0.05).

CONCLUSION: Molybdenum can increase the inhibitory effect of cisplatin on the proliferation of ECA-109 cells, which provides an experimental basis for the use of molybdenum as adjuvant chemotherapeutic agent for esophageal cancer.

Lymph node metastases and prognosis in oesophageal carcinoma--a systematic review

Oesophageal cancer is the 7th most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The 7th edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.