Tumor angiogenesis as an independent prognostic factor after extended radical esophagectomy for invasive squamous cell carcinoma of the esophagus

Prognostic value of microvessel density in esophageal squamous cell carcinoma-a systematic review and meta-analysis

OBJECTIVE

Angiogenesis produced by tumor microenvironment is play an important role in development of esophageal squamous cell carcinoma (ESCC). As a quantitative index of angiogenesis, literature has emerged contradictory results about the prognostic role of microvessel density (MVD) in ESCC. The aim of the study was to explore the impact of the correlation between MVD and the prognosis of ESCC based the published evidence.

METHODS

Pubmed and Web of science database were screened for the relationship of MVD with prognostic feature in ESCC up to March, 2021. 11 relevant articles were used for meta-analysis. The following data were extracted from the literature: author, year, country, the patients number of high/low MVD, tumor-node-metastasis (TNM) classification, clinical stage, lymphoid infiltrates, vessel invasion, invasive depth, differential degree and survival rate. The hazard ratio (HR) and odds ratios (OR) with 95% CI were used to assess the associations between MVD and overall survival (OS). Chi-squared test and I² statistics were completed to evaluate the heterogeneity in our study. A random-effects model was used when significant heterogeneity existed (I²>50% and p < 0.05). Egger test was used to calculate the publication bias. Subgroup analysis was stratified by antibody, region, sample capacity to explore the source of heterogeneity.

RESULTS

11 studies with 1055 patients were analyzed. Our results suggested that high MVD is an important factor to advanced TNM classification and clinical stage, and the high MVD is positive correlation with the lymph node invasion and vascular invasion(p < 0.05) in ESCC, but irrelevant to poor differential and invasive depth(p > 0.05). The result also indicated that low MVD is a benefit factor to prolong the survival rate (p < 0.05). And the source of the heterogeneity maybe is that the antibody used to detect the MVD was not consistent, patient number was not large enough and the count method on MVD.

CONCLUSION

Across multiple studies, high MVD is correlated with clinicopathological criteria of poor prognosis and survival in ESCC. MVD could be the quantitative index to reactive angiogenesis and may play a pivotal role in ESCC development and progression. MVD may represent a valuable addition to current pathologic analysis and help to guide prognosis and treatment.

Deregulated bone morphogenetic proteins and their receptors are associated with disease progression of gastric cancer

Bone morphogenetic proteins (BMP) are members of the transforming growth factor β superfamily (TGF-β). BMPs are involved in tumourigenesis and disease progression of certain malignancies. To date, the role played by BMPs in gastric cancer (GC) remains largely unknown. In the present study, we systematically analysed the expression and clinical significance of BMP and BMP receptors (BMPR) in TCGA gastric cancer database and GEO database and explored the possible mechanism of action. BMP5 is reduced in gastric cancer tissues, while ACVRL1, ACVR1, TGFBR1, and BMPR2 were significantly increased in the gastric tumours. BMP3, ACVR1, TGFBR1, BMPR1B (also known as ALK6), TGFBR2 and BMPR2 were significantly associated with poorer overall survival of GC patients. A negative correlation was seen between BMP/BMPR and proliferation markers which was supported by their correlation with the cell cycle promoters and inhibitors. More interestingly, further analyses showed that BMPs and their receptors are positively correlated with matrix metalloproteinases (MMPs), epithelial mesenchymal transition (EMT) markers and stemness in GC. Furthermore, positive correlations were also frequently seen between BMP receptors and markers/regulators of angiogenesis and lymphangiogenesis in the gastric tumours. Taken together, these findings suggest that BMPs play dual roles in GC. They may inhibit proliferation of GC cells. On the other hand, they can also promote disease progression through a promotion of invasion, EMT and stemness. The elevated expression of BMP receptors in GC were also highly associated with tumour associated angiogenesis and lymphangiogenesis which facilitate tumour growth, expansion and spread.

Microvessel density as a prognostic factor in esophageal squamous cell cancer patients: A meta-analysis

BACKGROUND

To date, literature has emerged that shows contradictory results about the prognostic role of microvessel density (MVD) in esophageal squamous cell cancer (ESCC). The aim of the study set out to evaluate the correlation between MVD and the prognosis of ESCC.

METHODS

Identified publications from various databases were obtained and reviewed. A meta-analysis was performed to evaluate the prognostic role of MVD among ESCC patients.

RESULTS

A total of 11 eligible studies containing 891 ESCC cases were included in the meta-analysis. The pooled hazard ratio for overall survival was 2.39 (95% confidence interval 1.92-2.96, P < .001). Heterogeneity among the studies was not significant, and publication bias was not found. Subgroup analyses were also performed on different issues, such as districts, antibodies, and median age.

CONCLUSION

High MVD is a prognostic factor among ESCC that indicated worse prognosis in these patients. More studies are needed, and through abundant evidence, the topic could be re-evaluated by then.

Bilateral approach for thoracoscopic esophagectomy with lymph node dissection in the dorsal area of the thoracic aorta in patients with esophageal cancer: A report of two cases

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We presented two esophageal cancer patients performed thoracoscopic esophagectomy.

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These two cases have lymph node metastasis of dorsal area of thoracic aorta (DTA).

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We performed successfully underwent the dissection of lymph node of DTA.

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The bilateral thoracoscopic approach performedsafely in the prone position.

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The long-term outcome of lymphadenectomy in the DTA among esophageal cancer patients remain controversial.

Introduction

The incidence of lymph node metastasis in the dorsal area of the thoracic aorta (DTA) is relatively low in patients with esophageal cancer. It is difficult to approach the DTA using surgical procedures, such as an open thoracotomy and thoracoscopy in the left decubitus position.

Case presentation

Case 1: A 70-year-old man with esophageal cancer underwent thoracoscopic esophagectomy with mediastinal lymph node dissection via a right thoracoscopic approach, followed by lymphadenectomy in the DTA via left thoracoscopy in the prone position. Microscopic findings revealed two metastatic lymph nodes in the DTA. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T2N3M0 (Union for International Cancer Control [UICC], 7th edition). The patient showed lung metastasis 8 months after the surgery. Case 2: A 72-year-old man with esophageal cancer underwent esophagectomy via a bilateral approach in the prone position, using a similar procedure as in case 1. The definitive diagnosis was squamous cell carcinoma of the esophagus, and the pathological stage was T3N2M0. The patient showed a metastatic mediastinal lymph node 4 months after the surgery.

Conclusion

Bilateral thoracoscopic esophagectomy in the prone position can be safely performed, and it might be an alternative curative surgery for esophageal cancer. However, both our cases showed metastasis in the early postoperative period. The long-term outcome and significance of dissection of lymph nodes in the DTA in patients with esophageal cancer remains controversial. Further studies are required to establish the indications and efficacy of this therapeutic approach.

Nestin: A novel angiogenesis marker and possible target for tumor angiogenesis

Abnormal vasculature, termed tumor vessels, is a hallmark of solid tumors. The degree of angiogenesis is associated with tumor aggressiveness and clinical outcome. Therefore, exact quantification of tumor vessels is useful to evaluate prognosis. Furthermore, selective detection of newly formed tumor vessels within cancer tissues using specific markers raises the possibility of molecular targeted therapy via the inhibition of tumor angiogenesis. Nestin, an intermediate filament protein, is reportedly expressed in repair processes, various neoplasms, and proliferating vascular endothelial cells. Nestin expression is detected in endothelial cells of embryonic capillaries, capillaries of the corpus luteum, which replenishes itself by angiogenesis, and proliferating endothelial progenitor cells, but not in mature endothelial cells. Therefore, expression of nestin is relatively limited to proliferating vascular endothelial cells and endothelial progenitor cells. Nestin expression is also reported in blood vessels within glioblastoma, prostate cancer, colorectal cancer, and pancreatic cancer, and its expression is more specific for newly formed blood vessels than other endothelial cell markers. Nestin-positive blood vessels form smaller vessels with high proliferation activity in tumors. Knockdown of nestin in vascular endothelial cells suppresses endothelial cell growth and tumor formation ability of pancreatic cancers in vivo. Using nestin to more accurately evaluate microvessel density in cancer specimens may be a novel prognostic indicator. Furthermore, nestin-targeted therapy may suppress tumor proliferation via inhibition of angiogenesis in numerous malignancies, including pancreatic cancer. In this review article, we focus on nestin as a novel angiogenesis marker and possible therapeutic target via inhibition of tumor angiogenesis.

Esophageal squamous cell carcinoma: assessing tumor angiogenesis using multi-slice CT perfusion imaging

OBJECTIVES

The purpose of this study was to investigate the correlation between multi-slice computed tomographic perfusion imaging (CTPI) parameters and immunohistologic markers of angiogenesis in esophageal squamous cell carcinoma (ESCC).

METHODS

Fifty patients with histologically proven esophageal squamous cell carcinoma were enrolled in this study. All subjects underwent multi-slice CT perfusion scan. The hemodynamic parameters of vascular tumor, including blood volume (BV), blood flow (BF), mean transit time (MTT) and permeability surface (PS) were generated. All the ESCC specimens were stained immunohistochemically to identify CD31 for quantification of microvessel density (MVD). CTPI parameters were correlated with MVD by using Pearson correlation analysis.

RESULTS

The value of CT perfusion parameters of ESCC were as follows: BF 116.71 ± 47.59 ml/100 g/min, BV 6.74 ± 2.70 ml/100 g, MTT 6.42 ± 2.84 s, PS 13.82 ± 6.25 ml/100 g/min. The mean MVD of all 50 tumor specimens was 34.44 ± 19.75. The PS values were significantly higher in ESCC patients with involvement of lymph node than those without involvement of lymph node (p < 0.01). Blood volume and permeability surface were positively correlated with MVD (p < 0.01), whereas no significant correlation was observed between MVD and BF or between MVD and MTT.

CONCLUSIONS

Blood volume and permeability surface were positively correlated with MVD. CTPI could reflect the angiogenesis in ESCC.

Whole tumour quantitative measurement of first-pass perfusion of oesophageal squamous cell carcinoma using 64-row multidetector computed tomography: correlation with microvessel density

PURPOSE

To assess correlations between whole tumour first-pass perfusion parameters obtained with 64-row multidetector computed tomography (MDCT), and microvessel density (MVD) in oesophageal squamous cell carcinoma.

MATERIALS AND METHODS

Thirty-one consecutive patients with surgically confirmed oesophageal squamous cell carcinomas were enrolled into our study. All the patients underwent whole tumour first-pass perfusion scan with 64-row MDCT. Perfusion parameters, including perfusion (PF), peak enhanced density (PED), blood volume (BV), and time to peak (TTP) were measured using Philips perfusion software. Postoperative tumour specimens were assessed for MVD. Pearson correlation coefficient tests were performed to determine correlations between each perfusion parameter and MVD.

RESULTS

Mean values for PF, PED, BV and TTP of the whole tumour were 28.85 ± 20.29 ml/min/ml, 23.16 ± 8.09 HU, 12.13 ± 5.21 ml/100g, and 35.05 ± 13.85 s, respectively. Mean MVD in whole tumour at magnification (×200) was 15.75 ± 4.34 microvessel/tumour sample (vessels/0.723 mm(2)). PED and BV were correlated with MVD (r=0.651 and r=0.977, respectively, all p<0.05). However, PF and TTP were not correlated with MVD (r=0.070 and r=0.100, respectively, all p>0.05).

CONCLUSION

The BV value of first-pass perfusion CT could reflect MVD in oesophageal squamous cell carcinoma, and can be an indicator for evaluating the tumour angiogenesis.

Prediction of survival from carcinoma of oesophagus and oesophago-gastric junction following surgical resection using an artificial neural network

AIM

The aim of this study was to assess the ability of artificial neural network (ANN) in predicting survival in patients undergoing surgical resection for carcinoma of oesophagus and oesophago-gastric junction.

METHODS

From January 1995 to August 2004 patients who underwent surgery for oesophageal and gastric carcinoma were identified. Biographical data, body mass index and pathological minimal cancer dataset were used to design an ANN. Post-operative survival was assessed at 1 and 3 years. Sixty percent of data was used to train and validate the ANN and 40% was used to evaluate the accuracy of trained ANN in predicting survival. This was compared with Union Internacional Contra la Cancrum UICC TNM classification system.

RESULTS

Two hundred and sixteen patients underwent resectional surgery for oesophageal and OGJ carcinoma. The accuracy of the ANN in predicting survival at 1 and 3 years was 88% (sensitivity: 92.3%, specificity: 84.5%, DP = 2.3) and 91.5% (sensitivity of 94.61%, specificity: 88%, DP = 2.72), respectively. These figures were significantly better than 1- and 3-year survival predictions using the UICC TNM classification system 71.6% (sensitivity of 66.4%, specificity: 75.5%, and DP < 1) and 74.7% (sensitivity of 70.5%, specificity: 74.9%, DP < 1), respectively (P < 0.01) (P < 0.05).

CONCLUSION

ANNs are superior to the UICC TNM classification system in correlating with survival following resection of carcinoma of oesophagus and OG junction and can become valuable tools in the management of patients with oesophageal carcinoma.

The role of cystatin C and the angiogenic cytokines VEGF and bFGF in patients with esophageal carcinoma

Angiogenesis is the formation of new blood vessels out of the existing vascular bed. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are potent circulating angiogenic factors, whereas cystatin C is one of the most important extracellular inhibitors of several cysteine proteinases. Because proteases degrade interstitial connective tissue and basement membranes during tumor growth and metastasis, an association between cystatin C and the angiogenic factors seems plausible. The primary aim of the present study was to investigate if such a correlation exists between these serum markers. The secondary aim was to determine the prognostic value of these circulating cytokines and cystatin C, collected prior to therapy, in patients with esophageal carcinoma.A total of 42 patients with esophageal carcinoma donated serum samples prior to therapy. VEGF and bFGF were correlated to platelet and leukocyte counts and VEGF was correlated to tumor volume (p = 0.04), whereas bFGF was not (p = 0.08). VEGF was significantly correlated with cystatin C (p = 0.027). Survival analysis showed that VEGF regarded as a continuous variable was associated with a significantly poorer survival in the univariate analysis (p = 0.023); however, this was not found for bFGF (p = 0.46). Neither of the angiogenic factors were associated with survival in the multivariate analysis. In the univariate analysis, cystatin c was correlated with survival (p = 0.01), but this was not found in the multivariate analysis (p = 0.28). In conclusion, VEGF was correlated with cystatin C, possible explanations being discussed in the present article. Results of the present study indicate that use of the angiogenic factors as prognostic factors, prior to therapy in patients with esophageal carcinoma, appears limited.

Clinical significance of angiogenesis in gastrointestinal cancers: a target for novel prognostic and therapeutic approaches

OBJECTIVE

To review the current data on the prognostic and therapeutic implications of tumor angiogenesis in gastrointestinal cancers.

SUMMARY BACKGROUND DATA

Numerous studies have evaluated the prognostic value of tumor angiogenesis and the potential role of antiangiogenic therapy in various gastrointestinal cancers.

METHODS

A Medline literature search was conducted using "angiogenesis" or the names of various angiogenic factors in combination with the names of gastrointestinal cancers as the key words.

RESULTS

Several studies have demonstrated a significant prognostic impact of tumor microvessel density and tumor expression of angiogenic factors, in particular vascular endothelial growth factor (VEGF), in various gastrointestinal cancers. A few studies have suggested that circulating VEGF might be a useful prognostic marker. However, results were not consistent across all studies and were limited by the retrospective nature of most studies. Antiangiogenic therapy has been shown to be effective against all common gastrointestinal cancers in preclinical studies, but currently there are few clinical data with regard to antiangiogenic therapy in gastrointestinal cancers.

CONCLUSIONS

There is mounting evidence to suggest that assessment of tumor angiogenesis might provide a novel approach of prognostication in patients with gastrointestinal cancers. However, current results from retrospective studies need to be validated by prospective studies. Antiangiogenic therapy is a promising strategy of cancer treatment that might be particularly useful in combination therapy for unresectable cancers or as an adjuvant therapy for resectable tumors.

Clinical significance of angiogenesis in gastrointestinal cancers: a target for novel prognostic and therapeutic approaches

OBJECTIVE

To review the current data on the prognostic and therapeutic implications of tumor angiogenesis in gastrointestinal cancers.

SUMMARY BACKGROUND DATA

Numerous studies have evaluated the prognostic value of tumor angiogenesis and the potential role of antiangiogenic therapy in various gastrointestinal cancers.

METHODS

A Medline literature search was conducted using "angiogenesis" or the names of various angiogenic factors in combination with the names of gastrointestinal cancers as the key words.

RESULTS

Several studies have demonstrated a significant prognostic impact of tumor microvessel density and tumor expression of angiogenic factors, in particular vascular endothelial growth factor (VEGF), in various gastrointestinal cancers. A few studies have suggested that circulating VEGF might be a useful prognostic marker. However, results were not consistent across all studies and were limited by the retrospective nature of most studies. Antiangiogenic therapy has been shown to be effective against all common gastrointestinal cancers in preclinical studies, but currently there are few clinical data with regard to antiangiogenic therapy in gastrointestinal cancers.

CONCLUSIONS

There is mounting evidence to suggest that assessment of tumor angiogenesis might provide a novel approach of prognostication in patients with gastrointestinal cancers. However, current results from retrospective studies need to be validated by prospective studies. Antiangiogenic therapy is a promising strategy of cancer treatment that might be particularly useful in combination therapy for unresectable cancers or as an adjuvant therapy for resectable tumors.

Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research

The vascular structure of cancer changes during tumour progression. A particularly dramatic change occurs during the early phase of progression when in situ tumour is transformed to invasive cancer. Recent advances in morphological investigations have made it possible to visualise and characterise the microvascular-network alterations. In addition, laboratory studies have also revealed the molecular profile--the changing levels of expression of different proteins--of cancer progression, which has helped to advance understanding of the mechanism of carcinogenesis. In this review, we discuss recent outcomes of research of oesophageal cancer and consider the responses of the vascular network and the development of new blood vessels during the early phase of cancer progression. Such considerations will be useful not only for understanding vascular biology but also for exploring novel diagnostic, therapeutic, and preventive approaches targeting early stage or latent phase human cancer.

Validation of a modified GTNM classification in peri-junctional oesophago-gastric carcinoma and its use as a prognostic indicator

AIM

A modified GTNM classification (with additional T and N subdivisions) has been used for many years. The aim of this paper was to validate this classification in a group of patients with oesophago-gastric carcinoma and to see if the more detailed information may be useful.

METHOD

The 3-year survival of 139 consecutive patients who survived resection has been related to the individual values of the modified and international classifications.

RESULTS

A step-wise reduction in the survival was found with increasing values of G, T, N and M. The international T3 value yielded a 17.7% survival rate, when subdivided, rates of 37.5%, 17.3% and 3.2% were found. The international N1 value yielded a rate of 12.9% which subdivided into rates of 25.0%, 18.7% and 7.5%.

CONCLUSION

If these results are repeated in a larger and more detailed study, this modified classification may provide added information when discussing prognosis and management.