Prognostic Impact of Pretreatment Serum CYFRA Status in 1047 Patients with Esophageal Squamous Cell Carcinoma Who Underwent Radical Resection: A Japan Esophageal Society Promotion Research

The role of squamous cell carcinoma antigen and cytokeratin 19 fragment in predicting the outcome of esophageal cancer patients: insights from a meta-analysis

BACKGROUND

The accurate prognostication and recurrence monitoring of esophageal cancer (EC) are pivotal yet challenging. Despite the promising roles of squamous cell carcinoma antigen (SCC) and cytokeratin 19 fragment (CK19 Fragment) as cancer biomarkers in EC, their prognostic value remains unquantified. This meta-analysis is the first to quantitatively assess the relationship between serum levels of SCC and CK19 Fragment and EC prognosis, aiming to bridge this knowledge gap.

METHODS

We conducted a comprehensive and systematic literature search across PubMed, Web of Science, Cochrane Library, and Embase databases, and Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and other survival outcomes were extracted and analyzed using random-effects or fixed-effects models depending on heterogeneity among the studies.

RESULTS

7309 patients from 29 studies were finally included in this meta-analysis. The quantitively summarized data revealed that elevated level of SCC and CK19 Fragment in serum was significantly correlated to poorer prognosis of EC patients with the pooled HR of OS was 1.25 (95%CI: 1.04-1.50, P < 0.05) and 1.69 (95%CI: 1.25-1.27, P < 0.05), respectively. Subgroup analyses indicated that the prognostic value of these biomarkers varied across different patient populations and treatment modalities.

CONCLUSION

This meta-analysis demonstrated that SCC and CK19 Fragment levels in serum were both strong prognostic biomarkers of EC patients. The elevated level of SCC and CK19 Fragment in serum was significantly associated with worse survival outcomes, advocating for the integration of these biomarkers into prognostic assessments to improve decision-making processes in the management of EC.

REGISTRATION NUMBER

CRD42022311617.

Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data

Esophagectomy for esophageal cancer is a highly invasive gastrointestinal surgical procedure. The National Clinical Database (NCD) of Japan, initiated in 2011, has compiled real-world data on esophagectomy, one of nine major gastroenterological surgeries. This review examines outcomes after esophagectomy analyzed using the Japanese big databases. Certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) have shown that institutional certification has a greater impact on short-term surgical outcomes than surgeon certification. Minimally invasive esophagectomy has emerged as a viable alternative to open esophagectomy, although careful patient selection is crucial, especially for elderly patients with advanced tumors. The NCD has significantly contributed to the assessment and enhancement of surgical quality and short-term outcomes, while studies based on Comprehensive Registry of Esophageal Cancer in Japan (CRECJ) have provided data on patient characteristics, treatments, and long-term outcomes. The JES has conducted various questionnaire-based retrospective clinical reviews in collaboration with authorized institutions certified by JES. The Diagnosis Procedure Combination (DPC) database provides administrative claims data including itemized prices for surgical, pharmaceutical, laboratory, and other inpatient services. Analyzing these nationwide databases can offer precise insights into surgical quality for esophageal cancer, potentially leading to improved treatment outcomes.

Prognostic Impact of Serum SCC Antigen in the 566 Upfront Surgery Group of Esophageal Squamous Cell Carcinoma: A Multi-Institutional Study of the Japan Esophageal Society

PURPOSE

This study aimed to determine the clinicopathologic and prognostic significance of squamous cell carcinoma antigen (SCC-Ag) in patients with esophageal SCC who underwent radical surgery without neoadjuvant therapy.

METHODS

This study included 566 patients with primary esophageal SCC who underwent radical resection without neoadjuvant therapy at 15 Japanese hospitals between 2008 and 2016. The cutoff value of SCC-Ag was 1.5 ng/mL based on the receiver operating characteristic curves. Preoperative SCC-Ag and postoperative SCC-Ag were analyzed to evaluate clinicopathological and prognostic significance. Survival curves were compared between the SCC-Ag-positive group and the SCC-Ag-negative group. The prognostic impact of SCC-Ag was evaluated using univariate and multivariate analyses.

RESULTS

The preoperative SCC-Ag-positive rate was 23.5% (133/566). SCC-Ag-positive status was significantly associated with old age (p = 0.042), tumor depth (p <0.001), and tumor stages (p <0.001). The preoperative SCC-Ag-positive group had significantly poorer overall survival than the SCC-Ag-negative group (p = 0.030), but it was not an independent predictor of poor prognosis. Postoperative SCC-Ag-positive status was an independent risk factor for poor overall survival (p = 0.034).

CONCLUSION

Both pre- and postoperative SCC-Ag-positive statuses were significantly associated with poor prognosis. Postoperative SCC-Ag-positive status was an independent risk factor for predicting overall survival.

Is High Score of Preoperative Lactate Dehydrogenase to Albumin Ratio Predicting Poor Survivals in Esophageal Carcinoma Patients?

PURPOSE

The lactate dehydrogenase-to-albumin ratio (LAR) has been reported as a potential prognostic biomarker in various cancers; however, only a few pieces of information have been reported on esophageal cancer. Therefore, this study aimed to evaluate the prognostic significance of preoperative LAR in patients with esophageal cancer.

METHODS

This study included 236 patients (193 men and 43 women; mean age of 66 years [range, 41-83 years]) with esophageal cancer who underwent curative surgery between September 2008 and March 2020. A total of 107 patients underwent upfront surgery, and 129 patients received neoadjuvant treatment. Patients were assigned into two groups, high and low LAR, based on preoperative LAR using a cutoff value of 6.2. The clinicopathological and prognostic significance of preoperative LAR was evaluated in univariate and multivariate analyses.

RESULTS

Patients with deep tumors and neoadjuvant treatment were significantly associated with high LAR (p <0.05). The high LAR group showed a significantly poorer prognosis than the low LAR group (p <0.01). The multivariate analysis for the overall survival showed that deep tumors, lymph node metastasis, and high LAR were independent poor prognostic factors (p <0.05).

CONCLUSION

High LAR was a useful poor prognostic biomarker in patients with esophageal cancer.