Advances of immunotherapy-related biomarker in esophageal carcinoma / 中华胃肠外科杂志

Esophageal carcinoma is one of the most common malignant tumors in the world, with incidence and mortality rankings of 7th and 6th, respectively. In recent years, immunotherapy represented by immune checkpoint inhibitors of programmed death-1 and programmed death ligand 1 (PD-L1) has been introduced into clinical practice and has changed the treatment status of esophageal cancer. Although immunotherapy has provided long-term survival benefits for patients with advanced esophageal cancer and high pathological response rates in the neoadjuvant therapy, only a few of the patients have satisfactory therapeutic outcomes. Therefore, effective biomarkers for predicting immunotherapeutic effects are urgently needed to identify those patients who could benefit from immunotherapy. In this paper, we mainly discuss recent research advances of biomarkers related to the immunotherapy of esophageal cancer and the clinical application prospects of these biomarkers.

Optimization of perioperative treatment strategies for locally advanced esophageal squamous cell carcinoma from the perspective of tumor heterogeneity / 中华胃肠外科杂志

Recent advances in multimodality treatment offer excellent opportunities to rethink the paradigm of perioperative management for locally advanced esophageal squamous cell carcinoma. One treatment clearly doesn't fit all in terms of a broad disease spectrum. Individualized treatment of local control of bulky primary tumor burden (advanced T stage) or systemic control of nodal metastatic tumor burden (advanced N stage) is essential. Given that clinically applicable predictive biomarkers are still awaited, therapy selection guided by diverse phenotypes of tumor burden (T vs. N) is promising. Potential challenges regarding the use of immunotherapy may also boost this novel strategy in the future.

Oligometastatic and oligoprogressive esophageal squamous cell carcinoma:clarifying conceptions and surgery perspectives / 中华外科杂志

The oligometastatic and oligoprogressive state has been a hot issue in cancer research. Its indolent tumor behavior, representing a novel therapeutic opportunity, has been identified as a clinical subtype in several malignancies. However, the clinical implications of the oligometastatic and oligoprogressive state in esophageal squamous cell carcinoma (ESCC) have not been thoroughly elucidated. There are still controversies regarding the existence of the oligometastatic state in ESCC, if the solitary regional lymph node metastasis should be viewed as oligoprogressive disease after esophagectomy, and the role of surgery and radiotherapy in ESCC oligometastatic disease. Despite many exciting contributions to the literature on these, further exploration is warranted. Thus, fostering the advance of research and scientific knowledge on the biological and prognostic characteristics scrupulously would facilitate personalizing treatment strategy for better outcomes.

Efficacy analysis of comprehensive treatment in small cell esophageal carcinoma following resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical outcome of patients with small cell esophageal carcinoma(SCEC).</p><p><b>METHODS</b>Clinical data of patients with esophageal carcinoma were retrospectively collected from March 2000 to March 2011 at the Thoracic Surgery Department of the Peking University Cancer Hospital. Data included tumor characteristics, staging, treatment, response, short-term outcome, and long-term survival.</p><p><b>RESULTS</b>A total of 546 patients with esophageal carcinoma were identified, among whom there were 15 patients with SCEC(2.7%). Fourteen cases received multimodality treatment based on operation and one underwent operation alone. Four patients had preoperative chemotherapy and 10 had postoperative chemotherapy. Four patients had postoperative radiation. After excluding one case of postoperative death within 3 months, the median overall survival was 14.3 months(range, 4 to 99 months), significantly worse than those with non-SCEC(42.2 months, P<0.05).</p><p><b>CONCLUSION</b>SCEC is rare and the outcomes are poor. It should be considered as a systematic disease.</p>

Impact of early enteral nutrition on the intestinal motility of patients after esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the impact of early enteral nutrition (EN) on the intestinal motility of patients after esophagectomy.</p><p><b>METHODS</b>Thirty-five consecutive patients undergoing esophagectomy for esophageal cancer by a single surgical team from the Peking University Cancer Hospital from June 2011 to July 2011 were enrolled. Patients were randomly divided into EN group (n=20) and parenteral nutrition group (control group, n=15) within 24 h after esophagectomy procedure. Bowel sound recovery time was monitored by auscultation, and the gastrointestinal tract symptoms were recorded.</p><p><b>RESULTS</b>Bowel sound recovery time was (45.1±20.3) h in the EN group, and was (56.7±17.0) h in the control group (P=0.082). Gastrointestinal symptoms such as nausea, abdominal distension, diarrhea occurred in 4 patients in EN group and 3 patients in control group and were alleviated by lowering infusion speed and more off-bed ambulation, and no significant difference was seen between the two groups (P=1.000).</p><p><b>CONCLUSIONS</b>Early enteral nutrition in the patients after esophagectomy is safe and feasible. Early enteral nutrition does not delayed bowel function recovery or increase gastrointestinal symptoms.</p>

Long-term efficacy of transhiatal esophagectomy for esophageal carcinoma and esophagogastric junction cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term efficacy of transhiatal esophagectomy (THE) for esophageal carcinoma or esophagogastric junction cancer.</p><p><b>METHODS</b>Between March 2000 and December 2009, a total of 544 patients with either esophageal carcinoma or esophagogastric junction cancer underwent esophagectomy via THE (n=63) or other approaches (n=481) in Beijing cancer hospital institution. Procedures were performed by a single surgeon team. Long-term survival was compared between two groups.</p><p><b>RESULTS</b>The 1-year, 3-year, 5-year, and 8-year accumulative survival rates in THE group were 91.0%, 60.5%, 44.6%, and 44.6%, respectively, while those in non-THE group were 84.5%, 49.2%, 37.2%, and 28.7%, respectively. The THE group showed better long-term survival than the non-THE group, however the difference was not statistically significant.</p><p><b>CONCLUSION</b>THE is a safe alternative for esophageal carcinoma and esophagogastric junction cancer.</p>