Research progress of CAR-T in the treatment of esophageal squamous cell carcinoma / 国际肿瘤学杂志

Chimeric antigen receptor T cell (CAR-T) therapy, an emerging immunotherapy, has achieved remarkable results in the treatment of hematologic tumors. However, it's limited in the treatment of solid tumors such as esophageal squamous cell carcinoma due to various factors. Clarifying the reasons for the limitation of CAR-T therapy and exploring the corresponding solutions can provide new ideas and insights for the treatment of esophageal squamous cell carcinoma.

Establishment and evaluation of a predictive model for clinical remission of advanced esophageal squamous cell carcinoma after neoadjuvant chemotherapy / 中国胸心血管外科临床杂志

@#Objective     To investigate the influencing factors for the clinical remission of advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy, establish an individualized nomogram model to predict the clinical remission of advanced ESCC with neoadjuvant chemotherapy and evaluate its efficacy, providing serve for the preoperative adjuvant treatment of ESCC. Methods     The clinical data of patients with esophageal cancer who underwent neoadjuvant chemotherapy (nedaplatin 80 mg/m2, day 3+docetaxel 75 mg/m2, day 1, 2 cycles, 21 days per cycle interval) in the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from February 2016 to August 2020 were analyzed retrospectively. According to the WHO criteria for efficacy assessment of solid tumors, tumors were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD). CR and PR were defined as effective neoadjuvant chemotherapy, and SD and PD were defined as ineffective neoadjuvant chemotherapy. Univariate and multivariate analyses were used to analyze the influencing factors for the short-term efficacy of neoadjuvant chemotherapy. The R software was used to establish a nomogram model for predicting of the model. C-index, calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the predictive performance of the nomogram. Results     Finally 115 patients were enrolled, including 93 males and 22 females, aged 40-75 (64.0±8.0) years. After receiving docetaxel+nedaplatin neoadjuvant chemotherapy for 2 cycles, there were 9 patients with CR, 56 patients with PR, 43 patients with SD and 7 patients with PD. Among them, chemotherapy was effective (CR+PR) in 65 patients and ineffective (SD+PD) in 50 patients, with the clinical effective rate of about 56.5%(65/115). Univariate analysis showed that there were statistical differences in smoking history, alcoholism history, tumor location, tumor differentiation degree, and cN stage before chemotherapy between the effective neoadjuvant chemotherapy group and the ineffective neoadjuvant chemotherapy group (P<0.05). Logistic regression analysis showed that low-differentiation advanced ESCC had the worst clinical response to neoadjuvant chemotherapy, moderately-highly differentiated ESCC responded better (P<0.05). Stage cN0 advanced ESCC responded better to neoadjuvant chemotherapy than stage cN1 and cN2 (P<0.05). The C-index and the area under the ROC curve of the nomogram were both 0.763 (95%CI 0.676-0.850), the calibration curve fit well, the best critical value of the nomogram calculated by the Youden index was 70.04 points, and the sensitivity and specificity of the critical value were 80.0% and 58.0%, respectively. Conclusion    The established clinical prediction model has good discrimination and accuracy, and can provide a reference for individualized analysis of the clinical remission of advanced ESCC with neoadjuvant chemotherapy and the screening of new adjuvant treatment subjects.

Meta-analysis of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To systematically evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) plus surgery versus neoadjuvant chemotherapy (NCT) plus surgery in the treatment of advanced esophageal squamous cell carcinoma.Methods:Clinical controlled trials of comparing the treatment of NCRT plus surgery with NCT plus surgery for esophageal squamous cell carcinoma were electronically searched from the databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang and VIP from the inception of databases to January, 2019. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And then, a meta-analysis was performed by using RevMan 5.3 software.Results:A total of 8 clinical control studies were included, including 995 patients with esophageal squamous cell carcinoma. Meta-analysis results showed that compared with the NCT group, the R 0 resection rate was significantly higher ( OR=2.14, 95% CI: 1.03-4.45, P=0.040) and the pathological complete response (pCR) rate was significantly higher ( OR=4.19, 95% CI: 1.71-10.28, P=0.002) in the NCRT group. The incidence of postoperative complications ( OR=1.37, 95% CI: 0.76-2.48, P=0.300) and the risk of perioperative death ( OR=1.28, 95% CI: 0.58-2.83, P=0.54) were not significantly different between two groups. The long-term survival of patients with esophageal squamous cell carcinoma in the NCRT group was significantly better compared with that in the NCT group ( HR=0.77, 95% CI: 0.64-0.92, P=0.005). Conclusions:Compared with NCT plus surgery for advanced esophageal squamous cell carcinoma, NCRT plus surgery has higher R 0 resection rate and pCR rate, does not significantly increase the risk of perioperative complications or perioperative death, and significantly improves the long-term survival of esophageal squamous cell carcinoma patients.

Several suggestions on the classification management process and countermeasures of pulmonary surgery during the COVID-19 / 中华胸心血管外科杂志

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Current status of surgical diagnosis and treatment of pulmonary malignant ground glass nodules / 中华胸心血管外科杂志

In recent years, with the development of imaging technology, more and more ground-glass Nodule (GGN) in the lungs have been discovered. After GGN is detected, it should be further judged whether it is benign or malignant by combining with existing inspection methods. Common diagnostic and examination methods include PET/CT, fiberoptic bronchoscopy, CT-guided puncture biopsy and High Resolution CT (HRCT), each of them with its own advantages and disadvantages. For GGN with high malignant risk, minimally invasive surgical intervention is needed to prevent the progress of the disease. The hot issues of surgical treatment include the selection of minimally invasive surgical methods, the precise positioning of GGN in the lung, the accuracy and limitations of intraoperative freezing examination, lymph node dissection of GGN, and postoperative follow-up of malignant GGN diagnosed as cancer. Under the premise that surgical diagnosis and treatment play an increasingly important role in the management of GGN, this paper will review the existing GGN related studies and make a summary of the surgical diagnosis and treatment of malignant GGN.

Research progress of neoadjuvant chemotherapy for esophageal squamous cell carcinoma / 中华消化外科杂志

China is a high risk region of esophageal cancer in the world,and 95％ of the esophageal cancer is the squamous cell carcinoma.Surgery is the main therapy for esophageal squamous cell carcinoma,however,the efficacy of single surgery for locally advanced esophageal squamous cell carcinoma is unsatisfactory.Compared with postoperative adjuvant treatment,neoadjuvant chemotherapy may reduce tumor volume,increase surgical resectability,eliminate subclinical metastases,prolong survival time and improve prognosis of patients with esophageal squamous cell carcinoma.Through combining recent evidence-based medicine,the authors review research progress of new adjuvant chemotherapy for esophageal squamous cell carcinoma.

Analysis of the Efficacy and Safety of Video Assisted Thoracic Surgery and Thoracic Surgery in the Treatment of Myasthenia Gravis / 现代生物医学进展

Objective:To investigate the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis.Methods:60 patients with myasthenia gravis were selected and randomly divided into two groups.The observation group(32 cases) received video assisted thoracic surgery.The control group(28 cases) received thoracic surgery.The efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis was evaluated by perioperative indexes,QMG scores before operation,after 3 months,6 months operation and complications during 6 months follow-up.Results:During the perioperative period,there was no statistical significance in the operation time between two groups(P＞0.05).The bleeding volume of observation group was less than that of the control group (P＜0.05).The drainage time,hospitalization and incision length of observation group were shorter than those of the control group (P＜0.05).Before operation,there was no statistical significance in the QMG scores.At 3 months,6 months after operation,the QMG scores were decreased in both groups.The QMG score of observation group was lower than that of the control group (P＜0.05).During 6 months' follow-up,complications were observed in 7 cases of the observation group and 17 cases of the control group,the major complication was pulmonary infection.The incidence of complications in the control group was higher than that of the observation group (P＜0.05).Conclusion:Video assisted thoracic surgery had advantages of smaller surgical incision,faster recovery and higher safety in the treatment of myasthenia gravis.

Significance of Nek8 expression in esophageal squamous cell carcinoma / 重庆医学

Objective To investigate the expression of Nek8 in esophageal squamous cell carcinoma(ESCC) tissues and cell line , and to evaluate its correlation with the clinicopathological features of ESCC and the survival rate of ESCC patients after operation . Methods The expression of Nek8 mRNA in human ESCC Eca109 cell line and two pairs of ESCC tissues and adjacent normal e‐sophageal mucosal epithelium were detected by semi‐quantitative reverse transcription polymerase chain reaction (RT‐PCR) .Immu‐nohistochemistry and tissue microarray technique were used to examine the expression of Nek 8 protein in ESCC tissues and tumor‐adjacent tissues .The correlation between Nek8 expression and clinicopathological features of ESCC and survival rate of ESCC pa‐tients was then analyzed .Results The expression of Nek8 mRNA was positive in Eca109 cells and two cases of ESCC tissue ,and it was negative in paired normal esophageal mucosal epithelium specimens .In tissue microarray ,the expression of Nek8 protein in ES‐CC tissues ,which was mainly in the cytoplasm ,was significantly higher than that in tumor‐adjacent tissues(P= 2 .16E‐13) .The high expression of Nek8 was associated with tumor size (P=0 .008) ,but not with sex ,age ,histological grade ,infiltration degree , lymph node metastasis ,and the survival rate(P>0 .05) .Conclusion The expression of Nek8 is up‐regulated in ESCC tissues and cell line ,and may be involved in tumorigenesis and development of ESCC .Nek8 could act as a potential biomarker for ESCC diag‐nose and target for therapy .

Research progress of narrow band imaging in the diagnosis of early esophageal cancer / 国际肿瘤学杂志

Early diagnosis of esophageal cancer is essential for improving both the effectiveness of esophageal cancer treatment and the prognosis of patients.As a new technology for esophageal cancer early diagnosis,narrow-band imaging (NBI) enables surgeon to clearly observe the mucosa and submucosal blood vessels changes in early esophageal cancer.It has initially shown excellent application value in the early diagnosis.In particular it has obvious advantages to the ordinary white light endoscopy which is currently used in esophageal cancer early diagnosis.If combined with Lugol iodine staining,magnifying endoscopy and other diagnostic methods in clinical,NBI will have a better value in early diagnosis of esophageal.

Anatomic Variation of the Common Palmar Digital Nerves and Arteries

Variations in the course and distribution of common palmar digital nerves and arteries are rare. A classic common palmar digital nerves and arteries are defined as concomitant. During routine dissection classes to undergraduate medical students we observed formation of each common palmar digital nerve divided into 2 or 3 branches and formed a ring enclosing the corresponding common palmar digital artery. Knowledge of the anatomical variations of the common palmar digital nerves and arteries is crucial for safe and successful hand surgery.

Evaluation of the value of 7th editions of UICC-AJCC esophageal and gastric cancer TNM staging systems for prognostic prediction of adenocarcinoma of esophagogastric junction (Siewert type II) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the value of applicability of the 7th edition of UICC-AJCC esophageal and gastric cancer TNM staging system in the prognostic prediction of adenocarcinoma of esophagogastric junction (EGJ).</p><p><b>METHODS</b>During June 1, 2007 through Dec. 31, 2010, a total of 199 patients with adenocarcinoma of esophagogastric junction (Siewert type II) underwent R0-intent resection from June 1, 2007 to Dec 31, 2010 in our hospital. Their clinicopathological and survival data were retrospectively analyzed with Kaplan-Meier and Cox regression models. They were restaged according to the 7th edition of UICC/AJCC TNM stage systems for esophageal adenocarcinoma and gastric cancer, respectively. Then the likelihood ratio chi-square test related to the Cox regression model and Akaike information criterion (AIC) were used for measuring goodness of fit for both staging systems.</p><p><b>RESULTS</b>199 patients with Siewert type II esophagogastric junction adenocarcinoma were identified in this study. Out of them, there were 162 males and 37 females. Their age range was from 38 to 79 years, with a median age of 62 years. 176 cases underwent transthoracic surgery, and other 23 cases underwent transabdominal surgery. TNM-EC and TNM-GC classified 4 patients to stage T1, 39 to T2, 139 to T3, and 17 to T4a, respectively, and classified 76 patients to stage N0, 58 to N1, 49 to N2, 16 to N3, respectively. The median follow-up period was 30 months. The 1-, 3-, and 5-year survival rates were 95.0%, 52.7% and 39.2%, respectively. Univariate analysis indicated that age at surgery (P = 0.009), surgical approach (P = 0.002), cell differentiation (P = 0.030), preoperative co-morbidity implications (P = 0.026), depth of tumor invasion (P < 0.001) and number of metastatic lymph nodes (P < 0.001) were significantly influencing factors of postoperative overall survival. Multivariate analysis showed that the independent prognostic factors for adenocarcinoma of esophagogastric junction were only T stage, N stage and preoperative co-morbidity and morbidities according to the 7th edition of esophageal cancer or gastric cancer TNM staging systems. The AIC value was 961.4 for the 7th edition of esophageal adenocarcinoma caner staging system, and 965.7 for the 7th edition of gastric cancer staging system.</p><p><b>CONCLUSIONS</b>The UICC/AJCC 7th edition of esophageal adenocarcinoma cancer TNM classification staging system is superior to the 7th edition of gastric cancer TNM staging system for adenocarcinoma of esophagogastric junction.</p>

The TNM staging for adenocarcinoma of the esophagogastric junction(Siewert Ⅱ) : Should the 7th or 6th edition of UICC-AJCC esophageal TNM classification be used / 中华胸心血管外科杂志

Objective To compare the applicability of the 7th and 6th editions of the UICC-AJCC esophageal cancer TNM staging systems for adenocarcinoma of esophagogastric junction (EGJ).Methods During June 2007 through December 2010,199 patients with EGJ adenocarcinoma(Siewert type Ⅱ) underwent R0-intent resection in our hospital.Their clinicopatholigical and survival data were retrospectively analyzed with Kaplan-Meier and Cox regression models.They were restaged according to the 7th and 6th UICC/AJCC TNM staging systems for esophageal cancer,respectively.Then the Akaike information criterion(AIC) was used for measuring goodness of fit of both staging systems.Results Among 199 patients,there were 162 males and 37 females.Univariate analysis indicated that age(P =0.009),surgical approach(P =0.002),cell differentiation (P =0.030),preoperative co-morbidity (P =0.026),depth of tumor invasion (P ＜ 0.000) and number of metastatic lymph nodes(P ＜ 0.000) were significant influencing factors on overall survival.Multivariate analysis demonstrated that the independent prognostic factors for EGJ adenocarcinoma were age,T stage,N stage and preoperative co-morbidity according to the 6th edition of esophageal cancer TNM staging system,and only T stage,N stage and preoperative co-morbidity according to the 7th edition of esophageal cancer TNM staging system.The AIC value was 961.4 for the 7th edition of esophageal cancer staging system and 972.4 for the 6th edition.Conclusion The 7th edition of UICC/AJCC esophageal cancer TNM classification is su perior to its 6th edition of esophageal cancer staging system for EGJ adenocarcinoma.

Surgical treatment of esophagogastric junction adenocarcinoma / 国际肿瘤学杂志

There are a variety of surgical treatments of advanced esophagogastric junction cancer,type Ⅰ 、Ⅱ mainly by transthoracic approach,part of the type Ⅱ by transabdominal approach,type Ⅲ mainly by left thoracoabdominal approach (LTA) or transabdominal.Intraoperative lymph node dissection is one of the most important factors which affect the postoperative survival rate.The cardia right lymph node (NO.1),the cardia left lymph node (NO.2),gastric lesser curvature (NO.3) and left gastric artery side (NO.7) should do regular cleaning.

Lymphatic vessel density of esophageal adenocarcinoma and its clinical significance / 中华消化外科杂志

Objective To investigate the differences on lymphatic vessel density (LVD) among esophageal adenocarcinoma (EAC),esophageal squamous cell carcinoma (ESCC) and normal esophageal tissues,and analyze the clinical significance.Methods Twenty samples of EAC,24 samples of ESCC and 20 cases of normal esophageal tissues were obtained at the Affiliated Hospital of North Sichuan Medical College from January 2004 to January 2011.D2-40 was used for immunostaining of lymphatic vessels in EAC,and antibodies of D2-40 and Ki-67 were used together to detect proliferation of lymphatic vessels.The differences in the LVD among EAC,ESCC and normal esophageal tissues were analyzed.All data were analyzed using the analysis of variance or t test.Results D2-40 staining could identify the lymphatic vessels,and antibodies of D2-40 and Ki-67 could detect the proliferation of lymphatic vessels.The LVD of EAC,ESCC and normal esophageal tissues were (3.3 ± 1.7)/0.17 mm2,(4.6 ± 1.2)/0.17 mm2 and (3.8 ± 1.2)/0.17 mm2,respectively,with significant differences (F =5.44,P ＜0.05).The LVD of EAC was significantly lower than that of ESCC (t =3.074,P ＜ 0.05),while there was no significant difference in the LVD between the EAC and normal esophageal tissues (t =-1.022,P ＞ 0.05).There were significant differences in the LVD between the ESCC and normal esophageal tissues (t =2.395,P ＜ 0.05).There were significant differences in the LVD between EAC patients with deglutition discomfort and those with pain (t =3.092,P ＜ 0.05).There were significant differences in the LVD between EAC patients with course ＜6 months and those with course≥6 months (t =3.092,P ＜ 0.05).No statistical difference in clinicopathological parameters including gender,age,site of lesion,tumor diameter,pathological morphology,T stage,N stage,G stage,TNM clinical stage and lymph node metastasis were detected (t ＝ 1.130,1.020,F =0.082,t =0.799,F =0.692,t =0.694,1.820,0.353,0.969,0.969,P ＞ 0.05).Conclusions The LVD of EAC is lower than that of ESCC,but is similar to that of normal esophageal tissues.The LVD of EAC is correlated with the symptoms and course of patients.