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.

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.

Perioperative nutrition support for esophageal cancer complicated with diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy between perioperative enteral and parenteral nutrition support for esophageal cancer patients complicated with diabetes mellitus.</p><p><b>METHODS</b>Thirty esophageal cancer patients complicated with diabetes mellitus between September and November 2012 were prospectively enrolled in this trial. According to random number table, 30 cases were randomly divided into enteral group (n=15) and parenteral group (n=15). During the period between 3 days before operation and 8 days after operation, patients received enteral nutrition (AnSure) and parenteral nutrition support respectively. The daily dynamic monitoring of blood glucose was performed. Nutritional indexes (albumin and prealbumin) were evaluated 1-day before operation and 8-day after operation. Postoperative recovery time of gastrointestinal function and complications associated with nutritional support were observed. The cost of nutritional support was calculated.</p><p><b>RESULTS</b>Patients in the two groups achieved satisfactory perioperative blood glucose control. Finger tip blood glucose was 5.0-9.0 mmol/L before meal, 7.0-10.0 mmol/L 2-hour after meal, and 4.0-8.0 mmol/L at 10 PM and 3 AM. No hypoglycemia (<3.5 mmol/L) was found in all the patients. The time to first flatus after surgery was (62.4±15.7) in the enteral group, significantly earlier than (90.8±22.4) h in the parenteral group (P<0.01). Postoperative nutritional indices and associated complications were not significantly different between two groups (all P>0.05). Cost in the enteral group was significantly lower than that in the parenteral group [(650.8±45.8) RMB vs. (3016.5±152.6) RMB, P<0.01].</p><p><b>CONCLUSION</b>Perioperative nutrition support can effectively control blood glucose and improve perioperative nutritional status simultaneously for esophageal cancer patients with diabetes mellitus. Compared with parenteral nutrition, enteral nutrition can accelerate the recovery of gastric bowel function and reduce the cost of nutritional support.</p>

Effect of PC cell-derived growth factor RNA interference on biological behavior of esophageal squamous carcinoma cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of PC cell-derived growth factor (PCDGF) RNA interference on esophageal squamous carcinoma cells Eca-109 in vitro.</p><p><b>METHODS</b>The PCDGF-shRNA expression vector was transfected into the Eca-109 cells by liposome. After transfection, the mRNA and protein expressions of PCDGF were detected by RT-PCR and Western-blot respectively. Cell Counting Kit-8 (CCK-8) assay and Boyden chamber method were performed to measure the cell proliferation and invasion ability respectively.</p><p><b>RESULTS</b>The expression levels of PCDGF mRNA and protein were both decreased in Eca-109 cells transfected with PCDGF-shRNA expression vector (transfection group). Twenty-four, 48 and 72 h after transfection, the cells proliferation in the transfection group was inhibited, and the inhibition rate was 20.4%, 21.1% and 20.9% respectively. The cell proliferation activity in the transfection group was significantly lower than that in the non-transfection group, liposome group and negative vector group (all P<0.05). The number of cell migration in the non-transfection group,negative vector group, liposome group and transfection group was 118.8±12.0, 100.8±9.0, 114.3±4.7, and 53.5±16.3 respectively. The differences were statistically significant between the transfection group and the other 3 groups (all P<0.05).</p><p><b>CONCLUSIONS</b>PCDGF RNA interference can inhibit the proliferation and invasion abilities of esophageal squamous carcinoma cells in vitro. PCDGF gene may be the new target of gene therapy.</p>

Study of different enteral nutrition formulation treatment after esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficiency of different early enteral nutrition (EN) with Ensure, Nutrison, and Peptison in postoperative patients with esophageal carcinoma.</p><p><b>METHODS</b>A total of 45 postoperative patients with esophageal carcinoma were randomly divided into three groups using random digit table: Ensure group (n=15), Nutrition group (n=15), and Peptison group (n=15). Enteral nutrition was given using nasogastric tube from the 2nd postoperative day for 8 days. Albumin and prealbumin were detected on the day before surgery and postoperative day 9 after fasting. The time to gastrointestinal tract function recovery, complications, and the cost of enteral nutrition were compared among the three groups.</p><p><b>RESULTS</b>There were no significant differences in postoperative nutrition indices(albumin and prealbumin) and EN-related complications among the three groups(all P>0.05). The time to gastrointestinal tract function recovery in Ensure group [(52.4±15.7) h] and Nutrison group [(50.8±12.4) h] was less than that in Peptison group [(60.3±16.8) h] (P<0.05). The expense of Ensure group [(443.3±45.8) RMB] was obviously less than that of Nutrison group[(639.5±52.6) RMB] and Peptison group [(990.5±95.5) RMB](both P<0.01).</p><p><b>CONCLUSIONS</b>Ensure, Nutrison and Peptison can be used for postoperative early enteral nutrition in patients with esophageal carcinoma, and the efficacy and complication are comparable. The cost of Ensure is the lowest.</p>

Clinical application of minimally invasive esophagectomy for esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of minimally invasive esophagectomy (MIE) for esophageal carcinoma.</p><p><b>METHODS</b>Clinical data of 298 esophageal carcinoma cases who were treated by MIE in the Fujian Provincial Cancer Hospital from June 2008 to April 2012 were retrospectively reviewed.</p><p><b>RESULTS</b>All the patients underwent MIE successfully except one conversion to open surgery. The mean operative time was (242.3±58.7) min. The postoperative length of hospital stay was (17.4±9.8) d. The number of harvested lymph nodes of total, the mediastinum, the abdomen and the cervix was 27.5±12.2, 10.7±5.7, 13.3±7.8, and 7.7±8.1, respectively. Postoperative complication rate was 29.9%, including pneumonia (n=41), recurrent laryngeal nerve injury (n=25), anastomotic leak (n=9), wound infection (n=7), and others (n=7). After follow up of 2 to 47 months, 3 patients were found to develop anastomotic stricture. There were no recurrence, metastasis, or death.</p><p><b>CONCLUSION</b>Minimally invasive esophagectomy is a safe, feasible, effective and minimally invasive surgical technique.</p>

Diagnostic accuracy research of needle puncture biopsy during operation for pulmonary single nodules / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic accuracy of needle puncture biopsy and pathological examination of frozen during operation for pulmonary nodules, and whether this diagnostic method can replace tumor resection examination.</p><p><b>METHODS</b>Totally 50 patients (28 males and 22 females, average age was 59 years) who had the single nodule after imaging examination without any pathological diagnostic from January to October 2010 were selected in this research work. During open operation or video assisted thoracic surgery, needle (14 G model) was used to puncture biopsy for pathological examination of frozen. All the adverse events during puncture biopsy would be recorded. The resection specimens would be accepted paraffin pathological examination. The relationship between puncture frozen pathological and paraffin pathological examination was analyzed.</p><p><b>RESULTS</b>All tumor sizes were ranged from 1.0 cm × 0.6 cm to 5.6 cm × 9.0 cm. The paraffin pathological examination after operation as the golden standard, there were 7 cases of benign tumor and 43 cases of malignant tumor. The diagnostic sensitivity of puncture biopsy was 90.7%, the specificity was 100%, the positive predictive value was 100% and the negative predictive value was 63.6%. There were 11 cases of benign tumor diagnosed by needle puncture biopsy, among which 4 cases were proved as malignant tumor by paraffin pathology, and the false negative rate was 9.3%. The main risk of puncture biopsy was bleeding after puncture immediately, and the rate was 4.0% (2/50).</p><p><b>CONCLUSIONS</b>The puncture biopsy during operation had a high specificity for malignant lung tumor, and there was a certain false negative rate for benign tumor. Puncture biopsy and pathological examination of frozen tissue can replace tumor section biopsy in a way.</p>