Long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions.</p><p><b>METHODS</b>One-hundred and seventy-one cases with early esophageal cancer (intramucosal carcinoma) and precancerous lesions were treated by APC from 1994 to 2005, and all the cases were followed up. One-hundred and sixty-eight (98.2%) cases were follow-up by endoscopic examination for several times. On average, each patient was endoscopically examined 2.8 times. The follow-up rate was 100%.</p><p><b>RESULTS</b>The precancerous lesion group had 160 patients. They were followed up for 5 years. 11 patients died of causes unrelated to cancer. The lesions developed into esophageal squamous cell carcinoma in five patients ( 2 died and 3 underwent esophagectomy). The remaining 144 cases survived without cancer. In this group, the esophageal cancer incidence rate is only 3.1% (5/160). The early cancer (i.e. intramucosal cancer) group had 11 patients. During the 5-year follow-up period, two patients died of causes unrelated to cancer,six patients had recurrence (4 patients died and 2 patients underwent esophagectomy), and only 3 patients survived without cancer. Therefore, the 5-year survival rate was only 27.3% (3/11).</p><p><b>CONCLUSIONS</b>The APC therapy for precancerous lesions of the esophagus is effective and successful. Indications should be carefully considered when treating early esophageal cancer such as intramucosal carcinoma by APC therapy.</p>

A prospective study of the origin of esophageal squamous cell carcinoma in the esophageal mucosa:result from a high risk area of esophageal cancer in China during a 15-year follow up (1987 - 2002) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to observe the association between the occurrence of esophageal cancer lesions and esophageal mucosa fold (white ridges), and further identify where is the initial origin of esophageal cancer lesions in the esophagus mucosa.</p><p><b>METHODS</b>This was a cohort study which recruited 551 subjects underwent endoscopic examination in a high risk area of esophageal cancer in Linxian, Henan Province in 1987. 339 subjects with esophageal white ridges, and with red area or erosion lesion at the surface of the white ridges, was studied as exposure group. Other 212 subjects whose esophagus had no white ridges and pathological diagnosis was negative, was studied as control group. The endpoint was occurrence of pathologically confirmed esophageal cancer. After a 15-year follow-up, the results were compared between two groups.</p><p><b>RESULTS</b>Among the 551 subjects, there were 339 cases with esophageal mucosal white ridges in the exposure group. During the period of 15 year follow-up, the incidence of esophageal cancer was 11.8% (9/76) in 76 case with simple mucosal white ridges, 33.5% (88/263) in 263 subjects with white ridges and red area, or erosions on the surface of white ridge. While only 8.0% of subjects (17/212) developed esophageal cancer after the 15-year follow up in the control group. There was a significant difference between the two groups (P < 0.001).</p><p><b>CONCLUSION</b>Esophageal mucosal white ridge, especially white ridge with red area or erosions is closely associated with subsequent esophageal cancer occurrence in the esophageal cancer high risk area in China. It is suggested that esophageal mucosa with white ridge may be the initial origin of esophageal cancer. Further investigations focused on this spot are required.</p>

Natural progression of early esophageal squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The survival time of untreated advanced esophageal squamous cell carcinoma is about 8 - 9 months. The objective of this study was to observe the natural progression of untreated early esophageal squamous cell carcinoma for 20 years.</p><p><b>METHODS</b>4800 subjects from a high risk area of esophageal cancer in Lin-zhou city, Henan province, were examined by endoscopy from 1985 to 1990. Among them, 132 cases were diagnosed as early esophageal cancer. Based on the criteria, the lesions were endoscopically diagnosed as superficial mucosal lesions and histopathologically confirmed by biopsy as carcinoma in situ, intramucosal carcinoma or squamous cell carcinoma. 48 of the 132 patients, who refused treatment, were followed up to the end of 2005. There were 43 death and 5 alive. 40 patients were re-examined for 1 - 4 times by endoscopy during the following up.</p><p><b>RESULTS</b>A total of 48 patients have been followed up for 20 years. 38 (79.2%) cases died of esophageal squamous cell carcinoma, 5 (10.4%) died of non-cancer diseases and 5 (10.4%) were surviving. 37 patients had survived for over 5 years. The 5-, 10-, 15- and 20-years survival rates were 77.1%, 39.6%, 25.0% and 10.4%, respectively.</p><p><b>CONCLUSION</b>The natural history of esophageal squamous cell carcinoma takes a long time to progress from early to advanced stage. It is very helpful for early diagnosis and selection of opportunity for treatment. The leading time bias by natural history of this disease should be considered when evaluate therapeutic effect on early stage esophageal cancer.</p>

A comparative study of endoscopic image stained by iodine and histopathology in early esophageal cancer and precancerous lesions (dysplasia) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study is to evaluate the relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis.</p><p><b>METHODS</b>A balloon cytological screening was conducted in 4000 participants in high-risk area of esophageal cancer in 1997-1998, 1050 out of these 4000 participants were confirmed as abnormal by cytology. Among them, 867 were given endoscopy examination during which mucosal stain with 1.2% iodine solution was used. The stain images were graded as four categories: Grade 1, dark yellow, protruding inlay-like with clear borders and showing pink after discoloration; Grade 2, between grade 1 and grade 3; Grade 3, light yellow, flat lesion with clear but not sharp borders and Grade 4, dark-brown color. According to the above criteria, the lesions were recorded and graded after the examination. The biopsies were taken from the unstained lesions and underwent pathologic evaluation. A comparison between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis was evaluated. The correlation coefficient was estimated using Spearman's Rank Correlation.</p><p><b>RESULTS</b>94.4% (68/72) of the superficial carcinoma and severe dysplasia, 61.8% (73/118) of moderate dysplasia and 27.7% (35/126) of mild dysplasia were distributed in the grade 1 and grade 2 of iodine stain images of which the patterns conforming to the principle and rule of formation of the image by iodine stain.</p><p><b>CONCLUSION</b>There is close relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis. The magnitude of exposure of the malignant tissue is the pathologic basis of formation of various images by iodine stain. Iodine stain greatly helps of early detection of esophageal cancer.</p>