The Prognostic Impact of Heat Shock Proteins Expression in Patients with Esophageal Cancer: A Meta-Analysis

PURPOSE: Heat shock proteins (HSPs) are highly conserved molecular chaperones. There are various studies that assess the prognostic value of HSPs in patients with esophageal cancer, but the conclusion remains controversial. This is the first meta-analysis study aiming to summarize the evidence on the suitability of HSPs to predict patients' survival. MATERIALS AND METHODS: Searching PubMed, Web of science and Medline until May 31, 2014, data were compared for overall survival in patients with down-regulated HSPs level with those with up-regulated level. We conducted a meta-analysis of 9 studies (801 patients) that correlated HSPs levels with overall survival. Data were synthesized with hazard ratios (HRs). RESULTS: The estimated risk of death was 2.93-fold greater in HSP27 negative patients than HSP27 positive patients [95% confidence interval (CI), 1.12-7.62]. When limited to esophageal squamous cell carcinoma (ESCC), the risk of death in HSP27 negative patients seemed more significant (HR, 3.90; 95% CI, 2.35-6.49). Decreased expression of HSP70 was also associated with worse survival in esophageal cancer (HR, 2.83; 95% CI, 1.90-4.23) and, when limited to ESCC, HR was 3.21 (95% CI, 1.94-5.30). Data collected, however, were not sufficient to determine the prognostic value of HSP90 in patients with ESCC nor esophageal adenocarcinomas (EADC). CONCLUSION: In this meta-analysis, reduced HSP27 and HSP70 expressions were associated with poor survival in patients with esophageal cancer, especially esophageal squamous cell carcinoma.

A prospective comparison between surgery alone and postoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the role of postoperative chemoradiotherapy (CRT) as a multimodality treatment option for locally advanced thoracic esophageal squamous cell carcinoma (ESCC) by a prospective comparison between surgery alone and postoperative CRT.</p><p><b>METHODS</b>Using preoperative computed tomography (CT)-based staging criteria, 158 patients with ESCC (stage II-III) were enrolled in this prospective study. With informed consent, the patients were randomized into two groups: postoperative CRT (78 cases) and surgery alone (S, 80 cases). After a few minor adjustments to the enrolled patients, the actual patients of postoperative CRT group and S group were 74 cases and 77 cases, respectively. Comparison of the complications, local recurrence rate, distant metastasis rate, survival rate and progression-free survival in the two groups was carried out.</p><p><b>RESULTS</b>With a median follow-up of 37.5 months, the 1-, 3-, 5-, 10-year overall survival (OS) rates were 91.0%, 62.8%, 42.3%, 24.4% and 87.5%, 51.3%, 33.8%, 12.5% for the postoperative CRT and S arm, respectively. A significant difference in OS was detected between the two arms (P = 0.0276). There was a significant difference of progression-free survival (PFS) between the two arms (P = 0.0136). The local recurrence rates in the postoperative CRT group and S group were 14.9% and 36.4%, respectively (P < 0.05). No significant difference was detected between the complications of the two groups (P > 0.05). Toxicities of chemoradiotherapy in the postoperative CRT arm were moderate, which can be relieved rapidly by adequate therapy.</p><p><b>CONCLUSION</b>Rational application of postoperative chemoradiotherapy can provide a benefit in progression-free survival and overall survival in patients with locally advanced esophageal squamous cell carcinoma.</p>

Operation combined with (125)I radioactive seeds implantation therapy on advanced esophageal squamous cell carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the united intraoperative (125)I seed implantation as a treatment option for thoracic advanced esophageal squamous cell carcinoma (ESCC).</p><p><b>METHODS</b>From January 2000 to August 2004, according to preoperative CT staging criteria, 298 patients in phase II to III of ESCC had been enrolled in this prospective study. With informed consent, they were randomized into two groups: intraoperative (125)I seed implantation (group A) and surgery alone (group B). With 0.5 mCi of single seed, total activity in 10 to 30 mCi, matched peripheral dose in 60 to 70 Gy, 20 to 40 (125)I seeds were implanted into the target under direct vision in accordance with treatment planning system. The post-operative complications were observed. The validation and quality assessment of radioactive seeds were demonstrated according to CT scan or X imaging. The short-term efficacy was evaluated according to WHO criteria. The 1-, 3-, 5-, and 7-year survival rate were followed up.</p><p><b>RESULTS</b>On the close date of August 31st 2008, the satisfied quality assessment of (125)I seeds was observed. There was no displacement or loss of seed. The local recurrence rates in the group A and group B were 14.9% and 38.7%, respectively, which were statistically significant (P < 0.05). The complete response and partial response rate in the group A was 78.8%. It was significantly higher than 30.3% in the group B (P < 0.05). There was no statistical difference among groups when comparing the complications (P > 0.05). The 1-year survival rates were no statistical difference among the two groups. However, the 3-, 5-, and 7-year survival rates in group A (64.0%, 42.7%, and 25.1%) were statistically different from that in the B group (52.0%, 34.5%, and 12.6%) (P < 0.05).</p><p><b>CONCLUSIONS</b>It is safe, effective and simple application about the intraoperative (125)I seed implantation for advanced ESCC. It may reduce the local recurrence rate and improve survival.</p>