The number of lymph node metastases influences survival and International Union Against Cancer tumor-node-metastasis classification for esophageal squamous cell carcinoma.

To study the influence of the number of metastatic lymph nodes (LNs) on survival and International Union Against Cancer tumor-node-metastasis (TNM) classification for esophageal carcinoma. The clinicopathological data on 1146 patients with esophageal squamous cell carcinoma who had undergone an esophagectomy were retrospectively studied. Survival was analyzed by the Kaplan-Meier method. By subclassifying the nodes (N) category according to the number of metastatic LNs as: N0 for no LN metastases; N1(1) for only one positive node; and N1(2) for >or=2 positive nodes. TNM staging was refined as stage IIa (T2-3N0M0), stage IIb (T1N1M0 and T2N1(1)M0), stage IIIa (T2N1(2)M0 and T3N1(1)M0), and stage IIIb (T3N1(2)M0 and T4NanyM0), and the survival was analyzed. LN metastases was found in 380 of 1146 (33.2%) treated esophageal cancer patients. In 4270 LNs harvested, metastases was detected in 807 (18.9%). The 5-year survival rates of the patients with 0, 1, and >or=2 positive nodes were 59.8, 33.4, and 9.4%, respectively. There was statistically significant difference among these three groups. The 5-year survival of the patients in stages T2N1M0 and T3N1M0 was significantly higher in the N1(1) group than in the N1(2) group (41.5 vs 24.1%, and 31.2 vs 6.8%, P<0.001). The 5-year survival rates of the patients in refined stage IIa, IIb, IIIa, and IIIb were 57.1, 42.2, 28.6, and 8.5%, with significant difference existing in each stage groups. The number of positive LNs significantly influenced survival of the patients with esophageal cancer. Three grade classification (0, 1, >or=2 positive nodes) could quite well demonstrate the effect of the number of LN metastases and the survival. The refined TNM classification based on the number of LN metastases could better reflect the prognosis of esophageal cancer. Our results offer a strong rationale for refining the International Union Against Cancer TNM classification for esophageal carcinoma.

Complications after esophagectomy for cancer: 53-year experience with 20,796 patients.

The incidence of esophageal cancer in Hebei Province in China is the highest in the world. Our experience in the Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University with the management of postoperative complications following esophagectomy was determined. From September 1952 to December 2005, a total of 20,796 patients underwent an intended esophagectomy for cancer in our department. Data for the outcome of these procedures was sourced from reported articles in the Chinese-language literature. The data were collated to determine the incidence and outcomes of postoperative complications. The incidence of major complications declined over the period of study. The likelihood of anastomotic leakage decreased from 5.0% to 2.3%, and pulmonary complications declined from 3.2% to 1.6%. The surgical mortality rate decreased from 17.1% to 0.6%. The incidence of postoperative complications and deaths following esophagectomy for cancer in our unit has fallen steadily over the past five decades. Improvements in preoperative preparation and postoperative management have contributed to this decrease.

Ecological study on the risks of esophageal cancer in Ci-Xian, China: the importance of nutritional status and the use of well water.

Our purpose was to determine the environmental risks in the development of esophageal cancer in Ci-Xian, which has one of the highest incidences of esophageal cancer in China. The subjects included 404, 352 and 400 inhabitants living in high-, medium-, and low-incidence areas of esophageal cancer, as well as 301 esophageal cancer patients. A food intake-frequency survey using a 7-day weighted inventory questionnaire was conducted on these individuals. Questions on occupation, working conditions, income per year, family disease history, medical complaints, and demographic features were also included in the questionnaire. The levels of nitrogen compounds in selected samples of well water were also measured in each of the 3 areas. Clear-cut differences in food intake were seen among inhabitants living in the 3 different areas, suggesting that regional differences in nutritional styles do exist. In both males and females, the intake of potatoes, fruit, vegetables, and meat were significantly lower in inhabitants living in the high-incidence area than in the other inhabitants, much the same as that of cancer patients. A low intake of carotene, and vitamins A and C was also seen in populations living in the high-incidence area of esophageal cancer. The well water polluted with nitrogen compounds was significantly related to the high incidence of esophageal cancer. In contrast, tobacco, alcohol consumption, and the intake of pickled vegetables and moldy foods did not relate to the different incidence rates. Our results suggest that low intake of fruit, vegetables, potatoes and meat, and the quality of well water may be important factors in the development of esophageal cancer in Ci-Xian.

p73, a gene related to p53, is not mutated in esophageal carcinomas.

A novel gene, termed p73, encodes a protein with a significant homology to p53 and has been mapped at chromosome 1p36.3, which is a locus of multiple suppressor genes for tumors including neuroblastoma and other cancers. Since the 1p36 locus is reported to be deleted and p53 is frequently mutated in esophageal carcinomas, we examined loss of heterozygosity (LOH) and mutation of the p73 gene in 48 untreated esophageal tumors, as well as mRNA expression in 8 tumors. We screened the P1 genomic library to obtain a P1 clone containing the p73 gene and found a polymorphic short tandem CT repeat site at intron 9. Intragenic sequences for 14 PCR primer sets and a primer pair flanking the repeat were also determined for the analysis of PCR single-strand conformation polymorphism (SSCP) and LOH studies, respectively. Expression of p73 mRNA was detectable but at low levels in all 8 tumor tissues by reverse transcriptase PCR. We did not find any type of mutation other than polymorphisms in the 48 esophageal carcinomas, though aberration of the p53 gene on the PCR-SSCP gels was observed in 15 of 38 (39%) tumors of the same set. In addition, LOH for p73 was found in only 2 of 25 (8%) tumors. These results suggest that, at least in esophageal carcinomas, allelic loss or mutation of p73 may not be a main genetic event for the tumorigenesis as it is with p53.

Genotyping of the CYP1A1 and GSTM1 genes in esophageal carcinoma patients with special reference to smoking.

BACKGROUND: Aromatic hydrocarbons, including benzol[a]pyrene, in tobacco smoke first require metabolic activation by phase I enzymes, cytochrome P450s (CYP450s), and then are subjected to detoxification by phase II enzymes, the glutathione-S-transferases. A high risk lung carcinoma group has been reported to have specific polymorphisms of the cytochrome P450 (CYP1A1) gene and the glutathione-S-transferase (GSTM1) gene. In this study, the authors investigated whether such genotypes were also risk factors for esophageal carcinoma. METHODS: Subjects were comprised of 89 esophageal carcinoma patients and 137 noncancer controls. Forty-nine of the patients and 60 of the control subjects were smokers. Genotypic studies of both CYP1A1 and GSTM1 were performed in the cancer tissues of all 89 patients. Genotypes of peripheral blood leukocytes taken from the control subjects were also determined. Genotypes of the CYP1A1 and GSTM1 genes were determined by the polymerase chain reaction. RESULTS: Patients who were heavy smokers with the genotypes Val/Val (V/V) for CYPIAI and the combined genotype of V/V for CYP1A1 and GSTM1- were a statistically high risk group compared with control subjects (P < 0.01, chi-square = 10.6 vs. P < 0.01, chi-square = 11.0). The association of V/V for CYPIAI with a smoking index > or = 600 in esophageal carcinoma patients was estimated at 6.63 (95% confidence interval [CI], 1.86-23.7). The association of combined genotypes of V/V of CYP1A1 and GSTM1 with a smoking index > or = 600 in esophageal carcinoma patients was estimated at 12.7 (95% CI, 1.97-81.8) CONCLUSIONS: Specific genotypes of the CYP1A1 and GSTM1- genes are related to the incidence of esophageal carcinoma, especially in heavy smokers.

Clinicopathologic characteristics and postoperative outcome in Japanese and Chinese patients with thoracic esophageal cancer.

We evaluated the clinicopathologic findings and surgical results of 140 patients with thoracic esophageal cancer treated at Shinshu University, Japan (Shinshu group), and compared them with those from 1164 patients treated at Hebei Medical College, China (Hebei group) to determine if the two groups showed any differences. The Shinshu group had significantly higher incidences of elderly patients (>70 years of age), male patients, and tumors located at the lower esophagus (p < 0.01). In the Hebei group, although the depth of tumor invasion was more advanced, the incidence of nodal metastasis was significantly lower (p < 0.01). Operative death and postoperative complications were more frequent in the Shinshu group. Comparison of the postoperative survival curves revealed significantly longer survival of patients with pT2 or pT3 tumor in the Hebei group (p < 0.01), but there were no significant differences between the two groups when the lesions were classified by pTNM stage. This study demonstrated several differences between the patients in the two areas in regard to the clinicopathologic characteristics of thoracic esophageal cancer. The most important characteristic of the esophageal cancer in the Hebei group appears to be the low incidence of nodal metastasis.

[Clinical application and technical problems of colonic interposition for esophageal substitution].

From Jan. 1980 to Jan. 1991, A total 41 patients, including 22 patients with corrosive stricture after esophageal chemical burns, 10 patients with cancer of the laryngopharynx, 7 patients with esophageal cancer and 1 case of cardiac carcinoma, underwent of colonic interposition for esophageal substitution. This accounted 0.7% of all of the esophageal reconstruction during the same period. There were 23 cases of retrosternal colonic bypass and 18 cases of trans-hiatal inversion-stripping esophagectomy without thoracotomy. The main postoperative complications were anastomotic leakage at the cervical region and incision infection, but no mortality. The indications, choice of the colonic segment and the technical problems of this operation were discussed.

[Multicentric carcinoma of the esophagus and double primary malignant neoplasm of the upper alimentary tract--report on 44 patients].

During the past fifteen years, 44 patients with multicentric carcinoma of the esophagus or double primary malignant neoplasm of the upper alimentary tract, collected from 5316 patients with cancer of esophagus or gastric cardia in the same period, were treated in our hospital. The incidence was 0.83%. All were proven by pathology. Exploratory thoracotomy was done in 32 patients and 26 lesions were resected with a resection rate of 81.3%. All patients with cancer resected survived over 1 year, 6 out of 9 survived over 3 years and 2 out of 3, over 5 years. In the 18 patients who received chemotherapy alone, 12 were followed and all died within 1 year. It is shown that multicentric carcinoma of the esophagus or double malignant neoplasm of the upper alimentary tract should be given energetic treatment. Finally, the incidence, diagnosis criteria, diagnosis method, etiology and management are discussed with a review of literature.