Clinical pathways and outcomes of patients with Barrett's esophagus in tertiary care settings: a prospective longitudinal cohort study in Australia, 2008-2016.

BACKGROUND: Clinical services for Barrett's esophagus have been rising worldwide including Australia, but little is known of the long-term outcomes of such patients. Retrospective studies using data at baseline are prone to both selection and misclassification bias. We investigated the clinical characteristics and outcomes of Barrett's esophagus patients in a prospective cohort. METHODS: We recruited patients diagnosed with Barrett's esophagus in tertiary settings across Australia between 2008 and 2016. We compared baseline and follow-up epidemiological and clinical data between Barrett's patients with and without dysplasia. We calculated age-adjusted incidence rates and estimated minimally and fully adjusted hazard ratios (HR) to identify those clinical factors related to disease progression. RESULTS: The cohort comprised 268 patients with Barrett's esophagus (median follow-up 5 years). At recruitment, 224 (84%) had no dysplasia, 44 (16%) had low-grade or indefinite dysplasia (LGD/IND). The age-adjusted incidence of esophageal adenocarcinoma (EAC) was 0.5% per year in LGD/IND compared with 0.1% per year in those with no dysplasia. Risk of progression to high-grade dysplasia/EAC was associated with prior LGD/IND (fully adjusted HR 6.55, 95% confidence interval [CI] 1.96-21.8) but not long-segment disease (HR 1.03, 95%CI 0.29-3.58). CONCLUSIONS: These prospective data suggest presence of dysplasia is a stronger predictor of progression to cancer than segment length in patients with Barrett's esophagus.

Expression and clinical significance of GFRα3 in esophagus squamous cell carcinoma / 临床与实验病理学杂志

Purpose To investgate the expression and clinical significance of GFRα3 in esophagus squamous cell carcinoma (ESCC).Methods Expression of GFRα3 in 114 esophagus squamous cell carcinoma,17 cases of high grade intraepithelial neoplasia and Tis,25 cases nomal tissue was detected by immunohistochemistry.Expression of GFRα3 in 12 paired flesh tissues had also been determined by Western-blot.Results The positive expression of GFRα3 in nomal esophageal tissues,high grade intraepithelial tissues and Tis was 0,29.4％,76.3％ respectively by immunohistochemistry.Expression of GFRα3 in carcinomatous tissues was higher than that of adjacent tissues (P ＜ 0.05).Moreover,the expression of GFRα3 was significantly associated with depth of invasion,higher clinical stage and survival outcome of patients with ESCC.Conclusion The expression of GFRα3 maybe a useful predictor of disease depth of invasion,progression and outcome in ESCC.

Primary malignant melanoma of esophagus: a case report and review of literature.

Primary malignant melanoma of esophagus is a rare but highly aggressive neoplasm, with an incidence less than 0.2% of all primary esophagus neoplasms. There are no clinical differences from other forms of esophagus cancer. Because initial symptoms are nonspecific, the patients are usually diagnosed at a late stage. The prognosis is poor, and curative effect seems disappointed. Several reports suggest that most of patients die from distant metastases, and the 5-year survival rate is approximately 4.2%. This case report includes a review of the surgical pathology, clinical features and treatment of primary malignant melanoma of esophagus. This case report presents a 56-year-old female with primary malignant melanoma of esophagus, treated by surgical resection. Till now, the patient is still alive for 5 months without any chemotherapy, radiotherapy and immunomodulatory therapy.

Non-Invasive Detection of Esophageal Cancer using Genetic Changes in Circulating Cell-Free DNA.

Cell free DNA (cfDNA) is a genetic biomarker that is present in serum or plasma in high concentration in many types of cancer. Identification of circulating cancer related DNA molecules in serum or plasma is a non-invasive tool for early diagnosis and prognosis in many cancer patients. For this review, study selection and data extraction were performed by the authors. Detection of point mutations, microsatellite alterations, DNA hypermethylations and losses of heterozygosity in circulating cell free DNA have been characterized in esophagus cancer. Application of circulating cell free DNA as a biomarker, provide the best opportunity for constructing non-invasive tests for early detection, prognosis and management of cancer patients, after therapy in many types of cancer.

Study on the birth order of patients with esophagus cancer in Shanxi province / 中华流行病学杂志

Objective To explore the relationship between esophagus cancer patients and both environmental and genetic factors,through analyzing the data on birth orders from esophagus cancer patients of Shanxi province.Methods Both Greenwood and Haldane methods on birth order were used to study the 1101 cases with esophagus cancer from Shanxi province.All the patients had received surgery and were diagnosed,by pathological evidence.First certificates of the patients were confirmed through the standard genetic epidemiologic investigation.Birth order was investigated on probands of the 1101 cases with esophagus cancer and their 44 siblings.Results Results form the Greenwood method showed that there was a tendency for cases with esophagus cancer in birth orders First to Third.However,the Haldane method showed that the results were quite different between actual value and the average theory value of 6A (6A(actual value)=17 118,(X)6A(average theory value) =19 290,X=∣6A-(X)6A∣/√V6A =7.63,X ＞ 2) which suggested that the birth order had some effects on the occurrence of esophagus cancer.In addition,the actual value of 6A was lower than the theoretic average value,and the parents at younger productive age or baby at the first birth was easy to develop esophagus cancer.Conclusion Esophagus cancer was related with the birth order,especially at early order,which was not consistent with the national reports on esophagus cancer.Results from this study suggested that there were certain effects of environmental risk factors on esophagus cancer patients.

Hyaline Vascular-Type Castleman Disease Presenting as an Esophageal Submucosal Tumor: Case Report

Castleman disease is a relatively rare disorder of lymphoid tissue that involves the gastrointestinal tract in a variety of clinical and pathologic manifestations. A submucosal location has never been described in the medical literature. We report a case of esophageal Castleman disease involving thesubmucosal layer in a 62-year-old man, which was confirmed on pathology. Esophagography and CT demonstrated an intramural tumor, and a leiomyoma or leiomyosarcoma was suspected based on the known incidence of such tumors.

The Effect of More Aggressive Surgery in Esophageal Cancer.

PURPOSE: One of the most controversial aspects of surgery for esophageal cancer is the appropriate extent of lymphadenectomy to achieve the best outcome. The purpose of this study was to clarify the effects of an extended lymphadenectomy (complete 2-field lymphadenectomy; complete 2-FL or 3-field lymphadenectomy; 3-FL) in esophageal cancer surgery. MATERIALS AND METHODS: In order to prevent a local recurrence and improve the long-term survival following surgery, an extended lymphadenectomy has systematically been performed at four hospitals of the Catholic University College of Medicine since 1995. And since that time, until the end of 2001, a total of 98 patients have undergone the procedure. Their clinical results were compared with those of 54 esophageal cancer patients who received an incomplete 2-field lymphadenectomy (incomplete 2-FL), between 1990 and 1994, at the same hospitals. RESULTS: After an extended lymphadenectomy a recurrence was noted in 41 cases (44.6%), a local recurrence occurred in 23 cases (25.0%) and a metastatic recurrence in 18 (19.6%), with the 5-year survival rate improved to 39.5%, than the 29% of the incomplete 2-FL. There was no difference in the morbidity of the fatal complications and the mortality between the two groups. CONCLUSION: The long survival rate was improved with an extended lymphadenectomy, but the morbidity and mortality rate had not increased.

The Effect of More Aggressive Surgery in Esophageal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: One of the most controversial aspects of surgery for esophageal cancer is the appropriate extent of lymphadenectomy to achieve the best outcome. The purpose of this study was to clarify the effects of an extended lymphadenectomy (complete 2-field lymphadenectomy; complete 2-FL or 3-field lymphadenectomy; 3-FL) in esophageal cancer surgery. MATERIALS AND METHODS: In order to prevent a local recurrence and improve the long-term survival following surgery, an extended lymphadenectomy has systematically been performed at four hospitals of the Catholic University College of Medicine since 1995. And since that time, until the end of 2001, a total of 98 patients have undergone the procedure. Their clinical results were compared with those of 54 esophageal cancer patients who received an incomplete 2-field lymphadenectomy (incomplete 2-FL), between 1990 and 1994, at the same hospitals. RESULTS: After an extended lymphadenectomy a recurrence was noted in 41 cases (44.6%), a local recurrence occurred in 23 cases (25.0%) and a metastatic recurrence in 18 (19.6%), with the 5-year survival rate improved to 39.5%, than the 29% of the incomplete 2-FL. There was no difference in the morbidity of the fatal complications and the mortality between the two groups. CONCLUSION: The long survival rate was improved with an extended lymphadenectomy, but the morbidity and mortality rate had not increased.

Clinical features and multimodality treatment of 11 cases with small-cell esophageal carcinoma / 中国癌症杂志

Purpose:To investigate the clinical feature of small-cell esophageal carcinoma,and try to find rational combined therapy modality.Methods:A retrospective study was conducted in a total of 11 cases of small cell esophageal carcinoma hospitalized from 1990 to 1999 and the literature of small cell esophageal carcinoma in recent years were re- viewed.Results:The median survival time of these patients is 11 months,five cases survived over 1 year,the 1 yr survival rate is 45.45%;only one patient survived over 3 years;nine cases received multimodality treatment,the median survival time was 12 months,and of which,the median survival time of the seven patients treated with combined regimens including surgical operation was 15 months,and the survival time was 10 months and 7 months respectively in two patients treated with combined regimens not including surgical operation.one patient underwent surgery alone,the survival time was 5 months;one patient received chemotherapy alone and survived 6 months.Conclusions:Small cell esophageal carcinoma has a poor prognosis.multimodality treatment including chemotherapy is an effective approach in improving survival;surgical operation play an important role which can not be replaced and preoperative chemotherapy combined with surgical resection and postoperative chemotherapy may be a better combined treatment modality in local regional small cell carcinoma of e- sophagus.

Diffuse Leiomyomatosis of The Esophagus: A Case Report / 대한흉부외과학회지

Though leiomyomas are the commonest benign tumors in the esohpagus, the vast majority of the leiomyomas of alimentary tract occurs outside the esophagus. Leiomyoma is mostly solitary, and multiple lesions are rare. Diffuse esophageal leiomyomatosis is a very rare disease, which is the condition having diffuse thickening of esophageal musculature and with or without discrete lesion. We are reporting a typical case of diffuse leiomyomatosis of the esophagus in a 37-year-old woman successfully resected.