Tumor location does not impact long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China.

BACKGROUND: The seventh edition of the American Joint Committee on Cancer staging system considers tumor location as a factor in staging esophageal squamous cell carcinoma (ESCC). However, more data are essential to test its efficacy. The purpose of this study is to assess whether tumor location should be included as a factor in staging of thoracic ESCC in Chinese patients. METHODS: A retrospective review of 1,220 patients with ESCC who underwent complete resection between December 1996 and December 2008 was conducted. Survival was calculated by the Kaplan-Meier method, and the log-rank test was used to assess survival differences between groups. Subgroup analysis and the Cox proportional hazards model were used to further determine the impact of tumor location on overall survival. RESULTS: The median survival times for patients with ESCC in the upper third, middle third, and lower third of the esophagus were 45.1 months, 62.9 months, and 39.2 months, respectively, with corresponding 5-year survival rates of 44.8%, 50.5%, and 45.6%, respectively (p=0.191). Subgroup analysis also demonstrated that tumor location did not determine survival prognosis. Multivariate Cox regression analysis suggested that being female (p=0.001), being young (p<0.001), having a lower grade of cell differentiation (p=0.030), T category (p<0.001), and N category (p<0.001) were independent factors favoring overall survival, whereas tumor location (p=0.295) and surgical approaches (p=0.521) were not independent factors impacting prognosis. CONCLUSIONS: Staging of ESCC in the Chinese population should be simplified by omitting tumor location as a variable. More data from Asian populations are warranted to verify these results.

Modification of nodal categories in the seventh american joint committee on cancer staging system for esophageal squamous cell carcinoma in Chinese patients.

BACKGROUND: More data are essential to test the efficacy of the American Joint Committee on Cancer (AJCC) system for staging esophageal squamous cell carcinoma. We tested the classifiers used in the AJCC staging system and propose a modification to this system to better represent the survival characteristics of esophageal squamous cell carcinoma in the Chinese population. METHODS: We used data from two centers, which established the training (n=1,006) and validation (n=783) cohorts. All the patients underwent curative surgical treatment. Survival was compared using AJCC classifiers to test the efficacy of this staging system. Martingale residuals from a Cox proportional hazards regression model were used to modify the nodal categories. The results obtained from the training cohort were validated with the validation cohort at each step. RESULTS: The evaluation of the patients' overall survival allowed only poor discrimination between AJCC IIIb and IIIc cancers in both cohorts. Also, in both cohorts, N2 and N3 classification cancers could not be well discriminated in terms of survival when AJCC nodal categories were used. Nevertheless, the survival rate could easily be distinguished when using the four modified categories: 0, 1, 2 to 3, and 4 or more positive nodes. The survival difference between IIIb and IIIc obtained using the modified nodal categories could easily be discriminated in both cohorts. CONCLUSIONS: Esophageal squamous cell carcinoma nodal staging for the Chinese population was more accurately classified using the following four categories: no positive node, 1 positive node, 2 to 3 positive nodes, and 4 or more positive nodes. Further studies are required to confirm these results.

Expression of G3BP and RhoC in esophageal squamous carcinoma and their effect on prognosis.

AIM: To investigate the expression and significance of G3BP and RhoC proteins in esophageal squamous carcinoma (ESC). METHODS: The expression of G3BP and Rhoc proteins in 80 cases of ESC was detected by immunohistochemistry. The relationship was studied between the expression of the two proteins and tumor size, differentiation degree, TNM stage, lymph node metastasis and prognosis of ESC. RESULTS: The positive expression rate of G3BP in ESC was 71.25%; and the rate in the lymph node metastasis group was significantly higher than that in the non-lymph node metastasis group (Z = -2.283, P = 0.022), but no relations were found between G3BP expression and tumor size, differentiation degree and TNM stage (P > 0.05). The group with G3BP positive expression had shorter survival time than the group with G3BP negative expression (P = 0.000). The positive expression rate of RhoC in ESC was 66.25%; and the rate in the lymph node metastasis group was significantly higher than that in the non-lymph node metastasis group (Z = -2.115, P < 0.05), but no relations were found between RhoC expression and tumor size, differentiation degree and TNM stage (P > 0.05). The RhoC positive expression group had a shorter survival time than the RhoC negative expression group (P < 0.001. The expression of G3BP protein correlated positively with the expression of RhoC in ESC tissues (rs = 0.656, P < 0.001). CONCLUSION: The expression of G3BP and RhoC protein is closely related to the lymph node metastasis and survival in ESC patients. G3BP and RhoC proteins can be considered as predictors of prognosis in ESC patients.

[Expression of Ras-GTPase-activating protein SH 3 domain binding protein and osteopontin in esophageal squamous carcinoma and their effects on prognosis].

OBJECTIVE: To investigate the expressions and significances of Ras-GTPase-activating protein SH 3 domain binding protein(G3BP) and osteopontin (OPN) proteins in esophageal squamous carcinoma (ESC). METHODS: The expressions of G3BP and OPN proteins in 80 cases of ESC were detected by immunohistochemistry. The relationships between the 2 protein expression and tumor size, differentiation degree, TNM stage, lymph node metastasis and prognosis of ESC were also explored. RESULTS: (1) The positive expression rate of G3BP in ESC was 71.3%, and the rate in lymphoid metastatic group was significantly higher than that in non lymphoid metastatic group (Z=-2.283, P=0.022), but no relations were found between G3BP expression and diameter of tumor, differentiation and TNM grade (P>0.05). The G3BP positive expression group had shorter survival time than G3BP negative expression group (P=0.000). (2) The positive expression rate of OPN in ESC was 100%, and the degree of OPN expression was correlated with the differentiation (chi(2)=10.766, P=0.005) and lymphoid metastasis (Z=-2.289, P=0.022), but no relationship was found between the diameter of tumor and TNM grade (P>0.05). The expression of OPN were significantly related to survivals in a negative time-dependent manner in ESC patients (P=0.000). (3) The expression of G3BP protein correlated positively with the degree of OPN expression in ESC tissue (r(s)=0.376, P=0.001). CONCLUSIONS: The expressions of G3BP and OPN proteins have a close relationship with lymphoid metastasis and survival in ESC patients. G3BP and OPN proteins can be considered as predictors of prognosis in ESC patients.

[Expressions of RhoC and osteopontin in esophageal squamous carcinoma and association with the patients' prognosis].

OBJECTIVE: To investigate the expressions of RhoC and osteopontin (OPN) protein in esophageal squamous carcinoma (ESC) and their association with the biological behavior of ESC. METHODS: The expressions of RhoC and OPN protein were detected in 80 ESC cases by immunohistochemistry. RESULTS: The positive expression rate of RhoC was 66.25% in these ESC cases. The rate was significantly higher in cases with lymph node metastasis than in those without (r(s)=-2.115, P<0.05), but RhoC expression was not associated with the tumor diameter, differentiation or TNM grade (P>0.05). The RhoC-positive patients had significantly shorter survival time than the negative patients (P<0.001). All the 80 ESC patients were positive for OPN expression, and OPN expression levels were correlated with the differentiation (chi(2)=10.766, P<0.05) and lymph node metastasis of the tumor (r(s)=-2.289, P<0.05), but not with the tumor diameter or TNM grade (P>0.05). Higher expression level of OPN was closely related to shorter survival time of the patients (P<0.05). A positive correlation was found between RhoC protein and OPN expressions (r(s)= 0.408, P<0.001) in these cases. CONCLUSION: The expressions of RhoC and OPN protein are closely related to lymph node metastasis of ESC and the patients survival time, and therefore may serve the purpose of prognostic evaluation of ESC.

[Expressions of vascular endothelial growth factor C and matrix metalloproteinases-2 and prognosis of non-small cell lung carcinoma].

OBJECTIVE: To investigate the expressions of vascular endothelial growth factor-C (VEGF-C) and matrix metalloproteinases-2 (MMP-2) proteins and its relationship with the biological behaviors of non-small cell lung carcinoma (NSCLC). METHODS: Immunohistochemical staining was used to detect the expressions of VEGF-C and MMP-2 proteins in 42 cases of NSCLC tissues. The relationship of VEGF-C and MMP-2 expressions was analyzed with the tumor size, lymphatic vessel density (LVD), histological type, differentiation, clinical recurrence, lymph node metastasis and patients' survival time. RESULTS: Out of the 42 cases of NSCLC, 23 and 26 cases showed positive expressions of VEGF-C and MMP-2 proteins, respectively, with the expression rates of VEGF-C and MMP-2 protein of 54.8% and 61.9%, respectively. VEGF-C expression was positively associated with LVD and lymph node metastasis (P<0.05), and inversely with the differentiation of NSCLC and the patients' survival time (P<0.05). MMP-2 expression was positively associated with lymph node metastasis (P<0.05) and inversely with the patients' survival (P<0.05). VEGF-C and MMP-2 expressions was positively associated (r=0.469, P<0.05). CONCLUSION: The expressions of VEGF-C and MMP-2 proteins are closely associated with the biological behaviors of NSCLC, and their high expression suggests probable lymph node metastasis and poor prognosis.

[Expression of vascular endothelial growth factor C and cyclooxygenase-2 in non-small-cell lung carcinoma and their clinical significance].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor-C (VEGF-C) and cyclooxygenase-2 (COX-2) proteins, and their relationship with biological behaviors of non-small-cell lung carcinoma (NSCLC). METHODS: Immunohistochemical staining was used to detect the expression of VEGF-C and COX-2 proteins in 77 cases of NSCLC. The relationship was analyzed between the expression of VEGF-C, COX-2 and lymphatic vessel density (LVD), tumor size, histological type, differentiation, lymph node metastasis, clinical recurrence and survival time of the patients. RESULTS: Out of 77 cases of NSCLC, 45 cases and 29 cases showed positive expression of VEGF-C and COX-2 proteins, respectively. The expression rates of VEGF-C and COX-2 protein were 58.4% and 37.7%, respectively. The expression of VEGF-C protein was correlated negatively with the degree of differentiation of NSCLC (P < 0.05). The expression of VEGF-C was positively correlated with lymph node metastasis, LVD and tumor size (P < 0.01). The survival time of the patients was negatively correlated with the expression of VEGF-C (P < 0.01). The expression of COX-2 was positively correlated with LVD (P < 0.01). The survival time of the patients was negatively correlated with the expression of COX-2 (P < 0.05). CONCLUSION: The expression of VEGF-C and COX-2 proteins are closely correlated with the biological behaviors of NSCLC, especially VEGF-C protein. Its high expression suggests probable lymph node metastasis and poor prognosis.