ObjectiveTo investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC).MethodsClinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed.ResultsAmong 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis.ConclusionT1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.
目的 探讨甲状腺鳞状细胞癌的临床特征和综合治疗效果。方法 回顾性分析1985年以来收治的4例原发性甲状腺鳞状细胞癌患者的临床资料。结果 单一手术的1例患者术后4个月死亡； 手术加放疗的2例患者术后6～13个月死亡； 手术加放、化疗的1例患者术后至今已两年仍存活。结论 甲状腺鳞状细胞癌系罕见的恶性肿瘤，生长速度快，术后易复发，预后差。早期行甲状腺癌联合根治术，并辅以放、化疗可降低复发机率，延长生存时间。
ObjectiveTo evaluate the effect of smoking and drinking status on the prognosis of patients with esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of 483 patients with ESCC who underwent surgical treatment in Shannxi Provincial People's Hospital from 2007 to 2016 were retrospectively analyzed. Among them, 352 patients were male and 131 were female, with a median age of 64 (37-80) years. There were 311 smokers and 172 drinkers. The relationship between preoperative drinking or smoking status and the clinicopathological characteristics of patients with ESCC was analyzed. Log-rank method and Cox risk regression were used to conduct univariate and multivariate survival analysis, respectively.ResultsThe preoperative smoking status was related to the patient's tumor location (P=0.030). Drinking status was associated with tumor location (P=0.001), degree of differentiation (P=0.030), pathological T stage (P=0.024) and pathological N stage (P=0.029). Univariate survival analysis showed that smoking status did not affect the disease-free survival (DFS) (P=0.188) and overall survival (OS) (P=0.127) of patients with ESCC. However, patients who drank alcohol had worse PFS than non-drinking patients (29.37 months vs. 42.87 months, P=0.009). It was further proved that alcohol consumption was an independent risk factor affecting patients' recurrence and metastasis by using multivariate analysis (RR=1.28, P=0.040). Alcohol consumption also reduced the OS of patients by 21.47 months (P=0.014), however, multivariate analysis did not yield significant results.ConclusionPreoperative drinking status is related to the stage and differentiation of patients with ESCC. It is an independent risk factor affecting the recurrence and metastasis of ESCC.
ObjectiveTo evaluate the prognostic value of preoperative inflammatory indexes in patients with local-advanced esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical and prognostic data of 150 local-advanced esophageal squamous cell carcinoma patients who were treated by esophagectomy in Guangyuan Central Hospital from July 2014 to July 2015. There were 128 males and 22 females with average age of 62.23±8.48 years. The optimal cutoff value was determined by receiver operation characteristics (ROC) curve analysis. Patients were grouped according to the optimal cutoff values (NLR=3.49, PLR=152.28, MLR=0.36). Log-rank test, and multivariate Cox logistic regression modelling were used to assess the simultaneous influences of prognostic factors for survival outcomes after esophagectomy.ResultsThe patients with higher ratio (NLR>3.49, PLR>152.28, MLR>0.36) had significantly shorter median progression free survival (PFS) and lower postoperative recurrent rate than those of the patients with lower ratio. The stratified analyses found that thelymph node staging and postoperative recurrent rate were positively correlated with the higher ratio. However, the tumor differentiation was negatively correlated with it. In univariate analyses, patients with preoperative NLR>3.49, PLR>152.28 and MLR>0.36 had a poorer prognosis. Furthermore, in multivariate analyses we found MLR>0.36 was also significantly associated with a decreased postoperative recurrent rate (HR=12.945, 95%CI 2.31 to 72.548, P=0.00).ConclusionsThe preoperative NLR, PLR and MLR are useful prognostic markers in patients with stage ⅢA-ⅣA esophageal squamous cell carcinoma who conducted esophagectomy.
Objective To evaluate the security and outcomes of thoracolaparoscopic esophagectomy (TLE) versus open approach (OA) for thoracic esophageal squamous cell carcinoma. Methods From June 2014 to June 2015, 125 patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy through McKeown approach, including TLE (a TLE group, 107 patients, 77 males and 30 females) and OA (an OA group, 18 patients, 13 males and 5 females). The data of operation and postoperative complications of the two groups were analyzed retrospectively. Results There was no statistical difference in the duration of operation and ICU stay and resected lymph nodes around laryngeal recurrent nerve between the TLE group and the OA group (333.58±72.84 min vs. 369.17±91.24 min, P=0.067; 2.84±1.44 d vs. 6.44±13.46 d, P=0.272; 4.71±3.87 vs. 3.89±3.97, P=0.408) . There was a statistical difference in blood loss, total resected lymph nodes and resected lymph nodes groups between TLE group and OA group (222.62±139.77 ml vs. 427.78±276.65, P=0.006; 19.62±9.61 vs. 14.61±8.07, P=0.038; 3.70±0.99 vs. 3.11±1.13, P=0.024). The rate of postoperative complications was 32.7% in the TLE group and 38.9% in the OA group (P=0.608). There was a statistical difference (P=0.011) in incidence of pulmonary infection (2.8% in the TLE group and 16.7% in the OA group). Incidences of complications, such as anastomotic leakage, cardiac complications, left-side hydrothorax, right-side pneumothorax, voice hoarse and incision infection, showed no statistical difference between two groups. Conclusion For patients with thoracic esophageal squamous cell carcinoma, TLE possesses advantages of more harvested lymph nodes, less blood loss and less pulmonary infection comparing with open approach, and is complied with the principles of security and oncological radicality of surgery.
Objective To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy. Methods The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1st and 3rd month. Results There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1%vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9%vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1st and 3rd month. However, the quality of life at postoperative 3rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3rd month (3.0±1.8 vs. 3.6±1.6, P=0.045). Conclusion The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.
ObjectiveTo investigate the expression of tumor metastasis associated genes-1 (MTA1) and vascular endothelial growth factor-C (VEGF-C) in esophageal squamous cell carcinoma (ESCC) and the relationship between them and lymphangiogenesis. MethodA total of 107 patients who received excision for ESCC in the Cardiothoracic Surgery Department of Suining Central Hospital from March 2013 through January 2014 were enrolled. And the paraffinembedded esophageal tissues in 56 healthy persons were collected. The expression of MTA1 and VEGF-C in ESCC was detected using the immunohistochemical method. And D2-40 was used to label the micro-lymphatic endothelial cells of the tumor tissues while the micro-lymphatic vessel density (LVD) was counted. Meanwhile, a statistical analysis was performed for the relationship between MTA1 with VEGF-C and clinical pathological parameters. ResultsThe expression rates of MTA1 protein and VEGF-C protein in ESCC (50.4% and 58.8%, respectively) were higher than those in normal esophageal tissues with a statistical difference (P<0.05). Besides, their high expression rates in stage T3/T4 ESCC and lymph node metastasis group were significantly higher than those in stage T1/T2 ESCC and metastasisfree group, with statistical differences (P<0.05). The high expression rates of MTA1 and VEGF-C protein in ESCC with different TNM stages were compared using Kruskal-Wallis test with statistical differences (P<0.05). Moreover, a positive correlation existed in the expression level between MTA1 protein and VEGF-C protein of ESCC (Spearman coefficient r=0.512, P=0.000). And LVD of the high expression group for MTA1 protein and VEGF-C protein was statistically different from that of the low expression group (P<0.05). ConclusionThe expression of MTA1 is positively correlated with the expression of VEGF-C in ESCC. And they may co-promote lymphangiogenesis and lymphatic metastasis in ESCC. Therefore, both can be used as the laboratory indicators to determine the prognosis of ESCC.
目的：研究小鼠头颈鳞癌细胞株SCCⅦ体外放射敏感性，并探讨其与细胞周期阻滞的可能关系。方法：利用细胞克隆形成试验及MTT法检测SCCⅦ细胞受X射线照射后细胞存活能力及细胞生长趋势的变化，通过流式细胞学检测X射线照射后细胞周期分布的变化。结果：相同剂量照射后的SCCⅦ细胞存活分数高于Hela细胞（Plt;0.05）；4 Gy照射后的SCCⅦ细胞在96 h内细胞生长速度仍高于Hela细胞（Plt;0.05）；4 Gy照射后SCCⅦ细胞G1期和G2期细胞比例明显升高（Plt;0.05）。结论：SCCⅦ细胞对放射线不敏感性，放射线导致的细胞周期阻滞是SCCⅦ细胞放射抵抗的可能原因之一