Prophylactic Noninvasive Ventilation Versus Conventional Care in Patients After Cardiac Surgery.

BACKGROUND: Cardiac surgery can be accompanied by postoperative complications, which are associated with increased postoperative morbidity and mortality. Therefore, it is necessary to investigate the effect of prophylactic noninvasive ventilation (NIV) after extubation versus conventional pulmonary care on complications after cardiac surgery. MATERIALS AND METHODS: An electronic search of PubMed, Cochrane Library, Ovid, and EMBASE was conducted to find randomized controlled trials which compared the effect of prophylactic NIV with controlled strategies on complications and which were published before April 2018. RESULTS: Ten studies (1011 patients) were included in the final analysis. The atelectasis rate was 32.6% in the prophylactic-NIV group, which was lower than that in the control group (48.71%). Prophylactic NIV could lower the rate of atelectasis, reintubation, and other respiratory complications (pleural effusion, pneumonia, and hypoxia) (odds ratio = 0.43, 0.33, and 0.45; 95% confidence interval: 0.21-0.88, 0. 13-0.84, 0.27-0.75; P = 0.02, 0.02, and 0.002, respectively). The effect on cardiac and distal organ complications (P = 0.07) and hospital mortality (P = 0.62) might be limited. CONCLUSIONS: Prophylactic NIV is associated with a lower rate of postoperative pulmonary complications. The effect on the other complications and hospital mortality might be limited. Further evidence with randomized controlled trials can discern the benefits.

Ten-year survival of patients with oesophageal squamous cell carcinoma.

OBJECTIVES: The standard predictive factors of actuarial survival such as T and N stage become less important as patients live for more than 10 years after treatment of cancer. Reports of actual 10-year survivors of oesophageal squamous cell carcinoma (SCC) are rare, and demographic and clinicopathological factors associated with 10-year survival have not been well documented. In this research we evaluated factors predictive of actual, as opposed to actuarial, 10-year survival. METHODS: We retrospectively analysed 1 046 patients who had undergone oesophagectomy for oesophageal SCC. The demographic and clinicopathological characteristics of patients who were alive more than 10 years after oesophagectomy and those of patients who had died were compared. RESULTS: Univariate analysis showed that 18 factors differed significantly between the two groups. Based on logistic regression analysis, factors associated with 10-year survival were younger age, female gender, absence of dysphagia, a left transthoracic surgical approach, lower pathological T stage, and fewer metastatic lymph nodes. CONCLUSION: The independent positive predictors of actual as opposed to actuarial 10-year survival are younger age, female gender, absence of dysphagia, lower pathological T stage, and fewer metastatic lymph nodes.

Removable, fully covered, self-expandable metal stents for the treatment of refractory benign esophagogastric anastomotic strictures.

The use of metal stents for malignant esophageal strictures for palliation is well accepted. However, utilization of metal stents for benign esophageal diseases has been controversial. Given the availability of removable, fully covered, self-expandable metal stents (RFCSEMSs), this study was undertaken to evaluate the effectiveness and safety of RFCSEMSs in patients with refractory benign esophagogastric anastomotic strictures. Twenty-four patients with RFCSEMSs were enrolled in this study. All patients had undergone endoscopic Savary-Gilliard bougie dilatation five times or more but there was no significant improvement in symptoms. For all 24 patients, the symptom of dysphagia was alleviated significantly while the stent was in place and for a short time after stent removal, and dysphagia scores decreased from 3-4 to 0-1. After 12 months of follow-up, 18 patients were free from dysphagia but the other 6 patients still suffered obvious dysphagia. RFCSEMSs are still not perfect and can induce some complications. The treatment failure rate of restenting was remarkably high after the first failure. Given that effective methods for treating refractory stricture have not been found, RFCSEMSs could be considered for treating refractory benign esophagogastric anastomotic stricture.

Hepatic resection for post-operative solitary liver metastasis from oesophageal squamous cell carcinoma.

BACKGROUND: Liver metastasis is common in patients with oesophageal cancer. The effect of operative intervention for post-operative solitary liver metastasis from oesophageal squamous cell carcinoma (ESCC) has not previously been examined. This research was to compare the effect of surgery and non-surgical therapy in patients with post-operative solitary liver metastasis from ESCC. METHODS: We retrospectively analysed the clinical data of 69 consecutive patients with solitary hepatic metastasis who had undergone oesophagectomy for ESCC and were subsequently referred to the First Affiliated Hospital of Zhengzhou University from January 2005 to December 2013. The survival rates of the surgical and non-surgical groups were compared. RESULTS: There were 26 patients in the surgical group and 43 patients in the non-surgical group. There was no operative death in the surgical group. Post-operative complications were observed in six patients, and all of these patients recovered after additional treatments. Patients in the surgical group had 1- and 2-year cumulative survival rates of 50.8 and 21.2%, respectively, which were significantly higher than the 31.0 and 7.1% survival rates of patients in the non-surgical group (P < 0.05). In each group, the patients with a disease-free interval (DFI) lasting >12 months had a better survival rate than those with a DFI lasting ≤12 months (all P < 0.05). CONCLUSIONS: Operative intervention is a better treatment choice for patients with post-operative solitary liver metastasis from ESCC, especially for patients with a DFI lasting >12 months. Patients selected for hepatic resection should be considered on an individual basis through a multidisciplinary team of specialists.

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.

Which factors are associated with extremely short-term survival after surgery in patients with esophageal squamous cell carcinoma?

AIMS: Esophageal squamous cell carcinoma (ESCC) is associated with a short median survival and low cure rates. The postoperative survival time of some patients with ESCC is extremely short. It is important to understand risk factors in subsets of patients associated with extremely short-term survival. The standard factors such as T and N stage, which are predictive of actuarial survival, become less important as patients live for ≤1 year. However, the prevalence of these factors in these patient populations has not been well documented. We evaluated factors predictive of ≤1 year survival in this research. METHODS: We analyzed 1596 patients underwent esophagectomy for ESCC retrospectively. The demographic and clinicopathologic characteristics were compared between patients who died within 1 year of esophagectomy and patients who survived more than 1 year after esophagectomy. RESULTS: Univariate analysis showed significant differences between the two groups regarding gender, weight loss, comorbidity, neoadjuvant treatment, completeness of resection, pathological T stage, pathological N stage, histologic grade, the number of metastatic lymph nodes, postoperative complications, postoperative pulmonary infection and postoperative hospital stay. Based on logistic regression analysis, significant factors associated with extremely short-term survival were male gender, incomplete tumor resection, higher pathological T stage, higher pathological N stage and postoperative pulmonary infection. CONCLUSION: The independent positive predictors for extremely short-term survival are male gender, incomplete tumor resection and postoperative pulmonary infection besides higher pathological T stage and higher pathological N stage.

[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.

The significance of subcarinal dissection in esophageal cancer surgery.

AIM: The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcome and survival following esophagectomy in patients with thoracic esophageal squamous cell carcinoma. METHODS: A total of 2252 patients underwent an esophagectomy for esophageal cancer from January 1997 to December 2008, of whom 1419 patients met the selection criteria. There were 335 cases without a subcarinal dissection and 1084 with a subcarinal dissection. Short-term outcomes and survival following the esophagectomy between the subcarinal non-dissection group and dissection group were compared. RESULTS: The average operation time of the subcarinal dissection group was longer than that of the non-dissection group (227 vs 208 min, P < 0.05). Both blood loss (246 vs 231 ml) and postoperative pleural drainage volume (1033 vs 950 ml) of the dissection group were significantly greater than in the non-dissection group (P < 0.05). For the entire cohort, the overall survival rate of the subcarinal non-dissection group was significantly lower than the dissection group (54 vs 36 mo., P < 0.05). However, in the N1-3 subgroup, no significant difference was found in overall survival rate between the two groups (P > 0.05). In the N0 subgroup the overall survival rate of the subcarinal non-dissection group was significantly lower than that of the dissection group (P < 0.05). CONCLUSION: Subcarinal dissection is still necessary in esophagectomy for esophageal squamous cell carcinoma.

Impact of subcarinal dissection on short-term outcome and survival following esophagectomy.

BACKGROUND: The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma. METHODS: Patients without subcarinal dissection were matched randomly to patients with subcarinal dissection in a 1:1 ratio according to 5 baseline variables (gender, pathologic stage, tumor location, histologic grade, and surgical approach) that may have major impacts on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma. Preoperative clinical characteristics, short-term outcomes, and survival after esophagectomy of the 2 groups were compared. RESULTS: There were 128 patients included in each group. Blood loss, postoperative pleural drainage volume, and the incidences of postoperative complications and pulmonary complications in the nondissection group were significantly less than in the dissection group. The comparison of overall survival curves and disease-free survival curves between the 2 groups showed no significant difference (P > .05). CONCLUSIONS: Subcarinal dissection might be futile for patients with thoracic esophageal squamous cell carcinoma.

Subcarinal node metastasis in thoracic esophageal squamous cell carcinoma.

BACKGROUND: Subcarinal node metastasis is common in patients with esophageal cancer. Some scholars have suggested that subcarinal nodes might not need to be sampled or dissected in patients with superficial squamous cell carcinoma of the thoracic esophagus. This research investigated the frequency of subcarinal node metastasis in patients with esophageal squamous cell carcinoma, identified the factors correlated to subcarinal node metastasis, and evaluated the clinical relevance of subcarinal node metastasis in thoracic esophageal squamous cell carcinoma. METHODS: We retrospectively analyzed the clinical data of 1,812 consecutive patients with thoracic esophageal squamous cell carcinoma who underwent esophagectomy in the Cancer Center of Sun Yat-sen University. The surgical procedures included the left transthoracic procedure, Ivor-Lewis approach, and the cervical-thoracoabdominal procedure. RESULTS: The frequency of subcarinal node metastasis was 10.0%. The univariate and multivariate analysis showed that longer tumor length, higher pathologic T stage, lower histologic grade, and positive lymph node metastases of other groups were associated with a higher frequency of subcarinal node metastasis (all p<0.05). Patients with solitary subcarinal node metastasis had a significantly lower 5-year cumulative survival rate than those with solitary paraesophageal node metastasis (25.3% vs 39.6%, p<0.05). CONCLUSIONS: Longer tumor length, higher pathologic T stage, lower histologic grade, and positive lymph node metastases of other groups are associated with a higher frequency of subcarinal node metastasis. Subcarinal node metastasis indicates worse prognosis of patients with thoracic esophageal squamous cell carcinoma compared with paraesophageal node metastasis.

Which factors are associated with actual 5-year survival of oesophageal squamous cell carcinoma?

UNLABELLED: OBJECTIVES; The demographic and clinicopathologic factors associated with 5-year survivors have not been well documented in oesophageal squamous cell carcinoma (OSCC). We evaluated factors predictive of actual 5-year survival in the present research. METHODS: We analysed 1241 patients underwent oesophagectomy for invasive OSCC retrospectively. The demographic and clinicopathologic characteristics were compared between patients who were alive >5 years after oesophagectomy and patients who died within 5 years of oesophagectomy. RESULTS: Univariate analysis showed significant differences between the two groups regarding 11 different factors. Further analysis by logistic regression showed that eight factors were identified as independent predictors of actual 5-year survival. CONCLUSIONS: The independent positive predictors for actual 5-year survival are younger patients, female gender, absence of weight loss, R0 resection, lower pathological T stage, lower pathological N stage, higher histologic grade and more resected lymph nodes.

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 and prognostic relevance of Id1 in stage III esophageal squamous cell carcinoma.

Inhibitor of differentiation 1 (Id1) plays a role in cellular differentiation, proliferation, angiogenesis and tumor invasion. In current study, we investigated the expression of Id1 protein in 189 specimens of stage III ESCC by immunohistochemistry. The correlation between Id1 expression and clinicopathological parameters in terms of gender, age, tumor location, differentiation, pathological T stage and pathological N stage was also explored. Immunohistochemical staining showed that Id1 was expressed in all cases (100%). According to ROC curve, we selected 6.33 as the cutoff score. There were 95 cases in high expression group (> 6.33) and 94 cases in low expression group (⩽ 6.33) respectively. The Id1 expression was associated negatively with differentiation, and positively with pathological N stage (P< 0.05, bothly); No significant correlation was observed between Id1 expression and gender, age, tumor location or pathological T stage (P> 0.05). As shown by the Kaplan-Meier curve, the overall survival rate of high expression group was significantly lower than that of low expression group (P< 0.001). The expression of Id1 protein has a close relationship with differentiation degree, pathological N stage and survival in ESCC patients. Id1 could be considered as a prognostic predictor for stage III ESCC 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.