Plasma EBV quantification is associated with the efficacy of immune checkpoint blockade and disease monitoring in patients with primary pulmonary lymphoepithelioma-like carcinoma.

Objectives: Primary pulmonary lymphoepithelioma-like carcinoma (PLELC) is a subtype of lung carcinoma associated with the Epstein-Barr virus (EBV). The clinical predictive biomarkers of immune checkpoint blockade (ICB) in PLELC require further investigation. Methods: We prospectively analysed EBV levels in the blood and immune tumor biomarkers of 31 patients with ICB-treated PLELC. Viral EBNA-1 and BamHI-W DNA fragments in the plasma were quantified in parallel using quantitative polymerase chain reaction. Results: Progression-free survival (PFS) was significantly longer in EBNA-1 high or BamHI-W high groups. A longer PFS was also observed in patients with both high plasma EBNA-1 or BamHI-W and PD-L1 ≥ 1%. Intriguingly, the tumor mutational burden was inversely correlated with EBNA-1 and BamHI-W. Plasma EBV load was negatively associated with intratumoral CD8+ immune cell infiltration. Dynamic changes in plasma EBV DNA level were in accordance with the changes in tumor volume. An increase in EBV DNA levels during treatment indicated molecular progression that preceded the imaging progression by several months. Conclusions: Plasma EBV DNA could be a useful and easy-to-use biomarker for predicting the clinical activity of ICB in PLELC and could serve to monitor disease progression earlier than computed tomography imaging.

Pretreatment radiomic biomarker for immunotherapy responder prediction in stage IB-IV NSCLC (LCDigital-IO Study): a multicenter retrospective study.

BACKGROUND: The predictive efficacy of current biomarker of immune checkpoint inhibitors (ICIs) is not sufficient. This study investigated the causality between radiomic biomarkers and immunotherapy response status in patients with stage IB-IV non-small cell lung cancer (NSCLC), including its biological context for ICIs treatment response prediction. METHODS: CT images from 319 patients with pretreatment NSCLC receiving immunotherapy between January 2015 and November 2021 were retrospectively collected and composed a discovery (n=214), independent validation (n=54), and external test cohort (n=51). A set of 851 features was extracted from tumorous and peritumoral volumes of interest (VOIs). The reference standard is the durable clinical benefit (DCB, sustained disease control for more than 6 months assessed via radiological evaluation). The predictive value of combined radiomic signature (CRS) for pathological response was subsequently assessed in another cohort of 98 patients with resectable NSCLC receiving ICIs preoperatively. The association between radiomic features and tumor immune landscape on the online data set (n=60) was also examined. A model combining clinical predictor and radiomic signatures was constructed to improve performance further. RESULTS: CRS discriminated DCB and non-DCB patients well in the training and validation cohorts with an area under the curve (AUC) of 0.82, 95% CI: 0.75 to 0.88, and 0.75, 95% CI: 0.64 to 0.87, respectively. In this study, the predictive value of CRS was better than programmed cell death ligand-1 (PD-L1) expression (AUC of PD-L1 subset: 0.59, 95% CI: 0.50 to 0.69) or clinical model (AUC: 0.66, 95% CI: 0.51 to 0.81). After combining the clinical signature with CRS, the predictive performance improved further with an AUC of 0.837, 0.790 and 0.781 in training, validation and D2 cohorts, respectively. When predicting pathological response, CRS divided patients into a major pathological response (MPR) and non-MPR group (AUC: 0.76, 95% CI: 0.67 to 0.81). Moreover, CRS showed a promising stratification ability on overall survival (HR: 0.49, 95% CI: 0.27 to 0.89; p=0.020) and progression-free survival (HR: 0.43, 95% CI: 0.26 to 0.74; p=0.002). CONCLUSION: By analyzing both tumorous and peritumoral regions of CT images in a radiomic strategy, we developed a non-invasive biomarker for distinguishing responders of ICIs therapy and stratifying their survival outcome efficiently, which may support the clinical decisions on the use of ICIs in advanced as well as patients with resectable NSCLC.

PD-1/PD-L1 combined with LAG3 is associated with clinical activity of immune checkpoint inhibitors in metastatic primary pulmonary lymphoepithelioma-like carcinoma.

Primary pulmonary lymphoepithelioma-like carcinoma (PLELC) is an Epstein-Barr virus (EBV)-related, rare subtype of non-small-cell lung cancer (NSCLC). Immune checkpoint inhibitors (ICI) show durable responses in advanced NSCLC. However, their effects and predictive biomarkers in PLELC remain poorly understood. We retrospectively analyzed the data of 48 metastatic PLELC patients treated with ICI. Pretreated paraffin-embedded specimens (n = 19) were stained for PD-1, PD-L1, LAG3, TIM3, CD3, CD4, CD8, CD68, FOXP3, and cytokeratin (CK) by multiple immunohistochemistry (mIHC). Next-generation sequencing was performed for 33 PLELC samples. Among patients treated with ICI monotherapy (n = 30), the objective response rate (ORR), disease control rate (DCR), median progression-free survival (mPFS), and overall survival (mOS) were 13.3%, 80.0%, 7.7 months, and 24.9 months, respectively. Patients with PD-L1 ≥1% showed a longer PFS (8.4 vs. 2.1 months, p = 0.015) relative to those with PD-L1 <1%. Among patients treated with ICI combination therapy (n = 18), ORR, DCR, mPFS, and mOS were 27.8%, 100.0%, 10.1 months, and 19.7 months, respectively. Patients with PD-L1 ≥1% showed a significantly superior OS than those with PD-L1 <1% (NA versus 11.7 months, p = 0.001). Among the 19 mIHC patients, those with high PD-1/PD-L1 and LAG3 expression showed a longer PFS (19.0 vs. 3.9 months, p = 0.003). ICI also showed promising efficacy for treating metastatic PLELC. PD-L1 may be both predictive of ICI treatment efficacy and prognostic for survival in PLELC. PD-1/PD-L1 combined with LAG3 may serve as a predictor of ICI treatment effectiveness in PLELC. Larger and prospective trials are warranted to validate both ICI activity and predictive biomarkers in PLELC. This study was partly presented as a poster at the IASLC 20th World Conference on Lung Cancer 2019, 7-10 September 2019, Barcelona, Spain.

Pathological Responses of the Primary Tumor and Locoregional Lymph Nodes After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Cancer.

Background: The current study attempted to describe the specific patterns of pathological tumor response and locoregional node metastases from surgically resected esophageal squamous cell carcinoma after neoadjuvant immunochemotherapy (NAIC), as well as to explore the association between clinicopathological characteristics and such oncological patterns. Methods: Fifty-one patients with cT3 or deeper esophageal squamous cell cancer underwent subtotal esophagectomy after NAIC. The NAIC regimen included intravenous administration of platinum-based and docetaxel- and taxane-based chemotherapeutics along with a 200 mg fixed dose of one programmed death 1 (PD-1) inhibitor, given every 3 weeks. We divided patients into tumor/nodal good-responders and poor-responders based on the pathological observation of the tumor or nodal responses. We also examined the association between clinicopathological factors and tumor/nodal responses. Further, significant baseline predictors for tumor and nodal good-responders were identified using multivariate binary logistic regression. Results: Of the 51 patients, 68.6% achieved marked primary tumor response. Notably, 21.6% of patients achieved complete pathological response. Significant differences in treatment cycles between tumor good-responders and tumor poor-responders (P = 0.019) were observed. For locoregional nodal responses, only 33.3% of patients achieved down-staged nodal disease. Of the investigated variables, neoadjuvant cycles (odds ratio (OR): 5.271, 95% confidence interval (CI): 1.278 - 21.740, P = 0.022) and pretreatment platelets (OR: 0.979, 95% CI: 0.962 - 0.996, P = 0.017) were identified as independent predictors for good tumor and nodal responses. Conclusions: We conclusively noted that most patients receiving NAIC were tumor good-responders, whereas only one-third of patients were nodal good-responders. Furthermore, we identified that treatment cycle number and baseline platelet counts were independent predictors of combined tumor and nodal responses.

High SHP2 expression determines the efficacy of PD-1/PD-L1 inhibitors in advanced KRAS mutant non-small cell lung cancer.

BACKGROUND: Src homology region 2 domain-containing phosphatase 2 (SHP2) is a novel target for Kirsten rat sarcoma oncogene (KRAS) mutant cancer. We retrospectively studied the significance of SHP2 in KRAS mutant non-small cell lung cancer (NSCLC) treated with immunotherapy and its relationship with tumor microenvironment (TME). METHODS: Sixty-one advanced KRAS mutant NSCLC patients who underwent immunotherapy were enrolled. Next-generation sequencing (NGS) was used to profile mutation status. The expression of SHP2, phospho-SHP2 (pSHP2), and programmed death ligand 1 (PD-L1) were analyzed by immunohistochemistry (IHC). Quantitative multiplexed immunofluorescence cytochemistry (mIFC) analysis was conducted to describe the TME. RESULTS: SHP2 was heterogeneously expressed in 32 samples in both tumor cells and immune cells and highly expressed (H-score >10) in 25 (78.1%) samples. The expression levels of SHP2 and pSHP2 were positively correlated. Stromal SHP2 (s-SHP2) was higher in tumors with PD-L1 ≥50% versus PD-L1 <50% (p = 0.039). By quantitative mIFC analysis, the expression of s-SHP2 had positive correlation with CD8, CD4, CD68, and PD-L1 levels in stromal area. Patients with high SHP2 expression made up 100.0% of the partial respond (PR) and 80.0% of the stable disease (SD), whereas 50.0% of the progress disease (PD). High SHP2 expression was associated with longer progression-free survival (PFS) and overall survival (OS) (p < 0.001, p = 0.013). Patients with high expression of both SHP2 and PD-L1 had longer PFS (p < 0.001). CONCLUSION: High SHP2 expression could predict the efficacy of immunotherapy and better survival in advanced KRAS mutant NSCLC. SHP2 may function in both tumor cells and immune cells, warranting further study on the potential diverse effects of SHP2 inhibition in TME.

TCF19 contributes to cell proliferation of non-small cell lung cancer by inhibiting FOXO1.

Transcription factor 19 (TCF19) harbors a forkhead association (FHA) domain, a proline-rich region, a PHD or RING finger region, suggesting that TCF19 possesses a powerful function. However, its expression and function remains unknown in non-small-cell lung cancer (NSCLC). The function cluster analysis was carried out using Metascape website. 3-(4,5-Dimethyl-2-thiazolyl)2,5-diphenyl-2H-tetrazolium bromide (MTT), colony formation, and anchorage-independent growth ability assay were carried out to detect the effect of TCF19 on cell proliferation. Bromodeoxyuridine (Brdu) labeling and flow cytometry assay were used to evaluate the effect of TCF19 on cell-cycle progression. Quantitative polymerase chain reaction and chromatin immunoprecipitation assay were performed to investigate the mechanism by which TCF19 is involved in cell-cycle transition. By analyzing the publicly available dataset, The Cancer Genome Atlas (TCGA), we found that TCF19 is significantly increased in the lung adenocarcinoma (LAC) and squamous cell carcinoma (SCC), two primary histological subtype of NSCLC. Besides, further function cluster analysis exhibited that TCF19 may mainly participate in cell cycle. MTT, colony formation, and anchorage-independent growth ability assay confirmed that overexpression of TCF19 enhances the proliferation of both LAC and SCC cells. Besides, further experiments revealed that TCF19 contributes to cell cycle G1/S transition. Not only that, upregulation of TCF19 can inhibit the expression of p21, p27, and p57, while promote the expression of cyclin D1 by inhibiting FOXO1. Our research offers important evidence that TCF19 can promote cell-cycle progression of NSCLC cells, and TCF19 may served as novel therapeutic targets.

[Predictive value of c-met for long-term mortality in patients with esophageal squamous cell carcinoma].

OBJECTIVE: To explore the correlation of c-met protein with the clinical staging and cell differentiation of esophageal squamous cell carcinoma (ESCC). METHODS: A total of 100 patients with ESCC were enrolled were examined for expression of c-met protein using immunohistochemistry, and the patients in negative and positive c-met expression groups were compared for clinicopathological characteristics and overall survival. RESULTS: s The 100 ESCC patients included 67 male and 33 female patients with a median age of 59 years; 49 of the patients were negative and 51 were positive for c-met expression. Positive c-met expression was significantly correlated with advanced TMN stages and lower tumor differentiation. Kaplan-Meier survival curve showed that the median survival time of c-met-positive patients was significantly reduced compared with that of c-met-negative patients (30.9 vs 48.2 months, P<0.05). COX regression analysis showed that c-met was a independent risk factor for the overall survival of the patients (HR: 2.34, 95% CI: 1.63-4.54, P<0.05). CONCLUSION: A positive expression of c-met protein is significantly correlated with an advanced TMN stage, lower tumor differentiation and a poor prognosis, and may serve as a indicator for predicting the prognosis of ESCC.

Surgical correction of 639 pectus excavatum cases via the Nuss procedure.

BACKGROUND: To review the clinical experience and short- to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). METHODS: From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3±5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3±1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). RESULTS: A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3±41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5±17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2±2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. CONCLUSIONS: Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined.

Prognostic factors in patients with recurrence after complete resection of esophageal squamous cell carcinoma.

BACKGROUND: Recurrence following complete resection of esophageal squamous cell carcinoma (SCC) still remains common. The aim of this study was to investigate the prognostic factors in patients with recurrence after complete resection of esophageal SCC. METHODS: The medical records of 190 patients with recurrent disease after complete resection of esophageal SCC were retrospectively reviewed. Recurrence pattern was classified as loco-regional recurrence and distant metastases. The Kaplan-Meier method was used for the survival analysis. Cox proportional hazards model was used for multivariate analysis. RESULTS: Mediastinal nodal clearance area was the most common sites of loco-regional recurrence, whereas lung, liver and bone were the most common sites for distant metastases. The median survival after recurrence was 8 months. The 1, 3, 5-year post-recurrence survival rates were 45.9%, 10.6% and 6.4%, respectively. The overall 1, 3, 5-year survival rates were 76.6%, 27.3% and 12.3%, respectively. The independent prognostic factors included time of recurrence (≥12 months vs. <12 months, HR: 3.228, 95% CI: 2.233-4.668), pattern of recurrence (local-regional recurrence vs. distant metastases, HR: 1.690, 95% CI: 1.170-2.439), and treatment of recurrence [no treatment vs. treatment (radiotherapy or surgery or chemotherapy), HR: 0.642, 95% CI: 0.458-0.899]. CONCLUSIONS: Our retrospective study showed that time of recurrence, pattern of recurrence and treatment of recurrence were independent prognostic factors in patients with recurrence after complete resection of esophageal SCC.

[Clinicopathological characteristics and prognosis of young esophageal cancer patients].

OBJECTIVE: To compare the clinicopathological features and prognosis of esophageal cancer between young and elderly patients. METHODS: Clinical data of 716 patients with esophageal squamous cell carcinoma undergoing curative operation from January 1990 to December 1998 at the Cancer Center of Sun Yat-sen University were analyzed retrospectively. Clinicopathological features and prognosis of 117 patients aged ≤45 years (young group) at diagnosis were compared with 599 patients aged >45 years (elderly group). RESULTS: Except for tumor stage, there were no significant differences of clinicopathology between the young group and the elderly group (all P>0.05). There were more pathologic stage III cancer in the young group than the elderly group (47.9% vs. 33.6%, P=0.010). The 5-year survival rate (36.0% vs 33.8%) and 10-year survival rate (29.2% vs 25.0%) were not significantly different between the two groups (P=0.418). Multivariate analysis showed that the age was not the independent prognostic factors of esophageal squamous cell carcinoma (P=0.160, RR=1.187, 95%CI:0.935-1.506). CONCLUSION: Young esophageal cancer patients have more advanced tumors than elderly patients. However, the survival is comparable to the elderly.

[Dendritic cell-tumor cell fusion vaccine prevents growth of subcutaneous transplanted esophageal carcinomas].

BACKGROUND AND OBJECTIVE: Our previous studies have shown that dendritic cell (DC)-tumor cell fusion vaccine can induce specific antitumor response against esophageal carcinoma cells. This study was to investigate the inhibitory effect of intratumor injection of the antigen-specific cytotoxic T lymphocytes (CTLs) induced by DC-tumor cell fusion vaccine against subcutaneously transplanted esophageal carcinoma cells in nude mice, and to analyze the influence of DC/tumor cell fusion vaccine on proliferation and apoptosis of esophageal carcinoma cells. METHODS: Fusion cell vaccine of mature DCs with EC109 cells were generated by the polyethylene glycol (PEG) protocol and the antigen-specific CTLs were induced. The models of transplanted human esophageal carcinoma in nude mouse were established using EC-109 cell line. Thirty-three nude mice with subcutaneous tumors were randomly divided into three groups. Subcutaneous tumors of group A (n=11), group B (n=11) and group C (n=11) were intratumorally injected with the CTLs induced by DC/tumor fusion vaccine, T lymphocytes and RPMI 1,640 medium respectively once a week. After four weeks of intratumor injection, the nude mice were killed and the nodules were anatomized. The mean volume and weight of tumors of each group were measured, and the tumor inhibitory rates of the Group A and the Group B were calculated and compared. The expression of proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry (S-P method). The mean PCNA-label index (LI) of three groups was compared. The cell cycle and cell apoptosis of the xenograft tumor cells were analyzed by flow cytometry. The mean S-phase fraction (SPF) and the mean rate of cell apoptosis of three groups was compared respectively. RESULTS: Both the mean volume and the mean weight of xenograft tumors in group A (881.45+/-31.14 mm3 and 0.88+/-0.04 g) were significantly smaller than those of group B (1493.37+/-51.67 mm3 and 1.38+/-0.07 g) and group C (2065.77+/-87.55 mm3 and 2.04+/-0.11 g). The tumor inhibitory rates of Group A was significantly higher than that of group B (56.86% vs. 32.35%, F=1218.08, P=0.001). The mean PCNA-LI of xenograft tumors was less in the group A (26.83+/-0.95)% than in the group B (51.82+/-1.51)% and group C (68.93+/-2.40)% (F=1528.39, P=0.000). The mean SPF of xenograft tumors was less in the group A (12.46+/-0.36)% than in the group B (29.39+/-0.96)% and the group C (42.25+/-1.43)% (P<0.05). The mean apoptotic rate of xenograft tumors was less in the group A (38.03+/-1.21)% than in the group B (17.75+/-0.56)% and the group C (6.59+/-0.22)% (P<0.05). CONCLUSION: The model of subcutaneous xenograft tumors in nude mice using human esophageal carcinoma cell line EC-109 has been successfully established. CTLs induced by DC/tumor fusion vaccine has specific antitumor immunity efficacy in vivo. CTLs can inhibit the proliferation of tumor cells and induce apoptosis of tumor cells in local tumors.

[Clinical analysis of 22 cases of esophageal adenosquamous carcinoma].

OBJECTIVE: This study was to review the clinical features, diagnosis, treatment, and prognosis of esophageal adenosquamous carcinoma (ASC). METHODS: Clinical data of 22 patients with pathologically confirmed esophageal ASC, treated in the Cancer Center of Sun Yat-sen University from May 1988 to April 2006, were retrospectively analyzed. The survival analysis was performed using Kaplan-Meier method. RESULTS: Of 4208 patients diagnosed as esophageal cancer during the same time in our center, only 22 had esophageal ASC, accounted for 0.52%. The median age of the 22 cases was 60 years (range, 42 to 69 years). Esophageal ASC showed similar clinical symptoms, radiological and endoscopic features to esophageal squamous cell carcinoma (ESCC). Nineteen cases were preoperatively misdiagnosed as ESCC by endoscopic biopsy. Among the 22 patients, 16 were treated by surgery alone, 3 by surgery plus postoperative radiotherapy, and the remaining 3 by radiotherapy, sequential chemoradiotherapy and concurrent chemoradiotherapy, each in one case, respectively. The overall 1-, 3- and 5-year survival rates were 67.6%, 33.8% and 18.1%, respectively, with a median survival time of 24.5 months. CONCLUSION: Esophageal adenosquamous carcinoma is a rare esophageal disease and prone to be misdiagnosed as esophageal squamous cell carcinoma. Initial surgical treatment combined with other therapies is suggested. The prognosis of esophageal adenosquamous carcinoma has not yet been well established.

[Surgical treatment and prognosis in patients with squamous cell carcinoma of thoracic esophagus].

OBJECTIVE: To analyze the prognostic factors of thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy. METHODS: The clinicopathologic data of 716 patients with thoracic ESCC from January 1990 to December 1998 were analyzed retrospectively. There were 538 male and 178 female patients aged from 24 to 78 years old with a median of 57 years old. Cumulative survival rate was analyzed by the Kaplan-Meier method and compared by the Log-rank test. COX regression model was used for multivariate prognostic analysis. RESULTS: The overall 1-, 3-, 5- and 10-year survival rates were 82.9%, 44.3%, 34.2% and 25.7% respectively. The 5-year survival rates was 80.0%, 51.2%, 19.7% and 13.3% for stage I, stage IIA, stage IIB and stage III respectively. Of the 716 patients, 151 (21.1%) patients recurred, including 48 (84.2%) of stage IIA recurrence, 22 (91.7%) of stage IIB recurrence and 63 (90.0%) of stage III recurrence occurred within 3 years postoperatively. Univariate analysis revealed that the factors impacting the prognosis were gender, depth of invasion, lymph node metastasis, pathologic stage, number of lymph node metastatic field, differentiation, surgical margin and tumor relapse. Multivariate analysis showed that depth of invasion, lymph node metastasis, pathologic stage and tumor relapse were independently associated to poor prognosis. CONCLUSIONS: Depth of invasion, lymph node metastasis, pathologic stage and tumor relapse are the independent factors of ESCC. Surgery is still the primary treatment for stage I-IIA esophageal cancer; but it is suggested to adopt surgical treatment as primary modality combined with other therapies for stage IIB-III esophageal cancer.

[Detection and clinical significance of cervical lymph node micrometastases in patients with cN0 tongue squamous cell carcinoma].

BACKGROUND & OBJECTIVE: Postoperative relapse in tongue squamous cell carcinoma patients with pathologically negative cervical lymph node might be related to micrometastases. This study was to detect the lymph node micrometastases in cN0 tongue cancer patients, and explore its clinical significance. METHODS: A total of 523 cervical lymph nodes taken from 49 tongue cancer patients were examined by routine HE staining and immunohistochemistry (IHC) with anti-cytokeratin antibody (CK19) staining. The follow-up period ranged from 9 to 83 (mean 56) months. RESULTS: Metastases were detected in 7 (1.3%) lymph nodes from 5 patients with HE staining, and in 34 (6.5%) lymph nodes from 19 patients with CK19 staining. Micrometastases were detected in 27 (5.2%) lymph nodes from 14 patients. The difference in detecting lymph node metastases between two methods was significant (P=0.001). HE staining upstaged 3 cases from cN0 to pN1, and 2 cases from cN0 to pN2b; IHC staining upstaged 3 cases from cN0 to pN1, and 16 cases from cN0 to pN2b. Lymph node micrometastases showed no correlation to sex, age, T stage, differentiation, and depth of primary tumor invasion (P>0.05). The 5-year survival rates of the patients with and without micrometastases were 78.5% and 86.7%, respectively (P>0.05). CONCLUSIONS: CK19 staining could increase the detection rate of cervical lymph node metastases and the accuracy of pathologic stage in tongue cancer. The results of our study showed that the presence of lymph node micrometastasis has no correlation to the prognosis. A further study is needed.

[Survival analysis of patients with stage II squamous cell carcinoma of the thoracic esophagus after esophagectomy].

BACKGROUND & OBJECTIVE: Esophageal cancer is a common malignant tumor in China. At the time of diagnosis, most patients are at locally advanced stage. Up to date, surgical resection is the main treatment of esophageal cancer. This study was to analyze the correlations of clinicopathologic features of stage II thoracic esophageal squamous cell carcinoma (ESCC) to the prognosis. METHODS: The clinicopathologic data of 467 patients with stage II thoracic ESCC, treated with surgery from Jan. 1990 to Dec. 1998 in Cancer Center of Sun Yat-sen University, were analyzed. Cumulative survival was analyzed by Kaplan-Meier method and compared by log-rank test. The prognosis was analyzed by Cox regression model. RESULTS: The overall 1-, 3-, 5-, and 10-year survival rates were 87.1%, 54.6%, 43.0%, and 32.3%, respectively. The 5-year survival rates of patients at stage II A and stage II B were 51.0% and 19.9%. Of the 467 cases, 81 (17.3%) recurred, and 70 (86.4%) of them recurred within 3 years after operation. Univariate analysis revealed that the factors affecting the prognosis included gender, depth of invasion, lymph node metastasis, pathologic stage, number of lymph node metastatic fields, differentiation, positive surgical margin and tumor recurrence. Multivariate analysis showed that gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence were independent prognostic factors. CONCLUSIONS: Gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence are independent prognostic factors of stage II ESCC. Surgery is still the primary treatment for stage II A esophageal cancer; but surgery-dominant treatment combined with other therapies is recommended for stage II B esophageal cancer.

[Application of helix water jet to parotid surgery].

BACKGROUND & OBJECTIVE: Dissecting the facial nerves safely is an important guarantee for the accomplishment of parotidectomy and reduction of postoperative complications. This study was to explore the application of helix water jet to parotidectomy. METHODS: Clinical data of 43 patients with parotid tumors, who received operation with helix water jet from Feb. 2004 to Feb. 2005 at Cancer Center of Sun Yat-Sen University, were analyzed. Meanwhile, traditional techniques in parotidectomy was performed in 36 patients (control group). Duration of operation, postoperative drainage volume, postoperative hospitalization, and occurrence of postoperative complications, such as facial nerve dysfunction and salivary fistula, of the 2 groups were compared. RESULTS: The postoperative drainage volume was significantly lower in water jet group than in control group [(9.89+/-3.74) mL vs. (12.15+/-2.11) mL, P<0.05]. There were no significant differences in duration of operation [(90.28+/-25.30) min vs. (76.32+/-20.74) min, P>0.05], postoperative hospitalization [(6.39+/-1.38) days vs. (6.45+/-1.05) days, P>0.05] between the two groups. Of the 43 patients in water jet group, 6 (14.0%) had grade II facial nerve dysfunction and 1 (2.3%) had grade III facial nerve dysfunction; of the 36 patients in control group, 5 (13.9%) had grade II facial nerve dysfunction, 2 (5.6%) had grade III facial nerve dysfunction, 1 (2.8%) had grade IV facial nerve dysfunction and 1 (2.8%) had salivary fistula. There was no permanent facial nerve dysfunction occurred in both groups. There was no significant difference in the occurrence of complications between the two groups. Nine patients who retained nervus auricularis magnus suffered from slight numbness symptom of auricular lobule. CONCLUSION: Use of helix water jet in parotid surgery is safe and confers some advantages over conventional methods of parotid dissection.