A comparative analysis of clinicopathological factors and survival between esophageal basaloid squamous cell carcinoma and conventional esophageal squamous cell carcinoma.

INTRODUCTION: Recently, the number of diagnosed esophageal basaloid squamous cell carcinoma (EBSCC) has gradually increased. However, available data on EBSCC are limited to date. METHODS: A total of 165 EBSCC (Cohort 1) and 515 conventional esophageal squamous cell carcinoma (ESCC) (Cohort 2) were retrospectively analyzed. RESULTS: In Cohort 1, 70 cases only had invasive EBSCC component (42.4%, defined as Group 1), 73 cases had concomitant invasive ESCC component (44.2%, Group 2), and 22 had concomitant invasive poor-differentiated component (13.3%, Group 3). Lymph node metastasis rates of Group 3, Group 2 and Group 1 were ranked from high to low (P = 0.044). There were higher patient age (P = 0.047), smaller tumor size (P = 0.009), more nerve invasion (P < 0.001), and lower pTNM stage (P < 0.001) in EBSCC (Cohort 1), compared with ESCC (Cohort 2). In Cohort 1 and Cohort 2, pTNM stage was an independent prognostic factor for both DFS and OS. No significant survival difference was found between EBSCC (Cohort 1) and ESCC (Cohort 2) in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage (P > 0.05). CONCLUSION: Our analysis of the largest EBSCC series from a single institution to date with conventional ESCC demonstrated that EBSCC carried a similar prognosis with ESCC in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage. And pure EBSCC, didn't have poorer survival than mixed EBSCC with concomitant ESCC or other components. Our findings may be valuable in the better understanding of EBSCC's biological behaviors, and the related molecular mechanism is needed to be explored in the future.

The Circular RNA-miRNA Axis: A Special RNA Signature Regulatory Transcriptome as a Potential Biomarker for OSCC.

Oral squamous cell carcinoma (OSCC) is a highly recurrent form of cancer arising from the oral epithelium, which is the result of mutational change due to etiological factors such as tobacco, smoking, chewing of areca nuts, and alcohol consumption. OSCC occurrence has been observed to be prevalent in different regions of Pacific countries and in most Asian countries. Despite the accessibility of the oral cavity, OSCC is diagnosed at an extremely late stage of pathogenic tumor node metastasis pTNM (III-IV), resulting in a poor prognosis for the individual. Therefore, it is important to make definitive, early, and efficient diagnoses. Owing to the development of omic-natured studies, the presence of proteins, transcribed elements, metabolic products, and even microflora detected in saliva helps us to select biomarkers, which is an especially exciting potential because of the availability and the non-invasive nature of sample collection. Since the discovery of circular RNA (circRNA) by Sanger sequencing, it has been reported to play a pivotal role in several human diseases, including cancer. circRNA functions as a microRNA (miRNA) sponge in the regulation of mRNA expression, forming the circRNA-miRNA regulatory axis. In the case of OSCC, overexpression of different circRNAs exhibits both tumor-progressive and tumor-suppressive effects.

Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy.

AIM: To assess the potential of using preoperative 18F-FDG PET/CT to predict the prognosis of patients with clear cell renal cell carcinoma (ccRCC) after nephrectomy. METHODS: Sixty-nine patients with newly diagnosed ccRCC who underwent 18F-FDG PET/CT prior to surgery were retrospectively reviewed. The metabolic parameters of maximum standardized uptake value (SUVmax) and tumor-to-liver ratio (TLR) from 18F-FDG PET/CT were obtained. Clinicopathological characteristics, including the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade, pathological tumor node metastasis (pTNM) stage, venous tumor thrombus, and so on, were acquired. Univariate and multivariate Cox proportional hazards analyses were performed to identify the prognostic factors for disease-free survival (DFS). RESULTS: Of the 69 patients, 25 patients (36.2%) experienced disease progression during the follow-up period. In univariate analysis, the primary tumor size (>4.85 cm), pTNM stage (Ⅲ/Ⅳ), WHO/ISUP grade (G3/4), venous tumor thrombus, adjuvant therapy, SUVmax (>3.55), and TLR (>1.66) were found to correlate with the incidence of decreased DFS (P < 0.05). In multivariate analysis, TLR (P = 0.007, HR: 5.489, 95%CI: 1.605-18.774) and pTNM stage (P = 0.024, HR: 10.385, 95%CI: 1.361-79.238) were revealed to serve as independent prognostic predictors for DFS after adjustment for other variables. Only 3 cases (8.3%) with normal TLR showed disease progression, while 22 cases (66.7%) with elevated TLR experienced disease progression. CONCLUSION: ccRCC patients with preoperatively elevated TLR (>1.66) and high pTNM stages (Ⅲ/Ⅳ) had significantly unfavorable survival outcomes. These patients should be carefully monitored to detect the possibility of disease progression after nephrectomy as early as possible.

Comparison of the prognostic difference between ypTNM and equivalent pTNM stages in esophageal squamous cell carcinoma based on the 8th edition of AJCC classification.

Objective: With the separate ypTNM stage groupings established in the 8th edition of AJCC staging system for esophageal squamous cell cancer (ESCC), we aimed to evaluate the prognostic difference between ypTNM stage and equivalent pTNM stage. Methods: ESCC patients with surgery alone (cohort 1) and patients with neoadjuvant therapy plus surgery (cohort 2) were enrolled in the study. Results: In p0, pIb, pIIa, pIIb, pIIIa, pIIIb and pIVa stages of cohort 1, the 5-year DFS and OS rates were 100/100%, 80.5/86.2%, 58.9/57.8%, 51.1/52.7%, 36.3/35.8%, 21.5/22.6% and 11.9/18.0%. In ypI, ypII, ypIII and ypIVa stages of cohort 2, the 5-year DFS and OS rates were 60.9/67.0%, 44.3/52.1%, 48.4/43.2% and 0. Patients in ypI stage had a tendency of poorer survival compared with those in pI stage (P=0.024 for DFS, P=0.067 for OS). There was no significant difference in terms of DFS (P=0.335) or OS (P=0.903) between ypII and pII. Patients in ypIII stage had a tendency of better survival compared with those in pIII stage (P=0.015 for DFS, P=0.059 for OS). Patients in ypIVa stage exhibited a significantly poorer OS compared with those in pIVa stage (P=0.038). Conclusions: With down-staged tumor after neoadjuvant therapy, survival of ypI was closed but not reached to the prognosis of equivalent pI, prognosis of ypII was similar to equivalent pII, and survival of ypIII tended to be better compared with equivalent pIII. However, without down-staged ypIVa tumor, the prognosis was worse compared with equivalent pIVa, indicating those patients were primary resistant to prescribed neoadjuvant therapy.

Type of preoperative therapy and stage-specific survival after surgery for rectal cancer: a nationwide population-based cohort study.

Preoperative chemoradiation therapy (CRT) may induce downstaging in rectal cancer (RC). Short-course radiation therapy (SC-RT) with immediate surgery does not cause substantial downstaging. However, the TNM classification adds the "y" prefix in both groups to indicate possible treatment effects. We aim to compare stage-specific survival in these patients. RC patients treated with surgery only, preoperative SC-RT followed by surgery within 10 days, or preoperative CRT, and diagnosed between 2008 and 2014 were included in this population-based study. Clinicopathological and outcome characteristics were analyzed. The study included 11,925 patients. Large discrepancies existed between clinical and pathological stages after surgery only. Surgery-only patients were older with more comorbidities compared with SC-RT and CRT and had worse 5-year survival (64%, 76%, and 74%, respectively; p < 0.001). Five-year survival for stage I was similar after CRT and SC-RT (85% vs. 85%; p = 0.167) and comparable between CRT-treated patients with stage I and those reaching a pathological complete response (pCR; 85% vs. 89%; p = 0.113). CRT was independently associated with worse overall survival compared with SC-RT for stage II (HR 1.57 [95%CI 1.27-1.95]; p < 0.001) and stage III (HR 1.43 [95%CI 1.23-1.70]; p < 0.001). Stage I disease after CRT has an excellent prognosis, comparable with pCR and with same-stage SC-RT-treated patients without regression. Stage II or III after CRT has worse prognosis than after SC-RT with immediate surgery. TNM should take the impact of preoperative therapy type on stage-specific survival into account. In addition, clinical stage was a poor predictor of pathological stage.

Different prognostic implication of ypTNM stage and pTNM stage for gastric cancer: a propensity score-matched analysis.

BACKGROUND: Pathological stage is considered as the best prognosis indicator for gastric cancer. With the increasing use of neoadjuvant chemotherapy (NACT), the latest TNM staging included a new pathological stage of ypTNM for patients with NACT. However, no study has investigated if ypTNM stage has the same prognostic implication as pTNM stage for gastric cancer. METHODS: We retrospectively selected eligible patients within a prospectively maintained database containing all patients treated with gastric cancer in Peking University Cancer Hospital from 2007 to 2015 using overall survival as the outcome. Patients using ypTNM and pTNM were 1:1 matched by propensity scores (PS) calculated from a model containing variables associated with ypTNM use or survival. Overall survival was compared by unconditional Cox regression. Conventional multivariate analysis was conducted to corroborate PS matching results. RESULTS: 1441 patients were included in the analysis with a median follow-up of 37 months (range = 2-106). The matched sample contained 756 patients. After PS matching, patients with specific ypTNM stage were 1.34 (95%CI = 1.05-1.72, P = 0.019) times more likely to die than patients with the same pTNM stage. Similar to the results of PS matching, multivariate Cox regression yielded a hazard ratio (HR) of 1.35 (95%CI = 1.09-1.67, P = 0.006). Subgroup analysis indicated this survival difference between ypTNM and pTNM stage varied by the specific TNM stage of patients. The HR was 3.44 (95%CI = 1.06-11.18, P = 0.040) and 1.28 (95%CI = 1.00-1.62, P = 0.048) for patients in stage I and III, respectively; whereas for stage II patients, no significant difference was observed (HR = 1.37, 95%CI = 0.78-2.38, P = 0.27). CONCLUSION: Gastric cancer patients with specific ypTNM stage had worse prognosis compared to those at the same stage defined by pTNM.

Expression of ACSL4 in gastric cancer tissues and its correlation with prognosis / 国际生物医学工程杂志

Objective To detect the expression of ACSL4 in human gastric cancer tissue and to analyze its clinical significance. Methods The bioinformatics method was used to analyze the mRNA level of ACSL4 in gastric cancer tissues and normal tissues, and to analyze the relationship between its expression and disease-free survival rate of gastric cancer patients. The clinical and pathological data of 62 patients with gastric cancer who underwent surgical treatment were retrospectively analyzed. Immunohistochemistry was used to detect the expression of ACSL4 protein in gastric cancer tissues and adjacent tissues, and to analyze its relationship with clinicopathological characteristics of gastric cancer patients. Results The results of bioinformatics analysis showed that the mRNA of ACSL4 was significantly overexpressed in gastric cancer tissues, and was significantly related to the disease-free survival rate of patients. Immunohistochemical results showed that ACSL4 was mainly cytoplasmic and highly expressed in gastric cancer tissues, while low or no expression in adjacent tissues. The protein expression level of ACSL4 was related to tumor size and pTNM (all P<0.05), but not to the patient's age, gender and tumor grade (all P>0.05). Conclusions The expression of ACSL4 in gastric cancer tissues is abnormally increased, and it is related to tumor size and pTNM stage. The results of this study suggest that the expression of ACSL4 is related to the prognosis of patients.

Is the new distribution of early esophageal adenocarcinoma stages improving the prognostic prediction of the 8th edition of the TNM staging system for esophageal cancer?

BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system released in 2017 reclassified the pTNM stage of early esophageal adenocarcinoma from stage IA in the 7th edition to stage IA and IB and from stage IB in the 7th edition to stage IC. In this study, we analyzed the reliability of the new staging system through clinical data analysis. METHODS: We selected patient data from the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2014, data for a total of 714 patients were included in the study and were divided into groups representing stage IA (n=84), IB (n=386) and IC (n=244) according to the 8th edition. RESULTS: In the 8th edition, there was no significant difference between groups IA and IB in overall survival (OS) (P=0.331) or esophageal cancer-specific survival (ECSS) (P=0.341). However, the long-term survival rates of groups IA and IB were significantly higher than those of group IC. Cox regression analysis indicated that the use of new staging system does not affect prognosis. We also attempted to stratify the tumors by T stage and histological grade but found no significant difference. CONCLUSIONS: We used the SEER database to compare the staging of early esophageal adenocarcinomas between the 8th and 7th editions of the AJCC/UICC TNM staging system. Based on our data, the 8th edition is not superior to the 7th edition.

A more sensitive detection of micrometastases of NSCLC in lymph nodes using the one-step nucleic acid amplification (OSNA) method.

BACKGROUND: Detection of tumor cells in lymph nodes (LNs) removed during the treatment of pulmonary tumor by radical surgery is limited by the possibilities of standard histopathological methods. The goal of this study was to obtain more accurate pTNM status by a more sensitive detection of micrometastases in LNs. METHODS: A total of 885 LNs, an average of 13.8 LNs per patient, were removed during 64 surgeries. LNs from the same zone were pooled together as a group, five groups of LNs were examined in each patient. A total of 320 groups of LNs were examined. One-step nucleic acid amplification (OSNA) method was compared to standard histopathological examination with haematoxylin-eosin (H&E) staining and CK19 immunohistochemistry, specifically by an ultimate analysis of all intraoperatively removed LNs. RESULTS: Identical results for H&E and OSNA examinations were recorded in 286 groups of LNs (89.4%). In total, positive examinations were recorded in 27 groups of LNs (8.4%) using the OSNA method, which were H&E negative. In seven groups of LNs (2.2%), the H&E examination was positive, while OSNA method produced negative results. CONCLUSIONS: The OSNA examination led to a higher pTNM stage classification in 14 (21.9%) patients. The clinical significance remains the subject of follow-up research.

Clinical and histopathological staging in oral squamous cell carcinoma - Comparison of the prognostic significance.

BACKGROUND: In oral cancer the prognostic significance of clinical staging (cTNM) is regarded inferior to histopathologic staging (pTNM) after surgery. This is mainly due to the point that the quality of the cTNM strongly depends on the clinical and radiological examination techniques applied and the physician's experience. The aim of this study was to evaluate the prognostic quality of cTNM and pTNM in a single center cohort. METHODS: This retrospective study included 392 patients with treatment-naive oral squamous cell carcinoma (OSCC). All patients received primary surgery including a neck dissection. According to tumor stage and histopathologic risk factors patients received adjuvant radiotherapy (RT) or radiochemotherapy (RCT). Prognostic factors were identified in univariate analysis by using the log rank test and in multivariate analysis through Cox regression. RESULTS: Clinical and histopathologic staging showed concordance in 62% for the primary tumor and 59% for cN- and pN-classification. In 58% of the cases of discordance the primary tumor was overstaged. In case of discordance of metastatic spread to the cervical lymph nodes, lymph node involvement showed overstaging in 78%. In univariate analysis cT-, cN-, cT- and pT-classification had a significant impact (p<0.05) on overall survival (OS). In multivariate analysis only pT- and pN-classification had a significant impact on OS. CONCLUSION: Despite advances and modern radiologic techniques, pTNM has a higher prognostic quality than cTNM. Discordance between clinical and histopathologic staging was observed in up to 40%. When discordance was observed overstaging for clinical T-stage and clinical N-stage was more likely than understaging.

[Prognostic value of preoperative carcinoembryogenic antigen: Is it useful in all stages of colorectal cancer?]. / Valor pronóstico pretratamiento del antígeno carcinoembrionario en el cáncer colorrectal operado. ¿Es útil en todos los estadios del tumor?

INTRODUCTION: Recent reports have reopened discussion of the prognostic value of elevated pre-treatment carcinoembryonic antigen (CEA) levels in colorectal cancer. Due to the discrepancies in the published results, we aimed to analyze the possible predictive value of CEA, both overall and in different tumoral stages in our environment. PATIENTS AND METHODS: We retrospectively studied 303 consecutive patients with colorectal cancer resected with curative intent by analysing tumor-related mortality. The frequency of patients with increased CEA levels (> 5mg/l) was registered. Univariate and multivariate analyses of survival curves were performed, comparing patients with increased CEA levels and those with CEA levels within normal limits, both in the overall series and in the different pTNM tumoral stages. RESULTS: Frequency of patients with CEA>5mg/l was 31%. The median clinical follow-up was 83 months. A poor survival rate was registered in the multivariate analysis of the whole series in patients with high CEA levels: hazard ratio (HR)=1.81; 95% confidence interval (95% CI)=(1.15-3.10); P=.012. This predictive value was only maintained in stage II in the survival analysis of the distinct tumoral stages (n=104): HR=3.02; 95% CI=(1.22-7.45); P=.017. CONCLUSIONS: Before treatment, 31% of our patients with colorectal cancer resected with curative intent had pathological CEA values. In the overall series, a high pretreatment CEA level showed an independent prognostic value for poor survival. When pTNM tumoral stages were analyzed separately, CEA level had predictive value only in pTNM II tumors.

Plasma miR-183 predicts recurrence and prognosis in patients with colorectal cancer.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. The prognosis for this cancer is poor, and the development of novel biomarkers, particularly non-invasive surrogate biomarkers, is urgently needed. Recent studies have demonstrated that microRNAs (miRNAs) are stably detectable in the blood and can serve as useful biomarkers for various types of cancer. In this study, the miR-183 expression levels were found to be significantly overexpressed in plasma samples from CRC patients compared with controls, and the postoperative plasma miR-183 levels were significantly reduced compared with the preoperative levels. The value of the area under the receiver operating characteristic (ROC) curve obtained for miR-183 was 0.829, which was higher than those for carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). High plasma miR-183 expression was significantly associated with lymph node metastasis, distant metastasis, higher pTNM stage (III-IV), and tumor recurrence. CRC patients with elevated miR-183 expression in plasma displayed shorter disease-free survival (DFS) and lower overall survival (OS). More importantly, plasma miR-183 was independently correlated with tumor recurrence and a lower OS. Collectively, our results suggested that the elevated miR-183 in the plasma could be a promising biomarker for predicting the risk of tumor recurrence and poor survival in CRC patients.

The clinicopathological significance of Lgr5 expression in lung adenocarcinoma.

BACKGROUND: The leucine-rich repeat-containing G-protein-coupled receptor 5 (Lgr5), also known as Gpr49, has been identified as a marker of crypt basal columnar stem cells along the gastrointestinal tract and of bulge stem cells in the hair follicle. The aims of this study were to immunohistochemically examine Lgr5 expression in surgically resected non-small cell lung carcinomas (NSCLC), and evaluate the relationships between Lgr5 expression and the clinicopathological parameters and prognosis of patients. METHODS: Lgr5 expression was immunohistochemically studied in 266 consecutive resected NSCLCs, and its associations with clinicopathological parameters including TTF-1 and CDX-2 expressions were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of Lgr5 expression on survival. RESULTS: Lgr5 was detected only in tumors with adenocarcinoma histology, and 16 cases were judged as positive. Among lung adenocarcinomas, Lgr5 expression was significantly associated with a larger tumor size (> 5 cm) (P = 0.033), higher pathological TNM stage of the disease (stage II and III) (P = 0.025), TTF-1-negative adenocarocinoma (P = 0.042), and poorer prognosis (P = 0.026). However, Lgr5 expression was not an independent predictor of poorer survival after controlling for clinicopathological factors. CONCLUSIONS: The present study reveals that Lgr5 is expressed in a subset of lung adenocarcinoma, and its expression is related to some clinicopathological parameters and a poorer prognosis, although further studies are required to clarify the biological function of Lgr5 in lung adenocarcinoma.

Expression patterns of interleukin-17 and matrix metalloproteinase-9 in non-small cell lung cancer and their relationship with pTNM stage / 肿瘤研究与临床

Objective To investigate the expression of interleukin-17 (IL-17) and matrix metalloproteinase-9 (MMP-9) in non-small cell lung cancer (NSCLC) and their relationship with pTNM staging.Methods IL-17 and MMP-9 expressions in cancer and adjacent tissues were detected from 102 cases of NSCLC by immunohistochemistry.x2 test was used to compare the ratio of their relationship with the pTNM stage.Results IL-17,MMP-9 expression rates in NSCLC cancer were 73.53 ％ (75/102),60.78 ％ (62/102)respectively,IL-17,MMP-9 expressions in different TNM stages were statistically significant correlated (P ＜ 0.05) respectively.The expression of IL-17 and MMP-9 in NSCLC tumor tissue were related statistically (P ＜ 0.05),and adjacent tissues were not related (P ＞ 0.05).Conclusion IL-17,MMP-9 in NSCLC tissues were significant increased,both may be involved in invasion and metastasis of NSCLC,IL-17 and MMP-9 were correlated in NSCLC tumor tissue but not in adjacent tissues.