Association of perioperative oral swallowing function with post-esophagectomy outcomes and nutritional statuses in patients with esophageal cancer.

Dysphagia after esophagectomy is a serious complication; however, no method has been established to accurately assess swallowing function. We evaluated the association of swallowing function tests with patients' post-esophagectomy complications and nutritional statuses. We retrospectively reviewed the data of 95 patients with esophageal cancer who underwent esophagectomy between 2016 and 2021. We performed perioperative swallowing function tests, including the repetitive saliva swallowing test (RSST), maximum phonation time (MPT), and laryngeal elevation (LE). Patients with recurrent laryngeal nerve palsy (RLNP) and respiratory complications (RC) had significantly lower postoperative RSST scores than patients without them; the scores in patients with or without anastomotic leakage (AL) were similar. Postoperative MPT in patients with RLNP was shorter than that in patients without RLNP; however, it was similar to that in patients with or without AL and RC. LE was not associated with any complications. Patients with an RSST score ≤2 at 2 weeks post-esophagectomy had significant weight loss at 1, 6, and 12 months postoperatively compared with patients with an RSST score ≥3. The proportion of patients with severe weight loss (≥20% weight loss) within 1 year of esophagectomy was significantly greater in patients with RSST scores ≤2 than in those with RSST scores ≥3. Multivariate analysis showed that an RSST score ≤2 was the only predictor of severe post-esophagectomy weight loss. RSST scoring is a simple tool for evaluating post-esophagectomy swallowing function. A lower RSST score is associated with postoperative RLNP, RC, and poor nutritional status.

The Prognostic Significance of Preoperative Anemia in Gastric Cancer Patients.

BACKGROUND/AIM: This study aimed to investigate the prognostic significance of preoperative anemia in gastric cancer patients. PATIENTS AND METHODS: The medical records of 801 patients with gastric cancer who underwent gastrectomy at the Nara Medical University hospital, were reviewed. Anemia was defined as a hemoglobin (Hb) level of <10 g/dl. Multivariate analysis was performed to identify prognostic factors. RESULTS: The mean Hb level was 13.1 (SD=2.0). Sixty-four (8.0%) patients were classified into the anemic group. Anemic patients were significantly older than nonanemic patients (p=0.007). Anemia was significantly associated with cardiovascular disease (p=0.041), chronic renal failure (p<0.001), tumor depth (p<0.001), and lymph node metastasis (p=0.001). The overall survival (OS) and cause-specific survival (CSS) rates of anemic patients were significantly lower in comparison to the nonanemic patients (p<0.001). In a subgroup analysis, the OS rate of anemic patients was significantly lower than that of nonanemic patients among patients with stage I and stage II disease. According to a multivariate analysis, preoperative anemia was an independent prognostic factor for OS (p<0.001), but not CSS (p=0.555). The rate of non-cancer deaths among anemic patients was significantly higher than that among nonanemic patients (p<0.001). CONCLUSION: Preoperative anemia is a simple and reliable predictor of poor prognosis, and it is associated with a higher risk of non-cancer death.

Impact of CT-assessed changes in tumor size after neoadjuvant chemotherapy on pathological response and survival of patients with esophageal squamous cell carcinoma.

PURPOSE: Neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC) in Japan. Computed tomography (CT) is usually used to assess the therapeutic effect of NAC; however, there are no reliable criteria for predicting pathological response or patient prognosis. METHODS: We included 84 patients who underwent esophagectomy between January 2009 and December 2018 and retrospectively reviewed their CT scans performed before and after NAC. The reduction rate of the largest tumor area (TA), long diameter (LD), and short diameter (SD) were measured on a transverse CT image. The pathological response and cutoff values were calculated using the receiver operating characteristic curve, and the most suitable ones for determining the effect were examined. RESULTS: The areas under the curve for predicting responders to NAC based on the reduction rate of the TA, LD, and SD were 0.755, 0.761, and 0.781, respectively. The optimal cutoff value of the SD reduction rate for predicting responders to NAC was 22%. An SD reduction ≥ 22% was an independent prognostic factor for overall survival in univariate (p = 0.005, hazard ratio [HR] = 2.755) and multivariate analyses (p = 0.030 HR 2.690). Furthermore, an SD reduction of ≥ 22% was also an independent prognostic factor for relapse-free survival in the univariate (p = 0.007, HR = 2.491) and multivariate analyses (p = 0.007, HR = 0.030). CONCLUSIONS: The reduction rate of the tumor SD is a simple predictor of pathological response and patient prognosis.

Effect of Oral Nutritional Supplementation on the Prognostic Nutritional Index in Gastric Cancer Patients.

This prospective study was undertaken to investigate whether preoperative oral nutritional supplementation (ONS) would increase the prognostic nutritional index (PNI) in gastric cancer patients undergoing gastrectomy. Before surgery for resectable gastric cancer, Racol® NF (Otsuka Pharmaceutical Factory, Japan) was administered orally at a recommended dose of 600 kcal/600 ml per day to patients with a PNI of <48. The primary endpoint was the change in the PNI, which was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm3). Forty-six patients received Racol® NF. The mean PNI at baseline and before surgery was 44 ± 3.9 and 43 ± 4.4, respectively (p = 0.049). The mean serum albumin level was significantly decreased after the administration of Racol® NF (p = 0.001), while the mean total lymphocyte count (p = 0.001) and body weight (p = 0.004) were significantly increased. The mean daily intake and duration of Racol® NF administration were 340 ml and 22.6 day, respectively. Adverse events during the administration of Racol® NF were observed in 12 (26.1%) patients. The present study indicated that preoperative ONS did not increase the PNI in gastric cancer patients with low PNI values.

Impact of pretreatment asymptomatic renal dysfunction on clinical course after esophagectomy.

PURPOSE: Recent large-scale clinical studies have shown that preoperative renal insufficiency is associated with an increased risk of postoperative complications after esophagectomy; however, it remains unclear whether asymptomatic renal dysfunction affects the postoperative course after esophagectomy. METHODS: The subjects of this retrospective study were 177 patients who underwent esophagectomy between May, 2009 and December, 2018. Renal function was evaluated based on the pretreatment estimated glomerular filtration rate (eGFR). Patients were divided into two groups according to the eGFR cut-off value of 55 ml/min per 1.73 m2. RESULTS: There were 17 patients in the low eGFR group and 160 patients in the normal group eGFR group. The rate of severe complications was significantly higher in the low eGFR than in the normal eGFR group. A low eGFR was the only significant complication risk factor identified; however, there were no marked differences in mortality or survival between the low and normal eGFR groups. CONCLUSION: Our findings demonstrate that pretreatment asymptomatic renal dysfunction may be a significant risk factor for severe morbidity after esophagectomy.

Ring box protein-1 is associated with a poor prognosis and tumor progression in esophageal cancer.

Ring box protein-1 (RBX1) is an essential component of the S-phase kinase-associated protein, Cullin and F-box containing ubiquitin ligases. Overexpression of RBX1 has been reported in several cancer types; however, little is known regarding the prognostic value and role of RBX1 in esophageal cancer. The present study examined 120 patients with esophageal cancer (EC) who underwent curative esophagectomy and 61 patients with EC who underwent neoadjuvant combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU; DCF) using immunohistochemistry. All specimens were classified into two groups according to the percentage of RBX1-positive tumor cells. In addition, the impact of RBX1 expression on cancer cell proliferation was analyzed in vitro using a small interfering RNA silencing technique. RBX1 expression levels showed significant differences according to tumor size (P<0.001), tumor depth (P=0.002), lymph node metastasis (P=0.004), pathological stage (P=0.001), lymphatic invasion (P=0.001) and venous invasion (P=0.001). The overall survival (OS) rate in the RBX1 high expression group was significantly lower compared with that in the low group (P=0.004). Multivariate analysis demonstrated that RBX1 status was an independent prognostic factor. RBX1 gene silencing inhibited the proliferation of human EC cells and enhanced the antitumor effect of 5-FU. Among patients who underwent neoadjuvant DCF therapy, the RBX1 high expression group had a significantly lower OS rate compared with that of the RBX1-low group (P<0.001). In conclusion, RBX1 has notable prognostic value, and RBX1 may serve an important function in the tumor progression of EC.

RNF126 as a Marker of Prognosis and Proliferation of Gastric Cancer.

BACKGROUND/AIM: Ring finger protein 126 (RNF126) belongs to the family of RING E3 ubiquitin ligases. Although RNF126 has been reported to be overexpressed in several cancers, the role of RNF126 in gastric cancer remains unclear. MATERIALS AND METHODS: We investigated the RNF126 expression in 170 primary gastric cancer tissues by immunohistochemistry, and explored its prognostic impact. The effect of the RNF126 expression on the proliferation of cancer cells was evaluated in vitro. RESULTS: The RNF126 expression was significantly associated with tumor depth and presence of venous invasion. The RNF126 status was identified as an independent prognostic factor (p<0.001). RNF126 gene silencing significantly inhibited the proliferation of gastric cancer cells, induced G1 phase arrest and increased the p21 protein level. CONCLUSION: RNF126 expression has a significant prognostic value in gastric cancer. RNF126 may play an important role in tumor progression of gastric cancer.

Risk factors for stage underestimation in patients with clinical T1N0 gastric cancer.

PURPOSE: Limited gastrectomy has been generally performed in clinical T1N0 gastric cancer. The aim of this study was to identify risk factors for stage underestimation in clinical T1N0 gastric cancer. METHODS: This study reviewed the medical records of 566 patients who underwent gastrectomy for clinical T1N0 gastric cancer. RESULTS: The tumor stage was underestimated in 122 (21.6%) patients. The relapse-free survival rate was significantly lower in the patients with pathological stage II (P = 0.021) and III (P < 0.001) disease than in those with pathological stage IA disease. In the multivariate analysis, a location in the upper third of the stomach, tumor size of ≥ 30 mm, undifferentiated adenocarcinoma and clinical tumor depth of SM were identified as independent risk factors for pathological stages II and III. The rate of pathological stages II and III was 0% in the patients with no risk factors, 3% in those with 1 risk factor, 10.5% in those with 2 risk factors, 19.8% in those with 3 risk factors and 50% in those with 4 risk factors. CONCLUSIONS: Location, tumor size, undifferentiated adenocarcinoma and clinical tumor depth were independent risk factors for pathological stages II and III in clinical T1N0 gastric cancer.

Overexpression of Cullin4A correlates with a poor prognosis and tumor progression in esophageal squamous cell carcinoma.

BACKGROUND: Cullin4A (CUL4A), which is a component of E3 ubiquitin ligase, is implicated in many cellular events. Although the altered expression of CUL4A has been reported in several human cancers, the role of CUL4A in esophageal cancer remains unknown. METHODS: We investigated the CUL4A expression in primary esophageal squamous cell carcinoma (ESCC) tissue specimens from 120 patients by immunohistochemistry and explored its clinical relevance and prognostic value. Furthermore, the effect of the expression of CUL4A on cancer cell proliferation was analyzed in vitro using an siRNA silencing technique. RESULTS: The higher expression of CUL4A was significantly associated with a deeper depth of tumor invasion (P < 0.001) and the presence of venous invasion (P = 0.014). The disease-specific survival (DSS) rate in patients with tumors that showed high CUL4A expression levels was significantly lower than that in patients whose tumors showed low CUL4A expression levels (P = 0.001). Importantly, the CUL4A status was identified as an independent prognostic factor for DSS (P = 0.045). Our results suggested that the CUL4A expression has significant prognostic value in ESCC. Furthermore, CUL4A gene silencing significantly inhibited the proliferation of ESCC cells in vitro. In addition, the knockdown of the CUL4A expression induced G1 phase arrest and increased the p21 and p27 protein levels. CONCLUSIONS: CUL4A might play an important role in regulating the proliferation of ESCC cells and promoting the development of postoperative recurrence.

Risk Factors and Risk Scores for Predicting Early Recurrence After Curative Gastrectomy in Patients with Stage III Gastric Cancer.

BACKGROUND: We revealed patients with pathological stage (pStage) III gastric cancer (GC) who had early recurrence within 12 months after curative surgery. We identified risk factors for predicting early recurrence in patients with pStage III GC who underwent curative gastrectomy. METHODS: Between January 2007 and December 2016, 758 patients underwent gastrectomy in our institution. This retrospective study included 96 patients with pStage III who were divided into two groups: early recurrence within 12 months (ERec) and non-ERec (nERec). We investigated clinicopathological differences between ERec and nERec and extracted risk factors, and constructed risk scores for ERec. RESULTS: Of the 96 patients, 20 (20.8%) were ERec and 76 (79.2%) were nERec. Pathological lymph node metastasis (pN) ≥ 14 (P = 0.03), preoperative carbohydrate antigen 19-9 (CA19-9) ≥ 37 IU/ml (P = 0.02), and blood loss (BL) ≥ 445 ml (P < 0.01) were independent risk factors for ERec in the multivariate analysis. In subgroup analysis, tumor size, clinical lymph node metastasis (cN), and CA19-9 were extracted for preoperative predictors for ERec. Risk scores were assigned to tumor size (< 65 mm, 0; ≥ 65 mm, 1), cN (cN-, 0; cN+, 2), and CA19-9 (< 37 IU/ml, 0; ≥ 37 IU/ml, 2). High-risk group (score, 4, 5) for ERec had significantly shorter relapse-free survival than those with low-risk group (score, 0-3) (P = 0.02). CONCLUSIONS: We found pN ≥ 14, CA19-9 ≥ 37 IU/ml, and BL ≥ 445 ml were independent risk factors for ERec after curative gastrectomy in pStage III GC. Our risk score system may be useful to select patients with high risk of ERec preoperatively.

Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy.

PURPOSE: To investigate the change in skeletal muscle mass and evaluate the prognostic impact of sarcopenia on esophageal cancer (EC) patients METHODS: The subjects of this retrospective study were 90 EC patients who were treated with neoadjuvant chemotherapy (NAC) and subsequent esophagectomy. The skeletal muscle index (SMI) was defined according to computed tomography (CT) imaging of the total cross-sectional muscle tissue, measured at the third lumbar level using a volume analyzer before NAC and surgery. The SMI was calculated by normalization according to height, and skeletal muscle loss (SML) was defined as (pre-NAC SMI value - preoperative SMI value) × 100/pre-NAC SMI. RESULTS: Sarcopenia was evident in 72 (80.0%) patients before NAC and 77 (85.6%) patients before NAC and surgery. The SMI value was decreased in 28 (68.9%) patients and the median SML was 3.3%. The 3-year overall survival rate was 68.9% in the low SML group and 0% in the high SML group (P < 0.001). Sarcopenia before NAC or surgery was not significantly associated with overall survival. Multivariable analysis identified high SML as an independent prognostic factor. CONCLUSIONS: These results suggest that skeletal muscle loss is associated with a worse long-term outcome for EC patients treated with NAC.

Postoperative Serum C-Reactive Protein Level Predicts Long-term Outcomes in Stage I Gastric Cancer.

BACKGROUND: The aim of this study was to investigate the prognostic impact of postoperative systemic inflammation in patients with stage I gastric cancer. METHODS: This study reviewed the medical records of 470 patients with stage I gastric cancer who underwent gastrectomy. The postoperative serum C-reactive protein (CRP) level on postoperative days (PODs) 1 and 3 and its peak value were evaluated as prognostic factors. A receiver operating characteristics curve analysis was performed to determine their cut-off values. RESULTS: The CRP level on POD 3 (P = 0.001) and the peak CRP level (P = 0.007) were significantly associated with the overall survival rate. In the multivariate analysis, the CRP level on POD 3 (P = 0.002) and the peak CRP level (P = 0.008) were identified as independent predictors of the overall survival. The high CRP on POD3 group had significantly higher mortality rate from relapse of gastric cancer (P = 0.001) and infectious disease (P = 0.003) than the low CRP on POD 3 group. The CRP level on POD 3 was significantly associated with the patient sex, surgical procedure, duration of the operation, amount of blood loss, postoperative infectious complication, and peak CRP level. CONCLUSIONS: The serum CRP level during the early postoperative period predicts the long-term outcomes in stage I gastric cancer. The present study suggests a significant influence of postoperative systemic inflammation on the survival of patients with stage I gastric cancer.

Anastomotic leakage following retrosternal pull-up.

PURPOSE: Narrow thoracic inlet might be associated with increased incidence of cervical anastomotic leakage (AL) after esophagectomy with retrosternal reconstruction. We retrospectively evaluated the relationship of the length from the suprasternal notch to the trachea (LST) and AL using computed tomography. METHODS: In this retrospective study including 121 patients with esophageal cancer who underwent subtotal esophagectomy with retrosternal reconstruction between 2008 and 2016, clinicopathological characteristics, including the LST, surgical procedures, and perioperative outcomes, were compared between the AL and non-AL groups. RESULTS: AL occurred in 19 of the 121 patients (15.7%). There were no associations between AL development and age, sex, body mass index, tumor location, TNM stage, histological type, surgical approach, or type of the anastomotic procedure. Surgery duration was longer in the AL group than in the non-AL group (p = 0.004). Other surgical factors such as intra-operative blood loss and anastomotic technique were not associated with AL. LST was significantly shorter in the AL group than in the non-AL group (p < 0.001). Multivariate analysis revealed that LST was a significant predictor of AL (p < 0.001). CONCLUSION: LST is a simple and useful predictor of AL after esophagectomy with retrosternal reconstruction.

Prognostic value of the fibrinogen-to-platelet ratio as an inflammatory and coagulative index in patients with gastric cancer.

PURPOSE: We assessed the prognostic value of the fibrinogen-to-platelet ratio (FPR) as an inflammatory and coagulative index by examining its clinicopathologic and prognostic efficiency in patients with gastric cancer (GC). METHODS: The subjects of this retrospective study were 182 GC patients whose FPR was measured preoperatively between January, 2001 and December, 2006. The FPR was defined as the plasma fibrinogen divided by the platelet counts. RESULTS: Patients aged ≥ 65 years and with venous invasion had a significantly higher FPR (p = 0.02 and p < 0.01, respectively) than those aged < 65 years and without venous invasion. We found a correlation between the FPR and all recurrences (p < 0.01). Patients with a low FPR had significantly better overall survival (OS) and relapse-free survival (RFS) rates than patients with a high FPR (p = 0.001 for both). Furthermore, the FPR was an independent predictor of OS and RFS (p = 0.02 and 0.001, respectively), but the fibrinogen level was not. In a subgroup analysis, the FPR was a significant prognostic factor for OS and RFS in patients with pathological stages II/III disease and in patients aged < 65 years. CONCLUSION: The FPR can be calculated easily and is more useful than the fibrinogen level for predicting the prognosis of GC patients. Patients with a high FPR, particularly those with undifferentiated tumors, those with pStage II/III disease, and those aged < 65 years, require more intensive chemotherapy.

The Prognostic Significance of the Geriatric Nutritional Risk Index in Patients with Esophageal Squamous Cell Carcinoma.

The aim of this study was to investigate the impact of the geriatric nutritional risk index (GNRI) on the long-term outcomes in 137 esophageal squamous cell carcinoma (ESCC) patients who underwent curative esophagectomy. The GNRI was calculated from the serum albumin value and the body weight. The cutoff value of the GNRI was set at 98. A multivariate analysis was performed to identify prognostic factors for the overall survival (OS). The mean preoperative GNRI was 99.9 ± 7.8. Forty-five (32.8%) patients had a GNRI of <98. The GNRI was significantly associated with the tumor depth (p = 0.001), level of carcinoembryonic antigen (CEA; p = 0.009) and level of C-reactive protein (CRP; p = 0.028). The GRNI was significantly associated with the OS (p < 0.001). The multivariate analysis identified the GNRI as an independent predictor for the OS. Death due to EC was more frequent in the patients with a low GNRI than in the patients with a high GNRI (p = 0.004). Our results suggest that the GRNI is a simple and reliable predictor of the postoperative survival in ESCC patients. A low preoperative GNRI may indicate a higher risk of EC death.

A neuroendocrine carcinoma with a well-differentiated adenocarcinoma component arising in Barrett's esophagus: a case report and literature review.

BACKGROUND: An esophageal neuroendocrine carcinoma arising in Barrett's esophagus is extremely rare. Here, we report a case of an esophageal neuroendocrine carcinoma with a well-differentiated adenocarcinoma component arising in Barrett's esophagus and review the literature. CASE PRESENTATION: A 71-year-old man with no symptoms was admitted to our hospital because of the detection of an esophagogastric junction tumor on regular upper endoscopy screening. Endoscopy revealed a sliding hiatal hernia and an approximately 10 mm elevated mass at the esophagogastric junction. Biopsy showed a moderately differentiated tubular adenocarcinoma. Computed tomography did not indicate lymph node metastasis or distant metastasis. Proximal gastrectomy with D1 lymph node dissection was performed along with jejunal interposition. On immunohistochemical staining, the tumor was positive for chromogranin A and synaptophysin. Ki-67 was positive in 40% of the tumor cells. The histological diagnosis was a neuroendocrine carcinoma with a well-differentiated adenocarcinoma component arising in Barrett's esophagus. The postoperative course was good, and the patient was discharged on the twentieth postoperative day. He has remained free of the disease at 36 months postoperatively. CONCLUSIONS: Barrett's esophagus may be related to the development of a neuroendocrine carcinoma.

Predictive Factors for Delayed Gastric Emptying after Distal Gastrectomy with Roux-en-Y Reconstruction.

Delayed gastric emptying (DGE) after distal gastrectomy (DG) followed by Roux-en-Y (R-Y) reconstruction is one of the most worrisome complications, and the course of DGE has not been completely elucidated. This retrospective study aimed to evaluate the frequency of DGE after DG followed by R-Y reconstruction for gastric cancer and identify the risk factors for its development. This study included 266 patients with gastric cancer who underwent DG followed by R-Y reconstruction between 2005 and 2016. We compared clinicopathological characteristics and surgical procedures between the DGE group and non-DGE group. DGE occurred in 24 of the 266 patients. There were no relationships of gender, age, TNM stage, historical grade, surgical approach, extent of lymphadenectomy, preservation of the vagal nerve, and reconstruction route with DGE development. Body mass index (BMI) was higher in DGE patients than in non-DGE patients (P = 0.053). Univariate analysis revealed that a tumor located in the lower third of the stomach (P = 0.005) and isoperistaltic reconstruction (P = 0.043) were significant factors for DGE. Multivariate analysis showed that a tumor located in the lower third of the stomach (P = 0.007), isoperistaltic reconstruction (P = 0.044), and BMI (P = 0.034) were significant predictors of DGE. Our findings suggest that tumor location, the direction of peristalsis for gastrojejunostomy, and BMI are associated with DGE after R-Y reconstruction.

Prognostic Significance of the Prognostic Nutritional Index in Patients with Recurrent Esophageal Squamous Cell Carcinoma.

The aim of this study was to evaluate the prognostic impact of the prognostic nutritional index (PNI) in patients with recurrent esophageal squamous cell carcinoma (ESCC). We retrospectively reviewed 76 ESCC patients who developed recurrence after curative subtotal esophagectomy at Nara Medical University Hospital between January 2001 and October 2016. The PNI at ESCC recurrence was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (/mm3). The cutoff value of the PNI was set at 45. Multivariate analysis was performed to identify the prognostic factors. The mean PNI was 44.0 ± 5.8, and 42 (55.3%) patients had a PNI <45 at recurrence. The multivariate analysis identified a low PNI (P = 0.047), multiple recurrence sites (P = 0.002), and no treatment for recurrence (P = 0.034) as independent factors for a short survival time after recurrence. A low PNI was significantly associated with a high performance status score, high C-reactive protein level, and short duration of treatment for recurrence. In conclusion, the PNI at recurrence can predict the survival time in patients with recurrent ESCC.

The prognostic significance of inflammation-based markers in patients with recurrent gastric cancer.

PURPOSE: The aim of this study was to evaluate the prognostic impact of inflammation-based markers, including the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI), in patients with recurrent gastric cancer (RGC). METHODS: This study reviewed 167 patients with RGC. A receiver operating characteristics (ROC) curve analysis was performed to determine the NLR and PNI cutoff values. The prognostic significance of the NLR and PNI was evaluated by a multivariate analysis. RESULTS: The optimal NLR and PNI cutoff values for predicting the 1-year survival after recurrence were 2.2 and 47, respectively. A univariate analysis revealed that the NLR (p < 0.001) and PNI (p < 0.001) were significantly associated with the survival time after recurrence, along with the histology, peritoneal recurrence, carbohydrate antigen 19-9, and chemotherapy for recurrence. In the multivariate analysis, a higher NLR (p < 0.001) and a lower PNI (p = 0.002) were independent predictors of a shorter survival time. Among the patients who underwent chemotherapy, the NLR and PNI were also independent prognostic factors. CONCLUSIONS: Inflammation-based markers, including the NLR and PNI, are simple and useful clinical biomarkers that can be used to predict the survival time of patients with RGC.

Usefulness of computed tomography density of a tumor in predicting the response of advanced esophageal cancer to preoperative chemotherapy.

BACKGROUND: In Japan, preoperative chemotherapy is considered essential for resectable stage II or III esophageal cancers. It is important to identify nonresponders for preoperative chemotherapy because continuing ineffective chemotherapy is not beneficial for them. We investigated the correlation between the computed tomography number of tumor and the effect of preoperative chemotherapy in patients with esophageal cancer. METHODS: This retrospective study included 50 patients receiving preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for stage II or III esophageal cancer. The computed tomography number of tumor was measured as the mean of Hounsfield Units of the primary lesion on a plain computed tomography measured within a freehand region of interest drawn around the tumor border. For analysis, the patients were classified into responders and nonresponders to chemotherapy, with the pathologic response evaluated using the Japanese and Mandard classification. We analyzed the associations between the computed tomography number of tumor and clinical factors; histopathologic features, including the tumor size, depth of tumor invasion, capillary invasion, Ki-67, p53, and CK5/6 expression; the pathologic response to chemotherapy and prognosis. RESULTS: There was a significant association between the computed tomography number of tumor and the response to chemotherapy. The cut-off value of the computed tomography number of tumor in predicting responders to chemotherapy was 40 Hounsfield Units (area under the receiver operating characteristic curve = 0.73, P = .009); patients with computed tomography number of tumor greater than this value significantly responded to chemotherapy (P = .02 in the Japanese and P = .009 in the Mandard classification) with good postoperative prognosis (P = .04). Only Ki-67 expression among the histopathogic features were associated with the computed tomography number of tumor in histopathologic features (P = .01). CONCLUSION: The computed tomography number of tumor may be useful to predict the efficacy of preoperative chemotherapy and subsequent prognosis for patients with advanced esophageal cancer.