Virtual Library

Background:
Lymph node metastasis is a significant prognostic factor in patients with resected esophageal cancer. Although the role of postoperative radiotherapy has not been confirmed, a large number of studies have shown that postoperative radiotherapy can improve the local control and survival, especially for stage III and lymph node positive patients. This study retrospectively analyzed the prognostic factors of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma (ESCC), and evaluated the prognostic value of different status of lymph node metastasis.

Method:
Data from 121 patients with locally advanced ESCC who underwent radical resection and received postoperative radiotherapy from 2006 to 2013 were reviewed retrospectively. OS and DFS were estimated using Kaplan-Meier. Univariate analysis and multivariate analysis were performed to investigate prognostic factors by the Log-rank test and the Cox regression model. The effects of different status of lymph node metastasis on OS and recurrence patterns were compared.

Result:
The median DFS of all patients was 22.57 months, and median OS was 32.90 months. Multivariate analysis showed that Karnofsky Performance Status, length of tumor and positive lymph nodes ratio (LNR) were independent prognostic factors of DFS and OS. For patients with lymph nodes metastasis, LNR has better prognostic value for OS (AUC=0.673, P =0.04) compared with the number of positive lymph nodes（AUC=0.584 P=0.31）. The median OS of patients with LNR≤ 15% and LNR>15% were 33.43 and 19.20 months, P =0.04. Patients without lymph node skip metastasis (NSM) had better OS than that with NSM, but the difference was not statistically significant. Among the patients with both LNR>15% and NSM, OS was significantly worse than other lymph node positive patients, with median OS of 14.33 vs. 32.50 months, P=0.02. The analysis of the treatment failure patterns showed that more distant metastases were observed in patients with LNR>15%, while more local and regional recurrences were observed with LNR≤ 15%.

Conclusion:
The status of lymph node metastasis was related to the prognosis of postoperative radiotherapy for locally advanced ESCC. LNR has better prognostic value for OS, treatment failure patterns varied in different LNR. The patients with both high LNR and NSM have significantly poorer prognosis.

Background:
To compare the perioperative outcome of minimally invasive (MIE) esophagectomy performed with a single- or a multi-incision in treating esophageal cancer.

Method:
Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3–4-cm incision was created in both the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients.

Result:
We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006–2015. There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (p < 0.05). There was no surgical mortality in the single-incision MIE group.

Conclusion:
Minimally invasive esophagectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.

Background:
c-Met is overexpressed in cancer cells and plays a crucial role in apoptosis evasion. BPI-9016M, a small-molecule inhibitor of c-Met, could enhance the cytotoxicity of various DNA-damaging agents and promote the cell apoptosis. Here, we evaluated the radiosensitizaion potential of BPI-9016M in Eca109 human esophageal squamous cell carcinoma (ESCC) cell line.

Method:
Cell viability was determined by CCK8 assay. The radiosensitization effect of BPI-9016M was evaluated by clonogenic survival and progression of tumor xenograft. Cell apoptosis were determined by flow cytometric analysis and TUNAL. Cell apoptosis regulators were detected by western blot analysis. Radiation-induced DNA double strand break (DSB) and homologous recombination repair (HRR) were detected by the activation of ATR-Chk 1/ATM-Chk2 pathways.

Result:
BPI-9016M induced radiosensitization in Eca109 cell of ESCC cell line, associated with 1) down-regulating mutation P53 and Bcl-2; 2) decreases phosphorylated ATR and ATM focus formation, and the expression of γ-H2AX; 3) up-regulates the rate of cell apoptosis protein cleaved-Caspase(Figure 1). The combination of BPI-9016M with irradiation delayed the growth of ESCC tumor xenograft to a greater extent compared with either treatment modality alone (P < 0.05). Figure 1. BPI-9016M enhanced radiation induced apoptosis and inhibited ATM- and ATR-dependent DNA damage homologous recombination repair (HRR) pathways analyzed by western blot.

Conclusion:
Our findings suggest that the enhanced apoptosis and the inhibition of HRR contribute to radiosensitization by c-Met inhibitor BPI-9016M in ESCC cell.