National Cancer Institute®
Last Modified: September 1, 2002
UI - 12019505
AU - Immanuel A; Lamb PJ; Wayman J; Preston S; Griffin SM
TI - Prevention of the neoplastic progression of Barrett's oesophagus by argon beam plasma ablation (Br J Surg 2001;88:1357-62).
SO - Br J Surg 2002 May;89(5):626; discussion 626
UI - 11901927
AU - Trudgill N
TI - Familial factors in the etiology of gastroesophageal reflux disease, Barrett's esophagus, and esophageal adenocarcinoma.
SO - Chest Surg Clin N Am 2002 Feb;12(1):15-24
AD - Department of Gastroenterology, Sandwell General Hospital, West Bromwich, West Midlands, United Kingdom. firstname.lastname@example.org
Familial aggregation of gastroesophageal reflux symptoms has been established clearly in patients with gastroesophageal reflux disease and its complications. Preliminary reports of twin studies suggest that this aggregation has a significant genetic component. A genetic predisposition to gastroesophageal reflux may be expressed phenotypically as disordered gastroesophageal motility and hiatus hernia but these disorders may be secondary to chronic gastroesophageal reflux. Linkage studies, the discovery of candidate genes for gastroesophageal reflux, and their phenotypic expression are awaited with interest.
UI - 11901936
AU - Casson AG
TI - Role of molecular biology in the follow-up of patients who have Barrett's esophagus.
SO - Chest Surg Clin N Am 2002 Feb;12(1):93-111, ix-x
AD - Division of Thoracic Surgery, Dalhousie University, QE II Health Science Centre, Halifax, Nova Scotia, Canada. email@example.com
At present, the follow-up of patients who have Barrett's esophagus (BE) should occur within the setting of an endoscopic biopsy surveillance program and with the frequency of surveillance as proposed by the American College of Gastroenterology. In the future, patients who have BE will be further stratified according to their risk for progression to invasive carcinoma. This stratification will permit the development of more rational surveillance programs. Models that incorporate epidemiologic risk factors, reflux symptoms, and endoscopic and histologic findings will likely include panels of biomarkers for further stratification of patients as low, intermediate, or high risk. Therefore, the challenge over the next decade will be to define the role of molecular markers in endoscopic surveillance strategies and to identify additional clinically relevant molecular markers for prognosis as intermediate markers for chemoprevention and as molecular targets for novel gene therapies.
UI - 11936261
AU - Goldblum JR; Lauwers GY
TI - Dysplasia arising in barrett's esophagus: diagnostic pitfalls and natural history.
SO - Semin Diagn Pathol 2002 Feb;19(1):12-9
AD - Cleveland Clinic Foundation, OH 44195, USA. firstname.lastname@example.org
Barrett's esophagus is a complication of chronic gastroesophageal reflux disease and is defined as a change in the esophageal epithelium of any length that can be recognized at endoscopy and is confirmed to have intestinal metaplasia by biopsy. Esophageal ulcerations and stricture are rarely seen, and the major complications of this disease are epithelial dysplasia and esophageal adenocarcinoma. Dysplasia is felt to represent the best currently available marker of increased cancer risk in these patients. However, there are many pitfalls in the histologic recognition of dysplasia, a particularly difficult problem in the face of active inflammation in patients with ongoing reflux disease. The recognition and grading of dysplasia is subject to significant interobserver variability, particularly at the lower end of the histologic spectrum (negative v indefinite for dysplasia v low-grade dysplasia). High-grade dysplasia and to a lesser degree low-grade dysplasia are markers of increased cancer risk, although their natural history are difficult to determine. Up to 40% of patients with a preoperative diagnosis of high-grade dysplasia have an adenocarcinoma in their esophagectomy specimen. Despite this observation, there is still debate as to whether esophagectomy or close endoscopic surveillance with biopsy is the most appropriate and cost-effective way to manage these patients. The search for more objective surrogate biomarkers that recognize patients who are truly at risk of progressing along the dysplasia-carcinoma sequence is underway. However, no biomarker has yet proven to be superior to the histologic recognition of dysplasia in identifying these high-risk patients.
UI - 11936262
AU - Dry SM; Lewin KJ
TI - Esophageal squamous dysplasia.
SO - Semin Diagn Pathol 2002 Feb;19(1):2-11
AD - Department of Pathology, University of California, Los Angeles, USA.
Esophageal squamous dysplasia (ESD) appears to be the most important precursor for squamous cell carcinoma (SCC), and this observation is supported by early molecular findings. Pathologists in high incidence areas of the world, such as China, frequently may encounter ESD during surveillance cytology and biopsy screenings of high risk populations. ESD in low risk areas, such as the United States, is more commonly seen in esophagi resected for squamous cell carcinoma. As at other sites, ESD can be graded histologically depending on the thickness of epithelial involvement and cytologically based largely on nuclear size and chromatin features. Most ESD lesions are endoscopically visible, especially if the esophageal mucosa is sprayed with iodine, allowing for directed biopsy. Several studies have shown that important differences in histologic and cytologic diagnosis and grading exist between Western pathologists and those in China or Japan. Despite these findings, the risk of developing invasive SCC is closely correlated to the severity of ESD encountered. Correct recognition of ESD thus is important.
UI - 12112555
AU - Chandra RK; Bentz BG; Haines GK 3rd; Robinson AM; Radosevich JA
TI - Expression of glutathione s-transferase pi in benign mucosa, Barrett's metaplasia, and adenocarcinoma of the esophagus.
SO - Head Neck 2002 Jun;24(6):575-81
AD - Department of Otolaryngology-Head & Neck Surgery, Northwestern University Medical School, 303 E. Chicago Ave, Searle Bldg. 12-561, Chicago, Illinois 60611, USA. email@example.com
BACKGROUND: Glutathione s-transferase pi (GSTpi) is an enzyme that provides cellular protection against redox-mediated damage by free radicals, which have been implicated in carcinogenesis. METHODS: Forty-three consecutive specimens from 19 patients were reviewed to identify samples of squamous mucosa, Barrett's metaplasia, adenocarcinoma, and peritumoral inflammation. Serial sections were stained with an anti-GSTpi polyclonal antibody, and GSTpi expression was quantified for each histologic group. RESULTS: GSTpi expression was diminished in peritumoral mononuclear inflammatory cells (p <.001) compared with squamous epithelium, Barrett's metaplasia, or adenocarcinoma. Barrett's metaplasia exhibited decreased GSTpi expression compared with squamous mucosa (p =.045). GSTpi expression by >50% of adenocarcinoma cells was associated with an increased risk (2.25x) of disease at last follow-up. CONCLUSIONS: GSTpi is prominently expressed in esophageal squamous mucosa and adenocarcinoma. Mononuclear cells may be susceptible to oxidative damage secondary to weak GSTpi production. GSTpi may protect the tumor cells themselves from the cytotoxic effects of free radicals. The biochemical role of GSTpi expression in malignant transformation deserves further investigation. Copyright 2002 Wiley Periodicals, Inc.
UI - 12170022
AU - Altorki N; Kent M; Ferrara C; Port J
TI - Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus.
SO - Ann Surg 2002 Aug;236(2):177-83
AD - Division of General Thoracic Surgery, Weill Medical College, Cornell University, New York, New York 10021, USA. firstname.lastname@example.org
OBJECTIVE: To determine the prevalence of occult cervical nodal metastases in patients with squamous cell cancer and adenocarcinoma of the esophagus, and to determine the impact of esophagectomy with three-field lymph node dissection on survival and recurrence rates. SUMMARY BACKGROUND DATA: Although esophagectomy with three-field lymph node dissection is commonly practiced in Japan, its role in the surgical management of esophageal cancer in the United States, especially in patients with esophageal adenocarcinoma, is essentially unknown. METHODS: This is a prospective observational study of esophagectomy with three-field lymphadenectomy. Eighty patients underwent resection between RESULTS: Hospital mortality and morbidity rates were 5% and 46%, respectively. Metastases to the recurrent laryngeal and/or deep cervical nodes occurred in 36% of patients irrespective of cell type (adenocarcinoma 37%, squamous 34%) or location within the esophagus (lower third 32%, middle third 60%). Overall 5-year and disease-free survival rates were 51% and 46%, respectively. Sixty-nine percent presented with nodal metastases. The 5-year survival rate for node-negative patients was 88%; that for those with nodal metastases was 33%. The 5-year survival rate in patients with positive cervical nodes was 25% (squamous 40%, adenocarcinoma 15%). CONCLUSIONS: Esophagectomy with three-field lymph node dissection can be performed with a low mortality and reasonable morbidity. Unsuspected metastases to the recurrent laryngeal and/or cervical nodes are present in 36% of patients regardless of cell type or location within the esophagus. Thirty percent of patients were upstaged, mainly from stage III to stage IV. An overall 5-year survival rate of 51% suggests a true survival benefit beyond that achieved solely on the basis of stage migration.
UI - 12170023
AU - Sato N; Koeda K; Ikeda K; Kimura Y; Aoki K; Iwaya T; Akiyama Y; Ishida
TI - K; Saito K; Endo S Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer.
SO - Ann Surg 2002 Aug;236(2):184-90
AD - Department of Surgery I, Iwate Medical University, School of Medicine, Morioka, Japan. email@example.com
OBJECTIVE: To investigate whether preoperative corticosteroid administration plays a role in attenuating postoperative morbidity. SUMMARY BACKGROUND DATA: There is as yet no consensus on the beneficial effects of steroids in alleviating surgical stress. METHODS: A total of 66 patients undergoing surgery for thoracic esophageal cancer were randomly categorized preoperatively into two groups of 33 patients each. One group was administered an intravenous infusion of methylprednisolone (10 mg/kg body weight) 30 minutes before the surgery (MP group), while the other group received a placebo infusion (control group). The primary endpoint was organ system failure during the first 7 days after surgery. Comparisons of surgery-related complications, cytokine responses, and blood counts were also made between the two groups. RESULTS: The percentage of patients in the MP group who had one or more organ system failures was 33%, significantly lower than the corresponding percentage of 61% in the control group. The surgery-related complication rate and long-term survival rate were similar in the two groups. The peak plasma levels of interleukin (IL)-1 receptor antagonist, IL-6, and IL-8 were significantly lower in the MP group than in the control group. Changes in the plasma levels of IL-10 were significantly larger in the MP group. No significant differences in the circulating lymphocyte and neutrophil counts were observed between the groups. CONCLUSIONS: The results suggest that prophylactic administration of corticosteroids is associated with a decrease in postoperative morbidity in patients undergoing invasive surgery. The laboratory data suggest that corticosteroids may attenuate surgical stress-induced inflammatory responses both directly by suppressing the release of proinflammatory cytokines and via inducing IL-10 synthesis.
UI - 12190229
AU - Silverstein MD; Nietert PJ; Ye X; Lackland DT
TI - Access to care and stage at diagnosis for patients with lung cancer and esophageal cancer: analysis of the Savannah River Region Information System cancer registry data.
SO - South Med J 2002 Aug;95(8):900-8
AD - Center for Health Care Research, Medical University of South Carolina, Charleston 29425, USA.
BACKGROUND: Disparities have been observed in both the incidences of lung and esophageal cancers and the survival of those patients. Our goals were to determine if race was associated with stage of cancer at diagnosis, and to identify predictors of advanced-stage lung and esophageal cancers. METHODS: All cases of lung and esophageal cancer between 1991 and 1995 in the Savannah River Region Information System cancer registry were studied. Data were analyzed using logistic regression to identify independent predictors of advanced disease at the time of diagnosis. RESULTS: Among lung cancer patients, histology and distance to nearest hospital predicted diagnosis at an advanced stage. Residence in an area with a high proportion of Medicaid recipients was a predictor of advanced stage in esophageal cancer patients. CONCLUSIONS: In this predominantly rural area, decreased utilization of health services was evident among older, poor, black, rural cancer patients. Further investigation involving prospective data collection from cancer patients is warranted.
UI - 11865692
AU - Cristofaro MG; Cafaro D; Lazzaro F; Onofrio L; Savino N; Macchione B;
TI - Mauro P; Musella S [Chromoendoscopy in the diagnosis of precancerous lesions of the esophagus. Our experience]
SO - Ann Ital Chir 2001 Jul-Aug;72(4):405-9; discussion 409-11
AD - Facolta di Medicina e Chirurgia, Universita degli Studi di Catanzaro.
The elements of an unfavourable prognosis for oesophageal cancer are frequent metastasis, high incidence of local recurrence and mainly the difficulty of an early diagnosis. Alcohol, tobacco and precancerous lesions are the most important risk factors of these tumours. According to literature, the authors suggest the method of chromoendoscopy, with vital staining by lugol or blue toluidine for endoscopic; guidance to biopsy in the aimed screening of patients, whose habits--alcohol, smoking--should cause, in time, the rising of lesions with neoplastic potentiality. Endoscopy with bioptic test is the best diagnostic investigation. In fact sensibility and specificity of these investigations increase using this method with vital staining.
UI - 11918244
AU - Fontes PR; Nectoux M; Escobar AG; Eilers RJ; Davila AR
TI - Is age a risk factor for esophagectomy?
SO - Int Surg 2001 Apr-Jun;86(2):94-6
AD - Surgical and Clinical Gastrointestinal Unit, Santa Casa Hospital and Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Brazil. firstname.lastname@example.org
In recent years, the number of elderly patients with esophageal cancer as well as the number submitted for esophageal resection has been increasing. With respect to nutritional and pulmonary evaluations, surgical staging, and mortality, 37 patients over the age of 65 who underwent esophagectomy and simultaneous reconstruction were analyzed. This group was compared statistically with a group of 162 patients younger than 65 to determine whether age was a factor influencing treatment and outcome. There was no statistical difference between the groups relating to the described variables. Age should not be a limiting factor when it comes to offering an aggressive surgical approach for the esophageal cancer patient aged 65 or more. This approach can be performed as safely in older patients as it is in younger patients, with similar incidence of mortality.
UI - 11930294
AU - Haag C; Ehninger G
TI - [Indications for chemotherapy in cancers of the esophagus, stomach and pancreas]
SO - Z Gastroenterol 2002 Apr;40 Suppl 1():S68-S70
AD - Medizinische Klinik I, Universitatsklinikum Carl-Gustav-Carus der Technischen Universitat Dresden, Germany. Haag@mkl.med.tu-dresden.de
During the last years the chemotherapy in osophageal, stomach and pancreatic cancer demonstrated some success. Radiochemotherapy for esophageal cancer is indicated as neoadjuvant therapy before surgery in locally advanced cancer or in patients with other diseases, which do not allow surgery. In stomach cancer patient there is a clear indication for chemotherapy in metastatic disease and within clinical trials as neoadjuvant chemotherapy in locally advanced cancer. In pancreatic cancer patient the chemotherapy shows less success comparing to other gastrointestinal cancer; it is part of the palliative concept with other therapeutic strategies.
UI - 12055380
AU - Spector NM; Hicks FD; Pickleman J
TI - Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study.
SO - Gastroenterol Nurs 2002 May-Jun;25(3):120-5
AD - Loyola University Niehoff School of Nursing, Chicago, Illinois 60626, USA. email@example.com
Oncologic outcomes of gastroesophageal surgery may be similar, but little is known about the impact on patients' postoperative symptom experience and quality of life (QOL). The purpose of this pilot study was to describe overall QOL and symptom experience of individuals who underwent either total gastrectomy with Roux-en-Y esophagojejunostomy or esophagogastrectomy for adenocarcinoma of the gastroesophageal junction. The Gastroenterology Quality of Life Index (GQLI) and the Life After Gastric Surgery (LAGS), developed by the investigators for measuring symptom frequency, were used to measure variables of interest. The sample (n = 27) had a relatively high QOL, but experienced difficulties with eating patterns, physical functioning, socialization, and happiness. There were significant differences between the two procedures related to QOL and symptom frequency in that individuals who had the total gastrectomy fared somewhat better. Further, patients who had esophagogastrectomy had greater symptom frequency and significantly poorer QOL. Although initially compelling, these data warrant further investigation into the QOL and symptom impact in a more diverse population of patients with cancer of the stomach or esophagus. These results, however, suggest several areas where nursing interventions could help these patients.
UI - 12096129
AU - Zhou G; Li H; DeCamp D; Chen S; Shu H; Gong Y; Flaig M; Gillespie JW; Hu
TI - N; Taylor PR; Emmert-Buck MR; Liotta LA; Petricoin EF 3rd; Zhao Y 2D differential in-gel electrophoresis for the identification of esophageal scans cell cancer-specific protein markers.
SO - Mol Cell Proteomics 2002 Feb;1(2):117-24
AD - Department of Biochemistry University of Texas Southwestern Medical Center, Dallas, Texas 75390-9038, USA.
The reproducibility of conventional two-dimensional (2D) gel electrophoresis can be improved using differential in-gel electrophoresis (DIGE), a new emerging technology for proteomic analysis. In DIGE, two pools of proteins are labeled with 1-(5-carboxypentyl)-1'-propylindocarbocyanine halide (Cy3) N-hydroxy-succinimidyl ester and 1-(5-carboxypentyl)-1'-methylindodi-carbocyanine halide (Cy5) N-hydroxysuccinimidyl ester fluorescent dyes, respectively. The labeled proteins are mixed and separated in the same 2D gel. 2D DIGE was applied to quantify the differences in protein expression between laser capture microdissection-procured esophageal carcinoma cells and normal epithelial cells and to define cancer-specific and normal-specific protein markers. Analysis of the 2D images from protein lysates of approximately 250,000 cancer cells and normal cells identified 1038 protein spots in cancer cell lysates and 1088 protein spots in normal cell lysates. Of the detected proteins, 58 spots were up-regulated by >3-fold and 107 were down-regulated by >3-fold in cancer cells. In addition to previously identified down-regulated protein annexin I, tumor rejection antigen (gp96) was found up-regulated in esophageal squamous cell cancer. Global quantification of protein expression between laser capture-microdissected patient-matched cancer cells and normal cells using 2D DIGE in combination with mass spectrometry is a powerful tool for the molecular characterization of cancer progression and identification of cancer-specific protein markers.
UI - 12147242
AU - Ishizuka T; Tanabe C; Sakamoto H; Aoyagi K; Maekawa M; Matsukura N;
TI - Tokunaga A; Tajiri T; Yoshida T; Terada M; Sasaki H Gene amplification profiling of esophageal squamous cell carcinomas by DNA array CGH.
SO - Biochem Biophys Res Commun 2002 Aug 9;296(1):152-5
AD - Genetics Division, National Cancer Center Research Institute, 1-1, Tsukiji 5-chome, Chuo-ku, 104-0045, Tokyo, Japan.
Gene amplification is one of the basic mechanisms that lead to overexpression of oncogenes. DNA array comparative genomic hybridization (CGH) has great potential for comprehensive analysis of both a relative gene-copy number and altered chromosomal regions in cancers, which enables us to identify new amplified genes and unstable chromosomal loci. We examined the amplification status in 32 esophageal squamous cell carcinomas (ESCCs) and 13 ESCC cell lines on 51 frequently amplified loci in a variety of cancers by both DNA array CGH and Southern blot analyses. The 1p34 locus containing MYCL1, 2p24 (MYCN), 7p12 (EGFR), and 12q14 (MDM2) were amplified in one of the 32 cases (3%), and the 17q12 locus (ERBB2) and 8p11 (FGFR1) in two of the 32 cases (6%), while only the 11q13 locus (Cyclin D1, FGF4, and EMS1) was frequently amplified (28%, 9/32), demonstrating this locus to be a major target in ESCCs. One locus, 8q24 (c-MYC) was found to be amplified only in the cell lines. Eight out of 51 loci (15.7%) were found to be amplified in at least one of the 32 primary ESCCs or the 13 ESCC cell lines, suggesting that chromosomal loci frequently amplified in a type of human cancer may also be amplified in other types of cancers. This paper is the first report of an application of DNA array CGH to ESCCs.
UI - 10206283
AU - Toh Y; Kuwano H; Mori M; Nicolson GL; Sugimachi K
TI - Overexpression of metastasis-associated MTA1 mRNA in invasive oesophageal carcinomas.
SO - Br J Cancer 1999 Apr;79(11-12):1723-6
AD - Division of Pathology, Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan.
The MTA1 gene is a recently identified novel candidate breast cancer metastasis-associated gene which has been implicated in the signal transduction or regulation of gene expression. We examined the mRNA expression levels of the MTA1, the human homologue of the rat mta1 gene in 47 surgically resected oesophageal squamous cell carcinomas by quantitative reverse transcription polymerase chain reaction. The relative overexpression of MTA1 mRNA (tumour/normal ratio > or = 2) was observed in 16 out of 47 (34.0%) oesophageal carcinomas. Oesophageal tumours overexpressing MTA1 mRNA (T/N ratio > or = 2) showed significantly higher frequencies of adventitial invasion (P < 0.05) and lymph node metastasis (P < 0.05), and tended to have a higher rate of lymphatic involvement than the remaining tumours. Thus, the data suggest that the MTA1 gene might play an important role in invasion and metastasis of oesophageal carcinomas.
UI - 12060035
AU - van Blankenstein M
TI - Barrett's esophagus: so what!
SO - Dis Esophagus 2002;15(1):1-4
AD - Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. firstname.lastname@example.org
UI - 12060037
AU - Kleeff J; Friess H; Liao Q; Buchler MW
TI - Immunohistochemical presentation in non-malignant and malignant Barrett's epithelium.
SO - Dis Esophagus 2002;15(1):10-5
AD - Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.
Barrett's esophagus, which is histologically characterized by metaplastic columnar epithelium, is a common condition observed in approximately 10-20% of patients with gastroesophageal reflux disease. These lesions can typically progress from metaplasia with atypia to low-grade dysplasia, high-grade dysplasia, and adenocarcinoma. It is of great clinical importance to correctly grade these lesions and to identify changes with a high risk of malignant transformation, inasmuch as high-grade dysplasias and early adenocarcinomas in patients with Barrett's esophagus have a high chance for cure. The identification of high-risk lesions in Barrett's esophagus by histologic evaluation has drawbacks, especially regarding sampling errors and frequent intra- and interobserver discrepancies in the histopathologic grading/staging of these lesions. Immunostaining with a variety of antibodies provides a better understanding of the process of malignant transformation and helps to identify early markers of malignant transformation in Barrett's esophagus lesions. In this review, we will summarize the current knowledge about the value of immunostaining in the diagnosis of malignant and non-malignant Barrett's epithelium and its role to better define lesions with high risk for malignancy in this disorder.
UI - 12060038
AU - Wilson KT
TI - Angiogenic markers, neovascularization and malignant deformation of Barrett's esophagus.
SO - Dis Esophagus 2002;15(1):16-21
AD - Department of Medicine, Division of Gastroenterology, and Greenebaum Cancer Center, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore 21201, USA. email@example.com
The molecular events underlying progression of Barrett's esophagus to adenocarcinoma remain an area of active investigation. Neovascularization and angiogenesis have been studied in esophageal adenocarcinomas by counting of microvessels after staining with vascular markers, and by immunohistochemistry for vascular endothelial growth factor. Angiogenesis appears to be increased early in the neoplastic process, but has poor prognostic value. We have demonstrated that expression levels of two important genes that regulate cell growth, namely inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, are frequently upregulated in Barrett's esophagus and associated adenocarcinomas. COX-2 expression may be related to reflux of bile salts, which induce COX-2 expression in Barrett's tissues and esophageal adenocarcinoma cells in vitro. COX-2 inhibition induces apoptosis and blocks proliferation in COX-2-expressing esophageal adenocarcinoma cells in vitro, and blocks angiogenesis in both in vivo and in vitro models. Although controversial, recent evidence suggest that iNOS-derived NO can inhibit angiogenesis in some model systems. In conclusion, both iNOS and COX-2 appear to be involved in Barrett's-associated neoplastic progression, but COX-2 inhibition is more promising as a chemopreventive strategy. COX-2 inhibition may exert beneficial effects by decreasing angiogenesis and epithelial proliferation, and by facilitating apoptosis of epithelial cells that have undergone DNA damage.
UI - 12060040
AU - Urosevic P; Kiroff GK
TI - Ablation of Barrett's epithelium: the promise and the problems.
SO - Dis Esophagus 2002;15(1):30-8
AD - The University of Melbourne, Department of Clinical and Biomedical Sciences, The Geelong Hospital, Victoria, Australia.
The incidence of adenocarcinoma of the esophagus has increased dramatically over recent years. Because Barrett's epithelium is recognized as a risk factor for adenocarcinoma there is an interest in reversing this metaplasia. A number of endoscopic methods of destruction of esophageal columnar epithelium have been described. The purpose of this article is to review the currently available methods of managing Barrett's epithelium with particular reference to the role of ablative therapy in reducing the risk of adenocarcinoma.
UI - 12060041
AU - Lin OS; Mannava S; Hwang KL; Triadafilopoulos G
TI - Reasons for current practices in managing Barrett's esophagus.
SO - Dis Esophagus 2002;15(1):39-45
AD - Division of Gastroenterology, Stanford University Medical Center, California, USA. firstname.lastname@example.org
We evaluated the reasons for current practices in managing Barrett's esophagus. Using a questionnaire, we assessed the practices and beliefs of 162 Californian gastroenterologists in managing Barrett's esophagus, using descriptive statistics as well as multivariate logistic regression. Out of the 103 respondents, 87% screened for Barrett's esophagus in patients with > 12 months of reflux symptoms, but only 72% believed that screening would improve survival, and 48% believed it to be cost-effective. In total, 98% surveyed patients with long-segment Barrett's esophagus at least biennially (76% thought this would improve survival and 49% believed it to be cost-effective) and 82% surveyed short-segment Barrett's esophagus at least biennially (57% thought this would improve survival and 30% believed it to be cost-effective). Finally, 44% surveyed microscopic intestinal metaplasia at least biennially (26% thought this would improve survival and 11% believed it to be cost-effective). In total, 18% performed endoscopic ablation, whereas 3% referred patients with low-grade dysplasia and 85% referred patients with high-grade dysplasia for esophagectomy. Finally, 81% treated asymptomatic Barrett's esophagus patients with proton pump inhibitors, but only 56% believed that this would reduce the risk of cancer. Logistic regression showed that the only independent factor predictive of surveillance practices was belief in efficacy. Practice patterns tend to be more aggressive than those recommended by recent guidelines and those reported by previous surveys. Medico-legal considerations affect practice substantially.
UI - 12060045
AU - Kajiyama Y; Hattori K; Tomita N; Amano T; Iwanuma Y; Narumi K; Udagawa
TI - H; Tsurumaru M Histopathologic effects of neoadjuvant therapies for advanced squamous cell carcinoma of the esophagus: multivariate analysis of predictive factors and p53 overexpression.
SO - Dis Esophagus 2002;15(1):61-6
AD - First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan. email@example.com
In 97 patients (60, chemotherapy; 22, chemoradiotherapy; 15, radiotherapy), histopathologic effects were evaluated microscopically, and histologic response rates were compared among three neoadjuvant treatment modalities. Predictive factors for neoadjuvant therapies were analyzed by logistic regression, including the results of p53 immunohistochemical staining. In the chemoradiotherapy group, the pathologic response rate was 86.4%, and was significantly higher than that for chemotherapy (P < 0.0001) or for radiotherapy (P = 0.0031). In patients with normal p53 protein expression, the histopathologic response rate to chemotherapy was 20.0%, a higher rate than that for patients with abnormal p53 overexpression. In the chemoradiotherapy or radiotherapy group, however, the response rates were almost the same, irrespective of p53 oncoprotein status. From multivariate analysis, the neoadjuvant treatment modality itself was identified as the most powerful predictive factor for the effect. Chemoradiotherapy had the most powerful effect on advanced esophageal cancer, and p53 status did not influence the clinical outcome in this group.
UI - 12060046
AU - Koide N; Nishio A; Hiraguri M; Kishimoto K; Nakamura T; Adachi W; Amano
TI - J Differences and relationships of thymidine phosphorylase expression in tumor-associated macrophages and cancer cells in squamous cell carcinoma of the esophagus.
SO - Dis Esophagus 2002;15(1):67-73
AD - Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. firstname.lastname@example.org
Thymidine phosphorylase (TP), which has been shown to be identical to platelet-derived endothelial cell growth factor, is expressed in tumor-associated macrophages (TAMs) as well as cancer cells. The aim of this study was to clarify the differences or relationships of TP expression in TAMs and cancer cells in esophageal squamous cell carcinoma (SCC). Tissues samples were taken from 56 patients with esophageal SCC after curative surgery. The expression of TP in TAMs or SCC cells was examined using a monoclonal antibody to TP (clone 654-1). Microvessels in SCC that stained positively for Factor VIII-related antigen were counted (microvessel density, MVD). Macrophages in SCC that stained positively for CD68 antigen were counted (monocytic count). Ki-67 antigen was immunostained with MIB-1, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end labeling was performed, and Ki-67 labeling index (LI) and apoptotic index were calculated. The expression of TP in stromal cells and cancer cells was observed in 43 (76.8%) and 33 patients (58.9%), respectively. There were significant correlations between TP expression in stromal cells (TAMs) as well as in cancer cells and venous invasion, distant metastasis, or MVD. There was a correlation between TP expression in cancer cells and lymph node metastasis, and there were correlations between TP expression in TAMs and monocytic count or Ki-67 LI; however, there was no correlation between TP expression in TAMs and lymph node metastasis. On the other hand, in SCCs with TP expression in both TAMs and cancer cells, higher frequencies of venous invasion and distant metastasis, higher MVD and lower apoptotic index were observed than in other SCCs. The 5-year survival rate in patients with TP expression in both TAMs and cancer cells was poorer than that in patients with TP expression in neither TAMs and cancer cell. In conclusion, these results suggest that co-expression of TP in TAMs and cancer cells is strongly associated with angiogenic promotion and distant metastasis. However, other effects of TP, such as promotion of tumor growth and lymph node metastasis, may be different depending on whether these are expressed in TAMs or cancer cells in esophageal SCCs. Patients with coexpression of TP in TAMs and cancer cells may be associated with a poor prognosis.
UI - 12060047
AU - Zhou Q; Dong Wang L; Du F; Zhou Y; Rui Zhang Y; Liu B; Wei Feng C; Gao
TI - SS; Fan ZM; Yang CS; Zheng S Changes of TGFbeta1 and TGFbetaRII expression in esophageal precancerous and cancerous lesions: a study of a high-risk population in Henan, northern China.
SO - Dis Esophagus 2002;15(1):74-9
AD - Laboratory for Cancer Research, College of Medicine, Zhengzhou University, Henan, People's Republic of China.
The level of transforming growth factor beta1 (TGFbeta1) and transforming growth factor betaII receptor (TGFbetaRII) was determined immunohistochemically in normal tissues and tissues with different severities of lesions (basal cell hyperplasia, BCH; dysplasia, DYS; carcinoma in situ, CIS; and squamous cell carcinoma, SCC) from surgically resected human esophagi and esophageal biopsies of symptom-free subjects. The samples were from an area with high esophageal cancer incidence in northern China (Linzhou, formerly Linxian, and nearby county Huixian in Henan Province). Peroxidase immunostain (ABC) and conventional hematoxylin and eosin stain were used. The tissue sections were incubated with antibodies of TGFbeta1 and TGFbetaRII overnight. The immunoreactivity was observed in cytoplasm of the esophageal specimen. From normal to BCH to DYS to CIS and to SCC, the positive immunostaining rates for TGFbeta1 increased significantly (P < 0.05). A linear correlation between the positive immunostaining rates of TGFbeta1 and the different lesions was observed (P < 0.05). From well- to moderately- and poorly differentiated SCC, the positive immunostaining rates for TGFbeta1 decreased gradually, but the difference was not significant (P > 0.05). In contrast, with the lesions progressing from normal to BCH to DYS to CIS and to SCC, the positive immunostaining rates for TGFbetaRII decreased significantly (P < 0.05). From well- to moderately- and poorly differentiated SCC, the positive immunostaining rates for TGFbetaRII decreased significantly (P < 0.05). There was a linear correlation between the positive rates of TGFbetaRII and different lesions and SCC differentiation (P < 0.05). The present results indicated that the alterations of TGFbeta1 and TGFbetaRII is a frequent event in esophageal multistage carcinogenesis, the absent or lower expression of TGFbetaRII may lead to the loss of cell proliferation control by TGFbeta1 and the overexpression of TGFbeta1 may be a negative feedback response caused by the lower expression of TGFbetaRII protein.
UI - 12060048
AU - Dong Wang L; Bin Yue W; Zhou Y; Wei Feng C; Liu B; Zhou Q; Ying Jia Y;
TI - Zheng S; Gao SS; Ji Xie X; Min Fan Z; Min Niou H; Hao Zhuang Z; Yang CS; Min Bai Y; Jun Qi Y Endoscopic screening and determination of p53 and proliferating cell nuclear antigen in esophageal multistage carcinogenesis: a comparative study between high- and low-risk populations in Henan, northern China.
SO - Dis Esophagus 2002;15(1):80-4
AD - Laboratory for Cancer Research, College of Medicine, Zhengzhou University, Henan, China. email@example.com
The objective of this study was to characterize the histologic changes from endoscopic screening for early esophageal cancer (EC) on subjects at high-incidence area (HIA) and low-incidence area (LIA) in Henan, China, and to further compare the changes in p53 and proliferating cell nuclear antigen (PCNA) in the multistage of human esophageal carcinogenesis from these two populations. The detection rate of basal cell hyperplasia (BCH) and dysplasia (DYS) was higher in the subjects from HIA than in those from LIA. Out of the 1568 symptom-free subjects examined at HIA, 10 (0.6%) cases with early squamous cell carcinoma (SCC) were identified. Immunoreactivity of p53 and PCNA was observed in cell nuclei of esophageal biopsies and surgically resected esophageal cancer specimens both in HIA and LIA. With the lesions progressed from normal epithelium to BCH to DYS to SCC, the positive-immunostaining cells expanded from basal layer to superficial layer, and the number of positive cells/mm2 for p53 and PCNA increased, and was significantly higher in HIA than in LIA among the similar morphological lesions (P < 0.01). The number of p53 positive cells/mm2 in SCC from HIA was almost fivefold higher than SCC from LIA (P < 0.01). The remarkable difference was also observed between HIA and LIA in DYS and BCH. The present results indicate that p53 protein accumulation is an important early biomarker for identifying high-risk subjects for EC.
UI - 12115874
AU - Gerber JK; Richter T; Kremmer E; Adamski J; Hofler H; Balling R; Peters
TI - H Progressive loss of PAX9 expression correlates with increasing malignancy of dysplastic and cancerous epithelium of the human oesophagus.
SO - J Pathol 2002 Jul;197(3):293-7
AD - Institute of Experimental Genetics, GSF-National Research Centre for