Aggressive surgical resection does not improve survival in operable esophageal squamous cell carcinoma with N2-3 status

AIM:To investigate the influence of nodal status on response and clarify the optimal treatment for operable esophageal squamous cell carcinoma(OSCC).METHODS:We retrospectively analyzed 1490 OSCC patients who underwent transthoracic esophagectomy and lymphadenectomy between December 1996 and December 2009 at the Sun Yat-sen University Cancer Center.The surgical approach and the number of resected lymph nodes(LNs) were considered in the assessment of surgery.Patients were classified according to their nodal statuses(NO vs N1 vs N2-3).Overall survival was defined as the time from the date of death or final follow-up.Survival analysis was performed using the Kaplan-Meier method and differences between curves were assessed by the logrank test.Univariate and multivariate Cox regression analyses were used to identify factors associated with prognosis.Statistical significance was assumed at a P<0.05.RESULTS:With a median time from surgery to the last censoring date for the entire cohort of 72.2 mo,a total of 631 patients were still alive at the last follow-up and the median survival time was 35.5 mo.The surgical approach(left transthoracic vs Ivor-Lewis/tri-incisional)was verified as independent prognostic significance in patients with NO or N1 status,but not in those with N2-3 status.Similar results were also observed with the number of resected LNs(≤14 vs ≥15).Compared with surgery alone,combined therapy achieved better outcomes in patients with N1 or N2-3 status,but not in those with NO status.For those with N2-3status,neither the surgical approach nor the number of resected LNs reached significance by univariate analysis,with unadjusted HRs of 0.826(95%CI:0.644-1.058) and 0.849(95%CI:0.668-1.078),respectively,and aggressiveness of surgery did not influence the outcome;the longest survival was observed in those patients who received the combined therapy.CONCLUSION:Combined therapy has a positive role in OSCC with LN metastasis,and aggressive surgical resection does not improve survival in patients with N2-3 status.

Clinicopathological Analysis of 155 Patients with Persistent Isolated Hematuria

Objectives To reveal etiologies of persistent isolated hematuria （PIH） through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH. Methods we retrospectively studied 155 P1H patients receiving renal biopsy between January, 2003 and December, 2008 in Peking Union Medical College Hospital. All the clinical data and follow-up result were analyzed. Results All subjects included 38 children and 117 adults, with mean age of 11.38±3.25 years for children and 35.17±8.44 years for adults. Thin basement membrane nephropathy （TBMN） was the most common pathology （55.3% of children and 49.6% of adults）, followed by IgA nephropathy （18.4% of children and 32.5% of adults, mainly grade 2-3） and mesangial proliferative glomerulonephritis （MsPGN） without IgA deposition （13.2% of children and 12.8% of adults）. Besides, A1port syndrome （2.6% of children） and membrane nephropathy （2.6% of children and 0.9% of adults） were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological types of PIH. Totally, 86 patients were followed up and 37 cases therein stayed on track for long term （mean duration 41.11±28.92 months, range 8-113 months）. Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN （without IgA deposition）, and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention. Conclusions Close follow-up should be required as the primary management for PIH. Equally important is careful monitoring for early identification of undesirable predictors; while renal biopsy and other timely intervention are warranted if there is hypertension, significant proteinuria or renal impairment.