Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma

AIM To identify the clinicopathological characteristics of pT1 N0 esophageal squamous cell carcinoma(ESCC) that are associated with tumor recurrence. METHODS We reviewed 216 pT1 N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrencefree survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence(≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.RESULTS Forty-seven(24%) patients had a recurrence at 3 to 178(median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence(Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.CONCLUSION These results should be useful for designing optimal individual follow-up and therapy for patients with T1 N0 ESCC.

Unnecessity of lymph node regression evaluation for predicting gastric adenocarcinoma outcome after neoadjuvant chemotherapy

BACKGROUND Neoadjuvant chemotherapy has been applied worldwide to improve the survival of patients with gastric adenocarcinoma(GAC). The evaluation of histological regression in primary tumors is valuable for predicting prognosis. However, the prognostic effect of regression change in lymph nodes(LNs) remains unclear.AIM To confirm whether the evaluation of regression change in LNs could predict the prognosis of GAC patients who received neoadjuvant chemotherapy followed by surgery.METHODS In this study, we evaluated the histological regression of resected LNs from 192 GAC patients(including those with esophagogastric junction adenocarcinoma)treated with neoadjuvant chemotherapy. We classified regression change and residual tumor in LNs into four groups:(A) true negative LNs with no evidence of a preoperative therapy effect,(B) no residual metastasis but the presence of regression change in LNs,(C) residual metastasis with regression change in LNs,and(D) metastasis with minimal or no regression change in LNs. Correlations between regression change and residual tumor groups in LNs and regression change in the primary tumor, as well as correlations between regression change in LNs and clinicopathological characteristics, were analyzed. The prognostic effect of regression change and residual tumor groups in LNs was also analyzed.RESULTS We found that regression change and residual tumor groups in LNs were significantly correlated with regression change in the primary tumor, tumor differentiation, ypT stage, ypN stage, ypTNM stage, lymph-vascular invasion,perineural invasion and R0 resection status. Regression change and residual tumor groups in LNs were statistically significant using univariate Cox proportional hazards analysis, but were not independent predictors. For patients who had no residual tumor in LNs, the 5-year overall survival(OS) rates were 67.5% in Group A and 67.4% in Group B. For the patients who had residual tumors in LNs, the 5-year OS rates were 28.2% in Group C and 39.5% in Group D.The patients in Groups A+B had a significantly better outcome than the patients in Groups C+D(P < 0.01). No significant differences in survival were found between Groups A and B, or between Groups C and D.CONCLUSION The existence of residual tumor in LNs, rather than regression change in LNs, is useful for predicting the prognosis after neoadjuvant chemotherapy in GAC patients. In practice, it may not be necessary to report regression change in LNs.

Programmed cell death ligand 1 expression in esophageal squamous cell carcinoma:a comparative analysis of three different assays

As one of the most aggressive and lethal malignant tumors,the 5-year survival rate of oesophageal cancer is less than 20%.[1]There are two main pathological subtypes of esophageal cancer:esophageal squamous cell carcinoma(ESCC)and esophageal adenocarcinoma.[1]In China,more than 95%of esophageal cancer is ESCC.Encourag-ingly,cancer immunotherapy has entered a new era recently with the discovery of drugs that interfere with specific immune checkpoints.Moreover,due to the good effect of immunotherapy in squamous cell carcinoma,it may be a new strategy for ESCC treatment in the future.

Development and validation of m6A RNA methylation regulatorsbased signature in lung adenocarcinoma

To the Editor:Primary lung cancer is the most commonly diagnosed type ofmalignant tumor and is the leading cause of cancer deathworldwide.Non-small cell lung cancer(NSCLC)makes up 80%to 85%of the overall incidents of primary lung cancer and is classified into two distinct histological subtypes:lung adenocarcinoma(LUAD)and lung squamous cell carcinoma(LUSC).LUAD constitutes nearly 30%to 35%of all primary lung cancer cases,and the recurrence of it seems to be increasing in most countries.[1]As a prevalent mRNA internal modification,N6-methyladenosine(m6A)methylation modification is of great significance for triggering the development of cancer and can be used as a cancer-promoting factor in many cancers.[2,3]In this study,we aim to develop an m6A RNA methylation regulators-premised prognostic signature for LUAD patients.