Systemic treatments for resectable carcinoma of the esophagus

One of the most prevalent malignancies in the world is esophageal cancer(EC).The 5-year survival rate of EC remains pitiful despite treatment advancements.Neoadjuvant chemoradiotherapy in conjunction with esophagectomy is the standard of care for patients with resectable disease.The pathological complete response rate,however,is not acceptable.A distant metastasis or a locoregional recurrence will occur in about half of the patients.To increase the clinical effectiveness of therapy,it is consequently vital to investigate cutting-edge and potent therapeutic modalities.The approach to the management of resectable EC using immunotherapy has been considerably altered by immune checkpoint inhibitors.Systemic immunotherapy has recently been shown to have the potential to increase the survival of patients with resectable EC,according to growing clinical data.A combination of chemotherapy,radiation,and immunotherapy may have a synergistic antitumor impact because,according to mounting evidence,these treatments can stimulate the immune system via a number of different pathways.In light of this,it makes sense to consider the value of neoadjuvant immunotherapy for patients with surgically treatable EC.In this review,we clarify the rationale for neoadjuvant immunotherapy in resectable EC patients,recap the clinical outcomes of these approaches,go through the upcoming and ongoing investigations,and emphasize the difficulties and unmet research requirements.

Basaloid squamous carcinoma of the esophagus:clinicopathological,immunohistochemical and electron microscopic studies of 16 cases

Abstract Objective To further clarify the clinicopathological, immunohistochemical and electron microscopic features, and prognostic aspect of a rare esophageal carcinoma, i.e., basaloid squamous carcinoma (BSC). Methods The archival materials of 763 cases of esophageal malignancies (1977 1996) from the Dept. of Pathology, General Hospital of Nanjing Military Region, PLA, were reviewed and sixteen cases (2.1%) of BSC were detected. The clinical and pathological features of these cases were evaluated. Immunohistochemistry (S P method), histochemical staining, and electron microscope were utilized to further characterize the neoplasm. Results There were 9 males and 7 females, with a mean age of 58 years. The tumors were classified as stage Ⅰ (n=1), stage ⅡA (n=6), stage ⅡB (n=2), stage Ⅲ (n=5), and stage Ⅳ (n=2) according to the criteria of the UICC TNM classification system of malignant tumors (1987). Most neoplasms in our series were located in the middle third of the esophagus. Grossly, they had an appearance similar to that of conventional esophageal carcinoma. Histologically, they showed a typical cytoarchitectural pattern of BSC. The most important histologic feature of this tumor was that the carcinoma had a basaloid pattern, intimately associated with squamous cell carcinoma, dysplasia, or focal squamous differentiation. The basaloid cells were round or oval in shape with scant cytoplasm. The nuclei showed pleomorphism, hyperchromatin, and numerous mitotic figures. The basaloid cells were arranged mainly in the form of solid, smooth contoured lobules with peripheral palisading. Comedo necrosis in the islands of basaloid cells, small cystic spaces containing Alcian blue or PAS positive material, and PAS positive hyalinized stroma were frequently found. A panel of immunostains were used for the basaloid component of the tumor with the following results: cytokeratin (Pan),14/16 (+); epithelial membrane antigen, 16/16 (+); Vimentin, 4/16 (+); S 100 protein, 7/16 (+). Carcinoembryonic antigen and smooth muscle actin were negative. Electron microscopic (EM) study of 7 cases revealed that the basaloid cells are poorly differentiated, with a few desmosomes and fibrils and numerous free and polyribosome. The microcystic and intertrabecular spaces identified by light microscopy were seen under EM to be lined by basal membranes and filled with either loose reduplicated or compact globoid basal lamina showing fingerprint like pattern. Of the 11 cases with adequate follow up, 8 cases died within 2 years, the average survival time being 16.2 months. No cases of stages Ⅱ, Ⅲ, or Ⅳ survived beyond 5 years. The one year survival rate was 60% and two year 20%. Conclusion It is indicated that the BSC of the esophagus is a distinct clinicopathological entity with poor prognosis. The cellular differentiation and biologic behavior of the esophageal BSC were assumed to be situated between those of conventional squamous cell carcinoma and small cell carcinoma.

CARCINOMA ARISING IN BARRETT'S ESOPHAGUS (A REPORT OF 51 CASES)

Fifty-one patients with carcinoma arising in Barrett's esophagus were treated surgically from 1971 to 1990. This represented 10.2% of all treated cases with esophageal carcinoma during the same period. The mean age was 63 years. The most common symptom was dysphagia. According to PTNM staging, 18 were stage II,3 stage III and 3 stage IV. All patients were treated bysurgery. The 30-day hospital mortality was 3.98%. Theone, two and five-year survival rates were 45.9%, 25.0%and 13.6%, respectively. The 5-year survival rate wassignificantly greater for patrents with stage II (25.0%)than for parients with stage III + IV (4.s%) (P<0.05) andfor tumor length less than 6 cm (21%) than for tumorlength greater than 6 cm (0). The results indicate that thesurvival rate following resection is closely related to theclinical stage and tumor size.

Clinical Application of Modified Anyang Type 2 Esophageal Intubation Instrument──A New Esophageal Intubation Method

The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal was reported. The diagnosis of all 11 cases was confirmed by bariummeal roentgenography. After intubation, all the patients could take liquid or soft diet by mouth.There was no operative mortality and the patients survived 2 to 14 months (mean5.7 months). All of them could take food by mouth before death. The clinical application proved that the intubation has been a safe and suitable management.

SUPERFICIAL CARCINOMAS OF THE ESOPHAGUS AND GASTRIC CARDIA A CLINICOPATHOLOGICAL ANALYSIS OF 141 CASES

From January 1970 to June 1999, 141 patients with superficial esophageal and cardiac carcinomas (SEC and SCC) underwent surgical treatment, Of the 141 patients 128 (90.8%) had slight symptoms related to swallowing, and the remaining 13 (9.2%) were asymptomatic, Balloon cytology and esophagoscopy proved very useful for the diagnosis of SEC and SCC, and Lugol's solution staining technique was an effective auxiliary diagnostic measure, Lymph node metastasis was not found in patients with epithelial (EP) cancer, However, it was present in one (2.9%) of 34 patients with muscularis mucosal (MM) invasion, and in 5 (8.6%) of 58 patients with submucosal (SM) cancer, The 5-year survival rates of the patients with SEC and SCC were 75.5% and 71.4%, respectively (P > 0.05). The different depth of tumor invasion including EP, MM and SM cancers showed significant differences in the 5-year survival rate (P < 0.05), Although the prognosis for the patients with lymph node metastasis is poor, we should advocate extended lymph node dissection in surgical treatment of the patients in whom MM and SM cancers are suspected.