Human papillomavirus DNA and P16～(INK4A) expression in concurrent esophageal and gastric cardia cancers

AIM:To investigate the relationship between human papillomavirus (HPV) infection and concurrent esophagus and gastric cardia cancer from the same patient (CC) and examine the significance of P16 INK4A protein expression.METHODS:Polymerase chain reaction was used to detect the presence of HPV type16 (HPV16).The expression of P16 INK4A protein was detected using immunohistochemistry.RESULTS:Among the CC specimens,HPV16-DNA was found in eight cases of esophageal squamous cell carcinoma (ESCC) and five cases of gastric cardia adenocarcinoma (GCA),respectively (47% vs 29%),and two of both ESCC and GCA.P16 INK4A was highly expressed in both ESCC and GCA.In the HPV-associated positive CC,higher P16 INK4A expression was observed in the GCA than in the ESCC (75% vs 25%,P < 0.05).CONCLUSION:HPV16 as a correlated risk factor may play an important role in the development of ESCC and GCA.P16 INK4A may be a screening index in the HPVassociated carcinoma of gastric cardia.

Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Methods The patients were divided into A,Band C groups:3155 patients (group A)were treated surgically in the first 14 years ,5952 patients (group B)in the next 10 years ,and 3863 patients (group C)in the last 10 years .The early stage lesions (Tis ,Ti)were as-signed as a separate group.The results of these groups were compared. Results The respectability for esophageal and gastric cardiac carcinoma wsa 94.0% and 84.4% respectively ,and the overall respectability .The overall operative mortality was 1.8%,it was 4.4% for group A, 1.6% for group B,and 0.5% for group C.The overall 5-year sur-vival was 31.6%.The 5-year survival for groups A, B,C and the early stage group was 27.0% ,29.1%,32.0% and 92.6%,respect-tively.Among the 3 temporal groups,differences were observed in tems of lesion stage,location and size,surgery with or without com-bined therapy and postoperative complications. Conclusion Best results were achieved in the early cases,with a respectability of 100% and a 5-year survival of 92.6%.The indications for surgical treatment were extended with increased respectability and decreased mortality.Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recur-rence,and to achieve better outcomes by using combined therapy for patients with≥stage Ⅲ lesion.

Relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China

AIM To study the relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhebitants of China, which is a unique Littoral high-risk area of esophageal carcinoma in China. The poor communication and transportation in the psst has made Cheoshan a relatively closed area and kept its culture and costure of old China thousend years ago.``METHODS Data on age, sex, ABO blood type and X-rayor psthological diagnose of the pstients with carcinoma of esophagus or cardia were collected from the Tumor Hospital. First Affiliated Hospital, Second Affiliated Hospital of Shantou University Medical College; and the Central Hospital of Shantou and the Central Hospital of Jieyang. A total of 6685 pstients with esophageal carcinoma (EC) and 2 955 patients with cardiac cancer (CC) in Chaoshen district were retrospectively assessed for their association with ABO blood groups.``RESULTS The distribution of ABO blood groups in patients with EC or CC was similar to the norrnal local population in Chaoshen. However, blood group B in male patients with CC and in the pstients with carcinoma in the upper third esophagus was 2.3% and 4.7% higher than the corresponding controls. The relative risk B: O was 1. 1415 (P＜0.05)and 1 .2696 (P＜0.05), respectively. No relationship was found between ABO blood groups and tumor differentiation.``CONCLTUSION ABO blood group B is associated with the incidence of CC in male individuals and carcinona in the upper third esophagus. The distribution of ABO blood groups varies in the different geographical and ethnic groups. As a result, proper controls are very important for such studies.

Percutaneous transsplenic embolization of esophageal and gastrio-fundal varices in 18 patients

AIM: Clinical application and potential complication of percutaneous transsplenic varices embolization (PTSVE) of esophageal or gastrio-fundal varices in patients with hepatocellular carcinoma (HCC) complicated with portal vein cancerous thrombosis (PVCT).METHODS: 18 patients with HCC complicated with PVCT and esophageal or gastrio-fundal varices who underwent PTSVE were collected. The rate of success, complication, mortality of the procedure and postoperative complication were recorded and analyzed.RESULTS: PTSVE were successfully performed in 16 of 18cases, and the rate of success was 89%. After therapy erythrocyte counts decreased in all of the natunts. 5 of patients needed blood transfusion, 2 patients requiredsurgical intervention because of and 11 patients with ascites were alleviated by diuresis. Among these 18patients, the procedure-related mortality was 11% (2/18),one died of acute hepatic failure on the forth day after procedure, another died of acute renal failure on the fifth day. The patients were follow up for 112 mon exceptone. 13of them died of their tumors but none of them experienced variceal bleeding.CONCLUSION: PTSVE is a relatively safe and effective method to treat esophageal or gastrio-fundal varices in HCCpatients with PVCT when percutaneous transhepatic varices embolization (PTHVE) of varices is impossible.

Despite shared susceptibility loci, esophageal squamous cell carcinoma embraces more familial cancer than gastric cardia adenocarcinoma in the Taihang Mountains high-risk region of northern central China

Background In China, esophageal squamous cell carcinoma （ESCC） and gastric cardia adenocarcinoma （GCA） share susceptibility loci, but different rates of multiple primary cancer and male/female ratio suggest the proportion of familial cancer is not equal. Methods The percent of cases with a positive family history, median onset age, rate of multiple primary cancer, and male/female ratio associated with upper, middle, lower third ESCC and GCA were compared to reveal the proportion of familial cancer. The 7267 subjects analyzed constituted all ESCC and GCA cases in whom the cancer was resected with cure intention between 1970 and 1994 at the 4th Hospital of Hebei Medical University. Results A positive family history for cancer was most often associated with the multiple primary ESCC and/or GCA cases, e.g. with 42% of the males and 59% of the females. For upper, middle, lower third ESCC and GCA, the percent of cases with a positive family history decreased by 38.5%, 26.3%, 26.5%, and 11.2% in males （P 〈0.000） and 25.0%, 22.3%, 23.9%, and 9.8% in females （P 〈0.0001）. Median onset age increased from 49, 52, 55, to 56 years old in males and from 50, 53, 55, to 56 years old in females （ both P 〈0.0001） for upper, middle, lower third ESCC and GCA. Male/female ratio increased from 2.2, 2.1, 2.2, to 6.2：1 for upper, middle, lower third ESCC and GCA （P〈0.0001）. For upper, middle, lower third ESCC and GCA, the percent of multiple primary cancers decreased from 21.2%, 2.3%, 2.2%, to 1.5% in males and from 14.3%, 2.4%, 3.4%, to 3.1% in females. The preponderance of males, smoking, drinking, or onset-age 〉50 years was significantly higher in GCA than in ESCC, and the difference in the rates of multiple primary cancers between the preponderant and the non-preponderant cases was significant in GCA, but not in ESCC, suggesting non-equal requirement for genetic susceptibility when environmental hazards did not exist. Conclusions The proportion of familial cancer in upper gastrointestinal carcinomas decreases by the priamry site of upper, middle, lower third esophagus and gastric cardia. Considering familial and sporadic cancers differ in preventability, screening strategy and recurrence, our findings have basic and clinical implications.

食管癌与贲门癌患者的临床症状对比分析

目的比较食管癌和贲门癌患者常见的临床症状类型与临床病理特点,分析两者临床症状的相似性。方法从《省部共建食管癌防治国家重点实验室临床诊疗、病理和随访信息数据库》,收集2019年11月至2020年1月间经胃镜联合病理活检确诊并进行根治性手术的食管癌患者380例、贲门癌患者177例,对两组患者的临床症状等信息进行整理和统计学比较,分析两种肿瘤患者的临床症状及病理特点。结果食管癌和贲门癌患者的临床症状可规范分类为13种,常见的依次为吞咽不适(68.04%)、腹部不适(11.49%)、消化道出血(3.77%)、胃食管反流(3.59%)等,其中吞咽不适、腹部不适、消瘦乏力3种临床症状在两类患者中的分布差异有统计学意义(P<0.05),但吞咽/腹部不适相关症状在两组患者之间无显著性差异(P>0.05)。胃食管反流和上消化道出血症状都多见于中晚期食管癌和贲门癌(P>0.05)。无症状食管癌患者多为早期,而无症状贲门癌患者以中晚期多见(P<0.01)。结论食管癌和贲门癌在流行病学特征、临床症状上表现出密切的联系,临床症状具有明显的相似性。

常规内镜和色素内镜对早期消化道肿瘤及癌前病变的诊断价值

目的探讨常规内镜和色素内镜在早期消化道肿瘤及癌前病变诊断中的价值。方法选取2020年7月至2021年7月新疆维吾尔自治区人民医院接诊的120例疑似早期食管癌、胃癌及癌前病变患者作为研究对象,按照检查方法不同分为甲苯胺蓝染色组、美兰染色组、常规内镜组,每组40例。常规内镜组行常规内镜检查,甲苯胺蓝染色组行甲苯胺蓝染色检查,美兰染色组行美兰染色检查,比较3种检查方法的诊断效能、清晰度评分。结果甲苯胺蓝染色组检查灵敏度、特异度、准确度均高于美蓝染色组、常规内镜组,美兰染色灵敏度、特异度、准确度均高于常规内镜组,差异有统计学意义(P<0.05)。甲苯胺蓝染色组清晰度评分高于美兰染色检查组、常规内镜组,且美兰染色组清晰度评分高于常规内镜组,差异有统计学意义(P<0.05)。结论甲苯胺蓝染色内镜检查诊断早期食管癌、胃癌及癌前病变,清晰度较高,便于观察胃肠道、食管情况,提高检出率,值得临床推广应用。

西黄胶囊辅助晚期肺癌、贲门/食管癌患者化疗的疗效分析

目的 探讨西黄胶囊辅助晚期肺癌、贲门/食管癌化疗的治疗效果。方法 选取2017年5月1日至2022年5月1日在安徽医科大学第三附属医院治疗的101例晚期肺癌、贲门/食管癌患者按是否使用西黄胶囊分为2组。对照组47例,采用常规方案化疗;观察组54例,采用西黄胶囊联合常规方案化疗;比较2组患者的临床疗效、免疫功能和不良反应。结果 观察组治疗有效率为92.5%;对照组治疗有效率为74.4%,2组差异有统计学意义(P<0.05)。观察组在治疗效果上明显优于对照组。观察组发生不良反应9例(16.6%),对照组发生不良反应18例(38.3%),2组差异有统计学意义(P<0.05)。治疗后,观察组的CD3^(+)、CD4^(+)、CD8^(+)的水平明显高于对照组,差异均有统计学意义(P<0.05)。结论 西黄胶囊对晚期的肺癌、食管/贲门癌化疗具有良好的辅助治疗效果,可有效减少化疗药物的不良反应,增强患者的免疫功能。

高龄食管癌贲门癌患者术后主要并发症的原因分析

回顾性分析 10 3例 70岁以上食管癌贲门癌患者临床资料 ,结果发现术后主要并发症为吻合口瘘及肺部并发症 ,吻合口瘘的发生与手术方式密切相关 ,三切口手术及食管拔脱左颈吻合术吻合口瘘的发生率显著高于其他手术方式 (P<0 .0 1)。肺部并发症的发生与术前肺功能及手术方式均密切相关 ,术前肺功能差者即使行不开胸的食管拔脱术 ,肺部并发症的发生率仍高达 6 0 % ;术前肺功能正常患者 ,三切口术及二切口右胸顶吻合术肺部并发症发生率亦高达 39% ,显著高于其他手术组(P<0 .0 1)。故对老年食管癌贲门癌患者应尽量避免三切口及二切口右胸顶吻合术 。

食管和贲门癌及癌前病变患者血清中多个自身抗体的检测及其临床意义

目的:探讨食管和贲门癌及癌前病变患者血清中多个肿瘤相关自身抗体的变化特征及其在食管和贲门癌高危人群筛查和早期诊断中的意义。方法:应用间接酶联免疫反应法和肿瘤相关抗原微阵列(包含8个重组的癌抗原蛋白:C-myc、p53、cyclinB1、p16、p62、Koc、IMP1和Survivin)检测376例食管和贲门各级病变患者(正常、癌前病变和癌)血清中的自身抗体。结果:在所检测的八种抗原中,p53、C-myc、cyclinB1、IMP1和p62从正常食管到癌前病变及癌患者血清中和p53、C-myc、p16、p62在正常贲门到癌前病变及癌患者血清中阳性百分率均具有线性升高趋势。单一抗体对食管和贲门癌检出率较低,p53在癌血清中的表达阳性率在所有抗原中最高,在食管癌和贲门癌患者中分别为23%(13/57)和21%(9/43)。但是,当应用8个抗原分析时,至少有1个反应为阳性时,其检出阳性率明显增高,食管和贲门癌的阳性检出率分别提高到63%(36/57)和61%(26/43),上述检测指标在正常食管和贲门与相应各级癌前病变和癌患者阳性表达率差异有统计学意义,P<0·05。结论:联合应用多个肿瘤相关抗原比应用单个肿瘤相关抗原分析食管和贲门癌及癌前病变患者血清中的自身抗体变化能够提高癌和癌前病变患者的检出率。食管和贲门癌多个相关抗原微阵列的进一步优化有可能成为临床上食管和贲门癌和高危人群检测和早期诊断的非侵袭性方法。

食管贲门双源癌患者癌组织中mdm2与Bcl-2和bax及p53蛋白的表达

目的:探讨同一个体食管贲门双源癌组织mdm2、Bcl-2、bax和p53蛋白变化特征及其意义。方法:采用免疫组化卵白素-生物素-过氧化物酶复合物(ABC)法和组织病理学方法,分析15例双源癌患者(同时发生食管鳞癌和贲门腺癌)mdm2、Bcl-2、bax和p53蛋白的表达状况。结果:15例食管和贲门双源癌患者食管鳞癌和贲门腺癌组织均出现不同程度的mdm2、Bcl-2、bax和p53蛋白的阳性表达,食管癌组织中免疫阳性率分别为67%(10/15)、87%(13/15)、73%(11/15)和73%(11/15);贲门癌组织中分别为67%(10/15)、80%(12/15)、80%(12/15)和67%(10/15),且免疫反应类型主要为弥漫型。mdm2、Bcl-2、bax和p53蛋白在食管和贲门双源癌肿瘤组织中一致性改变率分别为100%(15/15)、80%(12/15)、67%(10/15)和80%(12/15)。结论:食管和贲门双源癌存在较高的mdm2、Bcl-2、bax和p53蛋白表达一致性改变,提示食管贲门双源癌可能具有相似的发病因素和分子机制。

管状胃食管吻合术对食管癌患者术后生活质量影响的临床研究

目的探讨管状胃食管吻合术对食管癌患者术后生活质量的影响。方法自2007年8月至2008年4月期间,随机选择104例胸中下段食管癌患者行食管癌切除术,其中管状胃组54例行管状胃食管吻合术,全胃组50例采用传统全胃食管吻合术。分别于术后第3、6、12个月评价其生活质量。结果 104例患者均获成功,无手术死亡病例,术后并发症两组之间比较差异无统计学意义。术后第3个月两组的生活质量比较差异无统计学意义(P>0.05);术后第6个月和第12个月管状胃组生活质量指标改善比全胃组明显,差异有统计学意义(P<0.05)。结论管状胃食管吻合术组患者较全胃食管吻合术组患者术后远期生活质量明显提高。

食管癌贲门癌合并糖尿病的外科治疗

目的探讨食管、贲门癌合并糖尿病的手术治疗。方法回顾性总结23例食管贲门癌合并糖尿病的手术治疗经验。结果23例中食管癌17例,贲门癌6例;术前伴慢性阻塞性肺部疾病者4例,伴心血管疾病者5例,伴慢性肾功能衰竭1例;发现癌肿时糖尿病已明确者9例,另14例为术前检查所发现。空腹血糖5.9～14.6 mmoL/L;根治性切除18例,姑息性切除5例,切除率100%;术后胸部切口感染4例,发生低血糖休克1例;全组无手术死亡,均顺利渡过手术期。术前、术中、术后均用普通胰岛素控制糖尿病,补糖以5%等渗液体为主,按1U普通胰岛素5 g糖的比例补液,并按尿糖一个“+”:4U胰岛素的剂量追加,使患者尿糖控制在“+～++”,血糖保持在略高于正常水平。术后7天开始进食后改用口服降糖药。结论食管贲门癌合并糖尿病是一较严重的临床疾病,术后并发症发生率高,应予以重视,胰岛素的合理应用是治疗成功的关键。

食管癌和贲门癌外科治疗的2019例临床分析

我院1978年1月20日-2003年5月12日对新疆不同民族的2019例食管癌和贲门癌患者施行了手术治疗。其中，食管癌1350例，贲门癌669例。少数民族患者占1138例（56．4％）。2019例中总切除率为90．3％（1824／2019）。食管癌切除率为92．3％（1246／1350）；贲门癌切除率为87．0％（582／669）。术后发生并发症174例（8．6％）。其中，胸内吻合口瘘34例（1．9％，34／1824），手术死亡34例（1．7％，34／2019）。初步研究结果提示，新疆不同民族发病情况不同，哈萨克族患病率最高。病例的选择及术前分期对手术能否达到根治切除甚为重要。

食管癌术前及术后早期胸胃排空功能的对比观察

目的:研究食管癌术后早期胸胃排空的生理机制。方法:应用放射性核素对38例食管癌术后患者进行术前及术后24 h的流食胃排空检查,分析胃半排空时间(GET 1/2)的变化。结果:术后未出现胃潴留症状。30例(78.9%)患者术后胃排空显著快于术前(P<0.01)。术前男性胃排空时间显著快于女性(P<0.05),而在术后男女性之间则无显著性差异(P>0.05)。结论在重力作用的影响下,术后早期胸胃对流食的排空较术前显著加快,胸胃只是作为无功能的连接管道而存在。

食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究

目的研究颈部食管与管状胃侧侧吻合在食管癌术中的应用效果。方法将该科收治的44例胸段食管癌患者随机分为侧侧吻合组和全手工吻合组各22例。所有患者均行经右胸、腹部、颈部三切口食管癌切除、管状胃成形,并于颈部行食管胃吻合;侧侧吻合组采用内镜切割缝合器及全手工吻合相结合行食管与胃侧侧吻合,全手工吻合组采用间断分层缝合方法行食管胃端侧吻合。结果所有患者均顺利完成手术,术后侧侧吻合组失访1例。侧侧吻合组吻合口瘘1例,全手工吻合组吻合口瘘1例;全手工吻合组吻合口狭窄3例(13.7%),侧侧吻合组未发现吻合口狭窄病例,两组间比较差异有统计学意义(P<0.05)。两组患者吻合口狭窄、吻合口瘘、嗳酸、烧心及胃镜下反流性食管性等方面比较,差异无统计学意义(P>0.05)。结论食管癌术中颈部食管与管状胃侧侧吻合可有效预防吻合口狭窄。

高龄食管癌、贲门癌患者食管切除术结果分析

目的：探讨高龄食管癌、贲门癌患者行食管切除术的危险性及手术死亡率与年龄的关系。方法：１９８５年～１９９０ 年对４４４ 例食管癌、贲门癌患者食管切除术，根据年龄段分为两组：Ⅰ组，年龄≥６５ 岁，５６ 例，Ⅱ组，年龄＜６５ 岁，３８８ 例，比较两组术前危险因素、手术合并症及死亡率、平均住院日和长期生存率。结果：两组病例术后死亡率（３－６ ％ ｖ２－８ ％ ） ，平均住院日（２３－３ 天ｖ２２－３ 天） ，５ 年及１０ 年生存率（３４－５ ％ ｖ ３６－８ ％ ，２４－１％ ｖ２５－７％ ） 均无显著性差别。结论：高龄食管癌贲门癌患者行食管切除术并不增加手术死亡率，而长期生存率与年轻者相比无差异。

原发性食管胃交界处恶性黑色素瘤1例及文献复习

目的 分析原发性食管恶性黑色素瘤的临床病理学特征。方法 对 1例原发性食管胃交界处恶性黑色素瘤进行组织学观察和免疫组化标记 ,同时复习相关文献。结果 原发性食管胃交界处恶性黑色素瘤的组织学改变类似于皮肤发生的恶性黑色素瘤。免疫表型 :肿瘤细胞HMB4 5、S 10 0蛋白和vimentin阳性 ,cytokeratin阴性。同时必须排除皮肤、眼等处的原发病灶。结论 原发性食管胃交界处恶性黑色素瘤 (无色素性 )是一种罕见的肿瘤 ,应该与一些食管发生的肿瘤相鉴别如低分化癌、肉瘤和转移性恶性黑色素瘤等。本瘤预后极差 ,术后平均生存时间仅为 10个月。

贲门癌经腹入路手术适应证的前瞻性研究

目的探讨贲门癌经腹入路手术的适应证,旨在规范贲门癌经腹入路手术适应证的选择标准。方法根据食管及贲门解剖、贲门癌病理特点、文献资料及临床经验,制定贲门癌经腹入路手术适应证标准,自2001年1月开始,对经腹入路手术治疗的贲门癌病例进行前瞻性研究。至2005年12月,共研究153例。结果符合适应证选择标准的贲门癌病例,经腹入路均能行根治手术,手术切除率100%。标本术后经病理学检查证实切缘均无癌细胞残留,共检出淋巴结781个,癌阳性率为78.75%(615/781)。全组均无吻合口瘘、胸腔积液及肺部感染等并发症,手术死亡率为0。随访期间发现腹腔内有癌转移灶者35例,复发率为22.88%,其中无吻合口复发、胸腔或纵隔转移病例。结论合理掌握贲门癌经腹手术适应证,既能达到根治效果,又能减轻患者创伤、负担及风险,具有重要临床意义。