Quality of life after three kinds of esophagectomy for cancer

AIM： TO evaluate quality of life （QOL） following Ivor Lewis, left transthoracic, and combined thoracoscopic/ laparoscopic esophagectomy in patients with esopha- geal cancer. METHODS： Ninety patients with esophageal cancer were assigned to Ivor Lewis （/7 = 30）, combined thora- coscopic/laparoscopic （n = 30）, and left transthoracic （n = 30） esophagectomy groups. The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer, both developed by the European Organization for Research and Treatment of Cancer, were used to evaluate patients＇ QOL from 1 wk before to 24 wk after surgery. RESULTS： A total of 324 questionnaires were collect- ed from 90 patients, 36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits. QOL declined markedly in all patients at 1 wk postoperatively： preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis, combined thoracoscopic/laparoscopic, and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1 （P 〈 0.001）, 81.1±9.0 vs 53.3 ± 11.5 （P 〈 0.001）, and 83.6 ± 11.2 vs 46.4 ± 11.3 （P 〈 0.001）, respectively. Thereafter, QOL recovered gradually in all patients. Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL; global scores were lower in this group than in the combined thoracoscopic/laparoscopic （P 〈 0.001） and left trans- thoracic （P 〈 0.001） groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively. QOL declined least in patients under- going combined thoracoscopic/laparoscopic esopha- gectomy, and most indices had recovered to preopera- tive levels at 24 wk postoperatively. In the Ivor Lewis and combined thoracoscopic/laparoscopic groups, pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9 （P 〈 0.001） and 59.3 ± 16.1 vs 70.2 ± 19.2 （P = 0.02）, respectively, at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6 （P = 0.007） and 88.4 ± 10.5 vs 95.8 ± 7.3 （P = 0.003）, respectively, at 24 wk postop- eratively. Scores in the left transthoracic esophagecto- my group fell between those of the other two groups. CONCLUSION： Compared with Ivor Lewis and left transthoracic esophagectomies, combined thoraco- scopic/laparoscopic esophagectomy enables higher postoperative QOL, making it a preferable surgical ap- proach for esophageal cancer.

Detection of Mycoplasma Hyorhinis Infection in Ovarian Cancer with in situ Hybridization and Immunohistochemistry

OBJECTIVE To detect Mycoplasma hyorhinis in ovarian cancer tissues and the relationship between mycoplasma infection and ovarian cancer. METHODS All specimens obtained from 109 cases with ovarian cancer were fixed in freshly prepared 10% neutral buffered formalin, embedded in paraffin, and cut into 4-μm sections for insitu hybridization （ISH） and then detected with immunohistochemistry （IHC）. The expressions of 16S rRNA and P37 protein from mycoplasma hyorhinis were detected respectively using ISH and IHC. SPSS 13.0 software was employed to analyze the relationship between the results of the study and clinical pathological materials. RESULTS The expression rate of mycoplasma hyorhinis 16S rRNA gene and P37 protein was 20.2% （22/109） and 43.1% （47/109 cases） in ovarian cancer tissues, respectively, but it was 0 （0/30 cases） in the normal ovarian tissues. The difference in mycoplasma infection ratio between ovarian cancer tissues and normal tissues was extremely significant （P 〈 0.001）. Anyhow, we didn＇t found any association between the mycoplasma infection and clinical pathological characters. CONCLUSION There was a mycoplasma infection in ovarian cancer tissues, which may play a role in oncogenesis of ovarian cancer.

Histological differentiation impacts the tumor immune microenvironment in gastric carcinoma:Relation to the immune cycle

BACKGROUND Various histological types of gastric carcinomas(GCs)differ in terms of their pathogenesis and their preexisting background,both of which could impact the tumor immune microenvironment(TIME).However,the current understanding of the immune contexture of GC is far from complete.AIM To clarify the tumor-host immune interplay through histopathological features and the tumor immune cycle concept.METHODS In total,50 GC cases were examined(15 cases of diffuse GC,31 patients with intestinal-type GC and 4 cases of mucinous GC).The immunophenotype of GC was assessed and classified as immune desert(ID),immune excluded(IE)or inflamed(Inf)according to CD8+cell count and spatial pattern.In addition,CD68+and CD163+macrophages and programmed death-ligand 1(PD-L1)expression were estimated.RESULTS We found that GCs with different histological differentiation demonstrated distinct immune contexture.Most intestinal-type GCs had inflamed TIMEs rich in both CD8+cells and macrophages.In contrast,more aggressive diffuse-type GC more often possessed ID characteristics with few CD8+lymphocytes but abundant CD68+macrophages,while mucinous GC had an IE-TIME with a prevalence of CD68+macrophages and CD8+lymphocytes in the peritumor stroma.PD-L1 expression prevailed mostly in intestinal-type Inf-GC,with numerous CD163+cells observed.Therefore,GCs of different histological patterns have specific mechanisms of immune escape.While intestinal-type GC was more often related to PD-L1 expression,diffuse and mucinous GCs possessing more aggressive behavior demonstrated low immunogenicity and a lack of tumor antigen recognition or immune cell recruitment into the tumor clusters.CONCLUSION These data help to clarify the links between tumor histogenesis and immunogenicity for a better understanding of GC biology and more tailored patient management.