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Wang F.,Sun Yat Sen University | Duan H.,Sun Yat Sen University | Cai M.,Sun Yat Sen University | Fu J.,Sun Yat Sen University | And 10 more authors.
Thoracic Cancer | Year: 2015

Background: Body mass index (BMI) has been associated with the risk of esophageal cancer. But the influence of BMI on postoperative complications and prognosis has always been controversial. Methods: Between 2000 and 2007, 424 patients with esophageal squamous cell carcinoma (ESCC) underwent R0 esophagectomy at our center without neoadjuvant therapy. We performed univariate and multivariate analyses to identify prognostic factors for survival. Results: Patients were divided into three groups according to Asian-specific BMI cut-off value: underweight (n = 45), normal weight (n = 228), and overweight and obese (n = 151). Mean follow-up time was 39 months. The five-year overall survival (OS) rate was 19%, 34%, and 42% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). The five-year disease-free survival (DFS) rate was 24%, 41%, and 74% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). Multivariate analysis showed that pT, pN, and BMI were independent prognostic factors for DFS and OS. The C-index to the combined model showed improved predictive ability when compared to the pN classification (0.779 vs. 0.734). Conclusion: Preoperative BMI was an independent prognostic factor for OS and DFS. The proposed new prognostic model with the pN classification supplemented by BMI might improve the ability to discriminate ESCC patients' outcome. © 2015 China Lung Oncology Group and Wiley Publishing Asia Pty Ltd.


He Z.,Sun Yat Sen University | He Z.,Guangdong Esophageal Cancer Research Institute | Wu S.,Xiamen University | Li Q.,Sun Yat Sen University | And 4 more authors.
PLoS ONE | Year: 2013

Objectives:The objective of this study was to investigate the number of metastatic lymph nodes (pN) and the metastatic lymph node ratio (MLR) on the post-surgical prognosis of Chinese patients with esophageal cancer (EC) and lymph node metastasis.Methods:We enrolled 353 patients who received primary curative resection for EC from 1990 to 2003. The association of pN and MLR with 5-year overall survival (OS) was examined by receiver operating characteristic (ROC) and area under the curve (AUC) analysis. The Kaplan-Meier method was used to calculate survival rates, and survival curves were compared with the log-rank test. The Cox model was employed for univariate and multivariate analyses of factors associated with 5-year OS.Results:The median follow-up time was 41 months, and the 1-, 3- and 5-year OS rates were 71.2%, 30.4%, and 19.5%, respectively. Univariate analysis showed that age, pN stage, and the MLR were prognostic factors for OS. Patients with MLRs less than 0.15, MLRs of 0.15-0.30, and MLRs greater than 0.30 had 5-year OS rates of 30.1%, 17.8%, and 9.5%, respectively (p < 0.001). Patients classified as pN1, pN2, and pN3 had 5-year OS rates of 23.7%, 11.4%, and 9.9%, respectively (p < 0.001). Multivariate analysis indicated that a high MLR and advanced age were significant and independent risk factors for poor OS. Patients classified as pN2 had significantly worse OS than those classified as pN1 (p = 0.022), but those classified as pN3 had similar OS as those classified as pN1 (p = 0.166). ROC analysis indicated that MLR (AUC = 0.585, p = 0.016) had better predictive value than pN (AUC = 0.565, p = 0.068).Conclusions:The integrated use of MLR and pN may be suitable for evaluation of OS in Chinese patients with EC and positive nodal metastasis after curative resection. © 2013 He et al.


Zhang S.-S.,Sun Yat Sen University | Zhang S.-S.,Guangdong Esophageal Cancer Research Institute | Huang Q.-Y.,Sun Yat Sen University | Huang Q.-Y.,Guangdong Esophageal Cancer Research Institute | And 15 more authors.
Annals of Surgical Oncology | Year: 2013

Background: The value of p53 status for predicting response to chemotherapy-based treatment in patients with esophageal cancer has been controversial. We conducted a meta-analysis to elucidate the correlation of p53 status with the response to chemotherapy-based treatment. Methods: Studies were searched in PubMed, Embase, and Web of Science (up to September 2012). The p53 status and response to therapy were defined and standardized. Subgroup analyses based on the treatment and histopathology were performed to explore the usefulness of p53 status for predicting response to therapy in esophageal cancer. Sensitivity analyses were conducted by removing specific studies to assess the effects of study quality. Results: We included 28 studies with 1497 cases in our meta-analysis. Wild-type form of p53 status (low expression of p53 protein and/or wild-type p53 gene) was associated with high response to chemotherapy-based treatment in esophageal cancer (total major response [MR]: risk ratio [RR] = 1.09, 95 % CI = 1.03-1.16, P =.003; pathological MR: RR = 1.15, 95 % CI = 1.06-1.25, P =.001; total complete response [CR]: RR = 1.08, 95 % CI = 1.00-1.17, P =.040). The similar correlation between the wild-type form p53 and response to therapy were also detected in subgroup analyses (total MR, pathological MR, and total CR in chemoradiotherapy subgroup; total MR in chemotherapy subgroup; total MR and pathological CR in esophageal squamous cell carcinoma [ESCC]). Additionally, patients with wild-type form p53 status had high pathological complete response rate to neoadjuvant chemoradiotherapy in ESCC. Conclusions: The current meta-analysis suggested that p53 status might be a predictive biomarker for response to chemotherapy-based treatment in esophageal cancer. © 2013 Society of Surgical Oncology.


Zhang S.-S.,Sun Yat Sen University | Zhang S.-S.,Guangdong Esophageal Cancer Research Institute | Xie X.,Sun Yat Sen University | Wen J.,Sun Yat Sen University | And 11 more authors.
Diagnostic Pathology | Year: 2016

Background: TRPV6 is over-expressed and promotes the proliferation and invasion in many cancers. The association between the expression of TRPV6 and clinical outcome in esophageal squamous cell carcinoma (ESCC) has not been studied yet. We aim to elucidate the role of TRPV6 in predicting prognosis of patients with ESCC. Methods: In the retrospective study, mRNA level of TRPV6 was examined in patients (N = 174) from Sun Yat-sen University Cancer Center (mRNA cohort) and protein level of TRPV6 was examined in patients (N = 218) from Linzhou Cancer Hospital (protein cohort). Statistical analysis was performed to test the clinical and prognostic significance of TRPV6. Results: TRPV6 was down-regulated in ESCC tissues and cell lines. Patients with downregulation of TRPV6 trended to have a higher rate of advanced pT stage in both mRNA cohort (P = 0.089) and protein cohort (P = 0.073), though not statistically significant. No significant association was observed between TRPV6 expression and disease-specific survival (DSS) in both two cohorts. However, stratified survival analysis based on the gender showed that in mRNA cohort, downregulation of TRPV6 was associated with an unfavorable 3-year DSS in patients with male (47.3 % vs 63.6 %, P = 0.027) and with favorable 3-year DSS in patients with female (66.7 % vs 43.0 %, P = 0.031). The result was confirmed in protein cohort. Male patients with downregulation of TRPV6 had a poor 3-year DSS (20.0 % vs 57.1 %,P < 0.001) while female counterparts showed an enhanced 3-year DSS (56.1 % vs 28.6 %, P = 0.005). Conclusion: TRPV6 is down-regulated in ESCC. As a predictive biomarker, TRPV6 plays a Janus-like role in predicting survival of male and female ESCC patients. © 2016 Zhang et al.


Zhang S.S.,Sun Yat Sen University | Zhang S.S.,Guangdong Esophageal Cancer Research Institute | Yang H.,Sun Yat Sen University | Yang H.,Guangdong Esophageal Cancer Research Institute | And 23 more authors.
British Journal of Cancer | Year: 2013

Background: Body mass index (BMI) has been associated with the risk of oesophageal cancer. But the influence of BMI on postoperative complication and prognosis has always been controversial. Methods: In total, 2031 consecutive patients who underwent oesophagectomy between 1998 and 2008 were classified according to Asian-specific BMI (kg m -2) cutoff values. The impact of BMI on overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models. We performed a meta-analysis to examine the association of BMI with OS and postoperative complication. Results: Patients with higher BMI had more postoperative complication (P = 0.002), such as anastomotic leakage (P = 0.016) and cardiovascular diseases (P < 0.001), but less incidence of chylous leakage (P = 0.010). Logistic regression analysis showed that BMI (P = 0.005) was a confounding factor associated with postoperative complication. Multivariate analysis showed that overweight and obese patients had a more favourable survival than normal weight patients (HR (hazard ratio) = 0.80, 95% CI (confidence interval): 0.70-0.92, P = 0.001). Subgroup analysis showed that the association with higher BMI and increased OS was observed in patients with oesophageal squamous cell carcinoma (ESCC) (P < 0.001), oesophageal adenocarcinoma (EA) (P = 0.034), never-smoking (P = 0.035), ever-smoking (P = 0.035), never alcohol consumption (P = 0.005), weight loss (P = 0.003) and advanced pathological stage (P < 0.001). The meta-analysis further corroborated that higher BMI was associated with increased complication of anastomotic leakage (RR (risk ratio) = 1.04, 95% CI: 1.02-1.06, P = 0.001), wound infection (RR = 1.03, 95% CI: 1.00-1.05, P = 0.031) and cardiovascular diseases (RR = 1.02, 95% CI: 1.00-1.05, P = 0.039), but decreased incidence of chylous leakage (RR = 0.98, 95% CI: 0.96-0.99, P < 0.001). In addition, high BMI could significantly improved OS (HR = 0.78, 95% CI: 0.71-0.85, P < 0.001). Conclusion: Preoperative BMI was an independent prognostic factor for survival, and strongly associated with postoperative complications in oesophageal cancer. Copyright © 2013 Cancer Research UK.


Xie X.,Sun Yat Sen University | Xie X.,Guangdong Esophageal Cancer Research Institute | Zhang S.-S.,Sun Yat Sen University | Zhang S.-S.,Guangdong Esophageal Cancer Research Institute | And 12 more authors.
Biomarkers | Year: 2013

Objective: This study was to determine the role of HOXB7 in predicting outcomes of patients with oesophageal squamous cell cancer (OSCC). Methods: Samples were collected from 179 OSCC patients. HOXB7 mRNA expression was measured by quantitative real-time polymerase chain reaction. Results: HOXB7 mRNA expression was up-regulated in 85.1% of OSCC tumorous tissues, and correlated with age, pathological T and N category, as well as cancer-specific survival (CSS). However, subgroup analysis revealed its discernibility on CSS was only pronounced in early stage. Conclusions: HOXB7 mRNA expression might serve as a novel prognostic biomarker for resected OSCC patients in early stage. © 2013 Informa UK Ltd.


Zhu Y.,Sun Yat Sen University | Zhu Y.,Guangdong Esophageal Cancer Research Institute | Qiu B.,Sun Yat Sen University | Qiu B.,Guangdong Esophageal Cancer Research Institute | And 10 more authors.
Diseases of the Esophagus | Year: 2014

Summary: Primary small cell carcinoma of esophagus (SCCE) is a rare disease with poor prognosis. The aims of this study are to review the clinical characteristics, treatment modalities, and outcomes of SCCE and to investigate the prognostic factors and optimal treatment options. Sixty-four patients diagnosed as SCCE in Sun Yat-sen University Cancer Center from 1990 to 2011 were retrospectively reviewed. There were 46 patients with limited disease (LD) and 18 with extensive disease. The median survival time (MST) and overall survival rate were calculated and compared by the Kaplan-Meier method and log-rank test, respectively. The prognostic factors were calculated by Cox hazards regression model. With a median follow up of 11.6 months, the MST of all the 64 patients was 12.6 months, 16.5 months for LD and 9.0 months for extensive disease. The 1-, 3-, and 5-year overall survivals were 52.5%, 20.9%, and 7.5%, respectively. In univariate analysis, patients with ECOG performance score <2 (P = 0.009), lesion length ≤5cm (P = 0.009), T stage ≤2 (P = 0.004), LD (P = 0.000), and multimodality treatment (P = 0.016) had significant associations with MST. Multivariate analysis showed that ECOG performance score (P = 0.001), T stage (P = 0.023), limited-extensive stage (P = 0.007), and treatment modality (P = 0.008) were independent prognostic factors. Locoregional treatment combined with chemotherapy had a trend to increase MST from 15.3 to 20.0 months in LD patients (P = 0.126), while combined chemotherapy had a significant impact on MST in extensive disease patients (P = 0.000). SCCE is a highly malignant disease with poor prognosis. Patients might obtain survival benefit from the combination of locoregional treatment and systemic therapy. Prospective studies are needed to validate these factors. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

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