crossing96/oncoscreening huggingface dataset:
Preoperative Chemoradiation Therapy Versus Chemotherapy in Patients Undergoing Modified En Bloc Esophagectomy for Locally Advanced Esophageal Adenocarcinoma: Is Radiotherapy Beneficial?	BACKGROUND: Preoperative chemotherapy (ChT) or chemoradiation (ChRT) are associated with improved outcomes compared with up-front surgical resection in patients with locally advanced esophageal adenocarcinoma (EAC). Two randomized controlled trials comparing these therapies included nonradical resection and failed to reach significance. We hypothesized that additional regional radiotherapy does not benefit patients undergoing en bloc resection. METHODS: We performed a multiinstitutional study using three prospectively entered databases from high-volume esophageal centers. Inclusion criteria were patients with EAC treated with preoperative ChT or ChRT, followed by modified en bloc esophagectomy. To minimize issues of stage migration and heterogeneity, we limited the study to patients with cT3 N1 M0 EAC. Survival was assessed by the Kaplan-Meier method, and step-wise multivariable analyses were used to explore variables independently associated with survival outcomes. Radical resections included two- and three-field lymphadenectomies, dependent solely on surgeon/institutional preference. RESULTS: We identified 214 patients with cT3 N1 disease, of which 114 underwent preoperative ChT vs 100 who underwent ChRT. Median survival was 31.2 months (95% confidence interval, 20.7 to 41.7 months) for the ChT group vs 39.2 months (95% confidence interval, 27.3 to 51.0 months) for the ChRT group (p = 0.665). Mortality at 90 days was 5.3% for ChT vs 4% for ChRT (p = 0.754). No differences were noted between patterns of locoregional and distant recurrence between both groups. There were no significant differences in major postoperative morbidity between both groups. CONCLUSIONS: Given a modified en bloc esophagectomy, type of preoperative therapy was not a significant determinant of overall survival or disease-free survival. Although preoperative ChRT did not add perioperative risk, it also did not prolong survival. The role of preoperative radiotherapy in the setting of a planned radical resection should be further evaluated.	esophagus
Membrane type 1-matrix metalloproteinase induces epithelial-to-mesenchymal transition in esophageal squamous cell carcinoma: Observations from clinical and in vitro analyses.	Membrane type 1-matrix metalloproteinase (MT1-MMP) is associated with enhanced tumorigenicity in many cancers. A recent study has revealed that MT1-MMP induces epithelial-to-mesenchymal transition (EMT) in prostate and breast cancer cells. However, its role in esophageal squamous cell carcinoma (ESCC) has not been studied. Here, we investigated the role of MT1-MMP in the dissemination of ESCC. Expression of MT1-MMP was detected by immunohistochemistry and tissue microarray in 88 Kazakh ESCC patients. Western blotting was performed to detect endogenous and overexpressed exogenous MT1-MMP in the Eca109 and Eca9706 cell lines, respectively. Transwell assay was used to estimate MT1-MMP-induced invasion and metastasis. EMT-associated proteins were detected by immunohistochemistry and western blotting. The associations between the expression of MT1-MMP and EMT-associated proteins with clinicopathologic parameters were analyzed. Overexpression of MT1-MMP was confirmed in Kazakh ESCC patients. MT1-MMP levels were found to be correlated with the depth of tumor infiltration. MT1-MMP induced EMT in ESCC both in vivo and in vitro, N-cadherin and Vimentin expression was upregulated upon MT1-MMP transfection into cells. However, E-cadherin was found to be downregulated. MT1-MMP-induced EMT led to increase migration and invasion in ESCC cell lines. In conclusion, our results suggest that MT1-MMP promotes ESCC invasion and metastasis.	esophagus
Chronic Esophageal Perforation With Periesophageal Abscess Mimicking Malignancy on FDG PET/CT.	A 53-year-old man was admitted because of progressive dysphagia and retrosternal pain for 20 days. Esophagogastroduodenoscopy showed an irregular submucosal bulge on the distal esophageal wall. A barium swallow showed a triangular-shaped outpouching of contrast material with minimal contained extravasation into the periesophageal area. Enhanced CT showed thickening of the distal esophagus with an area containing air and septa. FDG PET/CT showed intense FDG uptake of the thickened esophageal wall mimicking malignancy. Endoscopic ultrasonography-guided biopsy of the submucosal mass revealed granulation tissue. The imaging and pathologic findings were consistent with chronic esophageal perforation with periesophageal abscess.	esophagus
Management of Tracheo- or Bronchoesophageal Fistula After Ivor-Lewis Esophagectomy.	BACKGROUND: The development of tracheo- or bronchoesophageal fistula (TBF) after Ivor-Lewis esophagectomy remains to be a rare complication associated with a high mortality rate. METHODS: In this retrospective study, the charts of patients with TBF after esophagectomy were analyzed in terms of individual patient characteristics, esophagotracheal complications, respiratory function, management, and outcome. RESULTS: Between January 2000 and December 2014, 1204 patients underwent Ivor-Lewis esophagectomy for esophageal cancer; 13 patients (1.1 %) developed a TBF. In all 13 patients, a concomitant leakage of the intrathoracic esophagogastrostomy was evident, either prior to diagnosis of TBF (metachronous TBF) or simultaneously (synchronous TBF). TBF was predominantly located in the left main bronchus (n = 6, 46.1 %) or trachea (n = 5, 38.5 %). Management of TBF included re-thoracotomy (n = 7), interventional endoscopic (n = 10) or bronchoscopic therapy (n = 4). In the majority of patients (n = 8), management consisted of two subsequent treatment modalities. In 3 out of four patients, TBF was successfully treated by endoscopic stenting only. Five patients (38.5 %) died following a septic course with multiple organ failure. CONCLUSIONS: The development of TBF after Ivor-Lewis esophagectomy is always combined with anastomotic leakage of the esophagogastrostomy. Treatment options primarily depend on the vascularization of the gastric conduit, the severity of the concomitant aspiration pneumonia, and the volume of the air leakage.	esophagus
Use of Positron Emission Tomography to Detect Recurrence and Associations With Survival in Patients With Lung and Esophageal Cancers.	BACKGROUND: Positron emission tomography (PET) scans are often used in cancer patients for staging, restaging, and monitoring for treatment response. These scans are also often used to detect recurrence in asymptomatic patients, despite a lack of evidence demonstrating improved survival. We sought to evaluate utilization of PET for this purpose and relationships with survival for patients with lung and esophageal cancers. METHODS: Using national Surveillance, Epidemiology, and End Results (SEER) and Medicare-linked data, we identified incident patient cases from 2005 to 2009, with follow-up through 2011. We identified cohorts with primary lung (n = 97 152) and esophageal (n = 4446) cancers. Patient and tumor characteristics were used to calculate risk-adjusted two-year overall survival. Using Medicare claims, we examined PET utilization in person-years (to account for variable time in cohorts), excluding scans for staging and for follow-up of CT findings. We then stratified hospitals by quintiles of PET utilization for adjusted two-year survival analysis. All statistical tests were two-sided. RESULTS: There was statistically significant variation in utilization of PET. Lowest vs highest utilizing hospitals performed .05 (SD = 0.04) vs 0.70 (SD = 0.44) scans per person-year for lung cancer and 0.12 (SD = 0.06) vs 0.97 (SD = 0.29) scans per person-year for esophageal cancer. Despite this, for those undergoing PET, lowest vs highest utilizing hospitals had an adjusted two-year survival of 29.0% (SD = 12.1%) vs 28.8% (SD = 7.2%) for lung cancer (P = .66) and 28.4% (SD = 7.2%) vs 30.3% (SD = 5.9%) for esophageal cancer (P = .55). CONCLUSIONS: Despite statistically significant variation in use of PET to detect tumor recurrence, there was no association with improved two-year survival. These findings suggest possible overuse of PET for recurrence detection, which current Medicare policy would not appear to substantially affect.	esophagus
Bypass Operation as Palliation for Unresectable Esophageal Cancer: Selection of Suitable Patients.	We evaluated the bypass operation as palliation for unresectable esophageal cancer. In this study, patients were divided into 2 groups. Group A included 19 patients with good progress, defined as sufficient oral ingestion for more than 2 months. The other 10 patients were in Group B and had poor progress. Oral ingestion was impossible postoperatively in 2 of 29 cases. Although there is a difference of a grade, other patients could have improvement of quality of life. Patients with no preoperative therapy and patients whose nutrient state was maintained comparatively well had a good adaptation after bypass surgery. We concluded that if the surgeon chooses the patients carefully, bypass is a very useful operative method.	esophagus
Genomic characterization of esophageal squamous cell carcinoma: Insights from next-generation sequencing.	Two major types of cancer occur in the esophagus: squamous cell carcinoma, which is associated with chronic smoking and alcohol consumption, and adenocarcinoma, which typically arises in gastric reflux-associated Barrett's esophagus. Although there is increasing incidence of esophageal adenocarcinoma in Western counties, esophageal squamous cell carcinoma (ESCC) accounts for most esophageal malignancies in East Asia, including China and Japan. Technological advances allowing for massively parallel, high-throughput next-generation sequencing (NGS) of DNA have enabled comprehensive characterization of somatic mutations in large numbers of tumor samples. Recently, several studies were published in which whole exome or whole genome sequencing was performed in ESCC tumors and compared with matched normal DNA. Mutations were validated in several genes, including in TP53, CDKN2A, FAT1, NOTCH1, PIK3CA, KMT2D and NFE2L2, which had been previously implicated in ESCC. Several new recurrent alterations have also been identified in ESCC. Combining the clinicopathological characteristics of patients with information obtained from NGS studies may lead to the development of effective diagnostic and therapeutic approaches for ESCC. As this research becomes more prominent, it is important that gastroenterologist become familiar with the various NGS technologies and the results generated using these methods. In the present study, we describe recent research approaches using NGS in ESCC.	esophagus
[Analysis of characteristics and factors affecting the recurrence of esophageal cancer within the first year after surgery].	OBJECTIVE: To analyze the characteristics and factors affecting the recurrence in esophageal cancer within the first year after esophagectomy. METHODS: We reviewed retrospectively the clinical and follow-up data of 320 patients who underwent surgical treatment from April 2009 to April 2013 in Sichuan Provincial Cancer Hospital. RESULTS: 72 cases (72/320, 22.5%) had tumor recurrence within the first year after surgery. The average recurrence time was 6.89±3.53 months and the median recurrence time was 6.02 months. Univariate analysis showed that T stage, N stage, G grade, and pathological stage are related to the recurrence (P<0.05 for all). Logistic regression analysis showed that pathological stage is an independent risk factor for recurrence (P=0.002). There were 46 cases (46/72, 63.9%) of local recurrence and 26 cases (26/72, 36.1%) of distant metastasis. Among the 46 cases of local recurrence, 27 cases (27/46, 58.7%) had upper mediastinal lymph node metastasis. Among the 26 cases of distant metastasis, there were 11 cases (11/26, 42.3%) of pulmonary metastasis. Among the 72 cases of recurrence, the average number of dissected lymph nodes and involved nodes were 29.40±11.41 and 4.37±5.65, respectively, in patients with distant metastasis, and 21.18±10.37 and 1.91±2.14, respectively, in patients with local recurrence. Both the number of dissected and involved lymph nodes were significantly higher in the patients with distant metastasis (P<0.05). CONCLUSIONS: Lymph node metastasis is the most common pattern of recent relapse after esophagectomy, and pathological stage is an independent risk factor for recurrence within the first year after surgery. Standardized lymph node dissection and rational treatment strategy is the key measures to reduce early recurrence of esophageal cancer.	esophagus
Description and analysis of clinical pathways for oesophago-gastric adenocarcinoma, in 10 European countries (the EURECCA upper gastro intestinal group - European Registration of Cancer Care).	AIMS: Outcomes for patients with oesophago-gastric cancer are variable across Europe. The reasons for this variability are not clear. The aim of this study was to describe and analyse clinical pathways to understand differences in service provision for oesophageal and gastric cancer in the countries participating in the EURECCA Upper GI group. METHODS: A questionnaire was devised to assess clinical presentation, diagnosis, staging, treatment, pathology, follow-up and service frameworks across Europe for patients with oesophageal and gastric cancer. The questionnaire was issued to experts from 14 countries. The responses were analysed quantitatively and qualitatively and compared. RESULTS: The response rate was (10/14) 71.4%. The approach to diagnosis was similar. Most countries established a diagnosis within 3 weeks of presentation. However, there were different approaches to staging with variable use of endoscopic ultrasound reflecting availability. There has been centralisation of treatments in most countries for oesophageal surgery. The most consistent area was the approach to pathology. There were variations in access to specialist nurse and dietitian support. Although most countries have multidisciplinary teams, their composition and frequency of meetings varied. The two main areas of significant difference were research and audit and overall service provision. Observations on service framework indicated that limited resources restricted many of the services. CONCLUSION: The principle approaches to diagnosis, treatment and pathology were similar. Factors affecting the quality of patient experience were variable. This may reflect availability of resources. Standard pathways of care may enhance both the quality of treatment and patient experience.	esophagus
Icariin displays anticancer activity against human esophageal cancer cells via regulating endoplasmic reticulum stress-mediated apoptotic signaling.	In this study, we investigated the antitumor activity of icariin (ICA) in human esophageal squamous cell carcinoma (ESCC) in vitro and in vivo and explored the role of endoplasmic reticulum stress (ERS) signaling in this activity. ICA treatment resulted in a dose- and time-dependent decrease in the viability of human EC109 and TE1 ESCCs. Additionally, ICA exhibited strong antitumor activity, as evidenced by reductions in cell migration, adhesion, and intracellular glutathione (GSH) levels and by increases in the EC109 and TE1 cell apoptotic index, Caspase 9 activity, reactive oxygen species (ROS) level, and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. Furthermore, ICA treatments upregulated the levels of ERS-related molecules (p-PERK, GRP78, ATF4, p-eIF2α, and CHOP) and a pro-apoptotic protein (PUMA) and simultaneously downregulated an anti-apoptotic protein (Bcl2) in the two ESCC cell lines. The downregulation of ERS signaling using eIF2α siRNA desensitized EC109 and TE1 cells to ICA treatment, and the upregulation of ERS signaling using thapsigargin sensitized EC109 and TE1 cells to ICA treatment. In summary, ERS activation may represent a mechanism of action for the anticancer activity of ICA in ESCCs, and the activation of ERS signaling may represent a novel therapeutic intervention for human esophageal cancer.	esophagus
Diagnosed chest lesion on diffusion-weighted magnetic resonance images using apparent diffusion coefficients.	PURPOSE: A novel diagnostic method using the standard deviation (SD) value of apparent diffusion coefficient (ADC) by diffusion-weighted (DWI) magnetic resonance imaging (MRI) is applied for differential diagnosis of primary chest cancers, metastatic tumors and benign tumors. MATERIALS AND METHODS: This retrospective study enrolled 27 patients (20 males, 7 female; age, 15-85; mean age, 68) who had thoracic mass lesions in the last three years and underwent an MRI chest examination at our institution. In total, 29 mass lesions were analyzed using SD of ADC and DWI. Lesions were divided into five groups: Primary lung cancers (N = 10); esophageal cancers (N = 5); metastatic tumors (N = 8); benign tumors (N = 3); and inflammatory lesions (N = 3). Quantitative assessment of MRI parameters of mass lesions was performed. The ADC value was acquired based on the average of the entire tumor area. The error-plot, t-test and the area under receiver operating characteristic (AUC) were applied for statistical analysis. RESULTS: The SD of ADC value (mean±SD) was (4.867±1.359)×10-4 mm2/sec in primary lung cancers, and (3.598±0.350)×10-4 mm2/sec in metastatic tumors. The SD of ADC values of primary lung cancers and metastatic tumors (P <  0.05) were significantly different and the AUC was 0.800 (P <  0.05). The means of SD of ADC values was 4.532±1.406×10-4 mm2/sec and 2.973±0.364×10-4 mm2/sec for malignant tumors (including primary lung cancers, esophageal cancers) and benign tumors with respectively. The mean of SD of ADC values between malignant chest tumors and benign chest tumors was shown significant difference (P <  0.01). The values of AUC was 0.967 between malignant chest tumors and benign chest tumors (P < 0.05). The ADC values for primary lung cancers, metastatic tumors and benign tumors were not significantly difference (P >  0.05). CONCLUSIONS: The mean of SD of ADC value by DWI can be used for differential diagnosis of chest lesions.	esophagus
[Sensitivity of esophageal squamous cell carcinoma cells to rapamycin can be improved by siRNA-interfered expression of p70S6K].	OBJECTIVE: To explore the differences in sensitivity to rapamycin of five esophageal squamous cell carcinoma cell lines with different differentiation and the changes of sensitivity of the cells after siRNA-interfered expression of p70S6K. METHODS: Effects of rapamycin on proliferation of ESCC cell lines with different differentiation, EC9706, TE-1, Eca109, KYSE790 and KYSE450 cells, were investigated using cell counting kit 8 (CCK-8) assay, and according to the above results, the EC9706 cells non-sensitive to rapamycin were chosen to be transfected with p70S6K-siRNA. The changes in sensitivity of cells to rapamycin were measured in vitro and in vivo using CCK-8 kit, flow cytometry and tumor formation in nude mice. RESULTS: CCK-8 results showed that all the five cell line cells were sensitive to low concentration of rapamycin (<100 nmol/L), but TE-1 and EC9706 cells, which were with poor differentiation, showed resistance to high concentration of rapamycin. After EC9706 cells were treated with 50, 100, 200, 500 and 1 000 nmol/L rapamycin and p70S6K-siRNA, the proliferation rates of EC9706 cells were (48.67 ± 1.68)%, (15.45 ± 1.54)%, (14.00 ± 0.91)%, (10.97 ± 0.72)% and (2.70 ± 0.32)%, respectively, and were significantly lower than that of cells treated with 50, 100, 200, 500 and 1 000 nmol/L rapamycin and control siRNA [(74.53 ± 1.71)%, (68.27 ± 1.35)%, (71.74 ± 2.44)%, (76.23 ± 1.02)% and (80.21 ± 2.77)%] (P<0.05 for all). The results of flow cytometry showed that the ratios of cells in G1 phase of the p70S6K-siRNA, rapamycin and p70S6K-siRNA+ rapamycin groups were (53.82 ± 1.78)%, (57.87 ± 4.01)% and (73.73 ± 3.68)%, respectively, significantly higher than that in the control group (46.09 ± 2.31)% (P<0.05 for all). The results of tumor formation test in vivo showed that the inhibitory effect of rapamycin on tumor growth was stronger after the cells were transfected with p70S6K-siRNA, and the inhibition rate was 96.5%. CONCLUSION: ESCC cells with different differentiation have different sensitivity to rapamycin, and p70S6K-siRNA can improve the sensitivity of cells to rapamycin in vitro and in vivo.	esophagus
The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer.	Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score.	esophagus
Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Apatinib in Patients With Chemotherapy-Refractory Advanced or Metastatic Adenocarcinoma of the Stomach or Gastroesophageal Junction.	PURPOSE: There is currently no standard treatment strategy for patients with advanced metastatic gastric cancer experiencing progression after two or more lines of chemotherapy. We assessed the efficacy and safety of apatinib, a novel vascular endothelial growth factor receptor 2 tyrosine kinase inhibitor, in patients with advanced gastric or gastroesophageal junction adenocarcinoma for whom at least two lines of prior chemotherapy had failed. PATIENTS AND METHODS: This was a randomized, double-blind, placebo-controlled phase III trial. Patients from 32 centers in China with advanced gastric or gastroesophageal junction adenocarcinoma, for whom two or more prior lines of chemotherapy had failed, were enrolled. Patients were randomly assigned to oral apatinib 850 mg or placebo once daily. The primary end points were overall (OS) and progression-free survival (PFS). RESULTS: Between January 2011 and November 2012, 267 patients were enrolled. Median OS was significantly improved in the apatinib group compared with the placebo group (6.5 months; 95% CI, 4.8 to 7.6 v 4.7 months; 95% CI, 3.6 to 5.4; P = .0149; hazard ratio, 0.709; 95% CI, 0.537 to 0.937; P = .0156). Similarly, apatinib significantly prolonged median PFS compared with placebo (2.6 months; 95% CI, 2.0 to 2.9 v 1.8 months; 95% CI, 1.4 to 1.9; P < .001; hazard ratio, 0.444; 95% CI, 0.331 to 0.595; P < .001). The most common grade 3 to 4 nonhematologic adverse events were hand-foot syndrome, proteinuria, and hypertension. CONCLUSION: These data show that apatinib treatment significantly improved OS and PFS with an acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy.	esophagus