crossing96/oncoscreening huggingface dataset:
Treatment of Barrett's esophagus with early neoplasia: a comparison of endoscopic therapy and esophagectomy.	BACKGROUND: Endoscopic therapies for early neoplasia in Barrett's esophagus may be a viable alternative to esophagectomy. OBJECTIVE: Our purpose was to compare endoscopic therapy and esophagectomy. DESIGN: Retrospective review from a single institution. SETTING: A medium-sized tertiary referral center. PATIENTS AND INTERVENTIONS: All patients with Barrett's esophagus and dysplasia or intramucosal carcinoma treated by photodynamic therapy (PDT), EMR, or argon plasma coagulation (APC) or esophagectomy with curative intent from May 1998 until November 2005. MAIN OUTCOME MEASUREMENTS: Survival, progression to cancer, eradication of dysplasia and Barrett's esophagus, major and minor complications, and costs were compared. RESULTS: Sixty-two patients who underwent endoscopic therapy (2 APC alone, 18 EMR + APC, 20 PDT + APC, and 22 EMR + PDT + APC) and 32 patients who underwent esophagectomy met the inclusion criteria. The 30-day mortality rate included 1 patient in the endotherapy group (2%) and none in the surgical group (P = .49). No deaths from esophageal cancer occurred in either group. Cancer developed in 6% of endotherapy patients and in none in the surgical cohort (P < .05). Major and minor complications occurred in 8% and 31% of endotherapy patients, respectively, and 13% and 63% of surgery patients (P = .50, P < .001). Median cost to date was $40,079 for endotherapy and $66,060 for esophagectomy (P < .001). LIMITATIONS: Retrospective study, relatively short follow-up, small numbers. CONCLUSIONS: Both endotherapy and esophagectomy can effectively treat high-grade dysplasia and intramucosal carcinoma associated with Barrett's esophagus. Endotherapy is associated with a higher risk of tumor progression, although this is uncommon. Esophagectomy incurs higher initial costs and results in more frequent minor complications but is usually curative.	esophagus
[Expression of metallothionein-3 in esophageal cancer and its correlations to expression of metallothionein-1 and -2].	BACKGROUND & OBJECTIVE: Metallothionein (MT)-3 can inhibit cell growth. Up to now, it is the only MT subtype with specific physiological function. This study was to investigate the expression of MT-3 in esophageal cancer and its correlations to the expression of MT-1 and MT-2. METHODS: The expression of MT-1, -2 and -3 in 76 specimens of esophageal cancer and 10 specimens of esophageal diverticulum were detected by SP immunohistochemistry. The correlations of MT-3 expression to MT-1 and MT-2 expression were analyzed. RESULTS: The expression level of MT-3 was significantly higher in esophageal cancer than in para-cancer normal tissues and benign esophageal lesions (Chi2=74.696, P<0.001). In tumor tissues, MT-3 was mainly expressed in cytoplasm. The expression level of MT-3 was related with differentiation (P=0.004), TNM stage (P=0.033), lymph node metastasis (P=0.017) and survival time (P=0.035), and negatively correlated to the expression levels of MT-1 and MT-2 (r=0.247, P=0.032). CONCLUSIONS: MT-3 is overexpressed in esophageal cancer. Its expression is closely related with the differentiation, development and prognosis of esophageal cancer, and its roles are obviously different from those of MT-1 and MT-2.	esophagus
[Survival analysis of patients with stage II squamous cell carcinoma of the thoracic esophagus after esophagectomy].	BACKGROUND & OBJECTIVE: Esophageal cancer is a common malignant tumor in China. At the time of diagnosis, most patients are at locally advanced stage. Up to date, surgical resection is the main treatment of esophageal cancer. This study was to analyze the correlations of clinicopathologic features of stage II thoracic esophageal squamous cell carcinoma (ESCC) to the prognosis. METHODS: The clinicopathologic data of 467 patients with stage II thoracic ESCC, treated with surgery from Jan. 1990 to Dec. 1998 in Cancer Center of Sun Yat-sen University, were analyzed. Cumulative survival was analyzed by Kaplan-Meier method and compared by log-rank test. The prognosis was analyzed by Cox regression model. RESULTS: The overall 1-, 3-, 5-, and 10-year survival rates were 87.1%, 54.6%, 43.0%, and 32.3%, respectively. The 5-year survival rates of patients at stage II A and stage II B were 51.0% and 19.9%. Of the 467 cases, 81 (17.3%) recurred, and 70 (86.4%) of them recurred within 3 years after operation. Univariate analysis revealed that the factors affecting the prognosis included gender, depth of invasion, lymph node metastasis, pathologic stage, number of lymph node metastatic fields, differentiation, positive surgical margin and tumor recurrence. Multivariate analysis showed that gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence were independent prognostic factors. CONCLUSIONS: Gender, depth of invasion, pathologic stage, number of lymph node metastatic fields, positive surgical margin and tumor recurrence are independent prognostic factors of stage II ESCC. Surgery is still the primary treatment for stage II A esophageal cancer; but surgery-dominant treatment combined with other therapies is recommended for stage II B esophageal cancer.	esophagus
The role of surveillance endoscopy and endosonography after endoscopic ablation of high-grade dysplasia and carcinoma of the esophagus.	Barrett's esophagus (BE) with high-grade dysplasia (HGD) or early carcinoma treated with surgery or photodynamic therapy (PDT) is at risk of recurrence. The efficacy of endoscopic ultrasound (EUS) for surveillance after PDT is unknown. Our objective was to determine if EUS is superior to esophagogastroduodenoscopy (EGD) and/or CT scan for surveillance of BE neoplasia after PDT. The study was designed as a retrospective review with the setting as a tertiary referral center. Consecutive patients with BE with HGD or carcinoma in situ treated with PDT were followed with EUS, CT scan and EGD with jumbo biopsies every 1 cm at 3, 4, or 6-month intervals. Exclusion criteria was < 6 months of follow up and/or < 2 EUS procedures. Main outcome measurements were residual or recurrent disease discovered by any method. Results showed that 67/97 patients met the inclusion criteria (56 men and 11 women). Median follow-up was 16 months. Recurrent or residual adenocarcinoma (ACA) was detected in four patients during follow-up. EGD with random biopsies or targeted nodule biopsies detected three patients. EUS with endoscopic mucosal resection of the nodule confirmed T1 recurrence in one of these three. In the fourth patient, CT scan revealed perigastric lymphadenopathy and EUS-FNA (fine needle aspiration) confirmed adenocarcinoma. There were two deaths, one related to disease progression and one unrelated. The rate of recurrent/persistent ACA after PDT was 4/67 = 6%. EUS did not detect disease when EGD and CT were normal. Limitations of this study include non-blinding of results and preferential status of non-invasive imaging (CT) over EUS. Our experience suggests that EUS has little role in the surveillance of these patients, unless discrete abnormalities are found on EGD or cross-sectional imaging.	esophagus
Changes in antioxidant defense status in response to cisplatin and 5-FU in esophageal carcinoma.	The ability of reactive oxygen species to induce cellular damage and to cause cell death opens the possibility of exploiting this property in the treatment of esophageal cancer through a free radical mediated mechanism. The present study was carried out with the aim of evaluating the changes in the antioxidant defense status in esophageal cancer patients treated without and with neoadjuvant therapy (NAT). Forty surgically resected tissue specimens from tumors, tissue adjoining the tumors and paired macroscopically normal mucosa were obtained from esophageal cancer patients treated with or without chemo-radiotherapy. An evaluation of antioxidant defense system in the normal, adjoining and tumor esophageal tissues in response to NAT revealed decreased catalase activity in tumor and adjoining tissues as compared to their respective normal tissue levels. Similarly, decreased superoxide dismutase activity was observed in tumor tissue in response to NAT. In both the treatment groups (with and without NAT), no significant change was observed in the enzyme activity of glutathione reductase in the normal, adjoining and tumor tissues. Enhanced glutathione peroxidase activity was found in tumor tissue, as compared to the adjoining and paired normal tissue of patients after NAT. Estimation of reduced glutathione (GSH) levels showed a significant decline in GSH levels in esophageal tumors after NAT. Depletion of GSH, an endogenous antioxidant, would elevate drug sensitivity and might predispose neoplastic cells to apoptosis in response to NAT. The antioxidant enzymes in the esophageal carcinoma thus may play an important role in influencing the final outcome upon NAT course.	esophagus
Minimally invasive therapy for benign tumors of the distal third of the esophagus--a single institute's experience.	INTRODUCTION: Traditionally, the treatment of benign esophageal tumors is enucleation achieved via a thoracotomy. Since 1992, many reports of thoracoscopic and laparoscopic approaches have been published. In this paper, we present a retrospective study of 18 patients with benign distal esophageal tumors who underwent minimally invasive procedures. MATERIALS AND METHODS: A total of 18 patients were treated in our institute form 1994 to 2006. Tumors of the middle third were approached thoracoscopically, and laparoscopic transhiatal enucleation was performed for tumors of the lower third. One patient had associated achalasia cardia, for which a cardiomyotomy with Toupet fundoplication was also performed, and another patient underwent an esophagectomy for a large tumor. RESULTS: There were 12 males and 6 females and the average age was 59 years. The majority of the tumors were in the lower third, and the most common type of tumor was leiomyoma. Postoperative complications were recorded. DISCUSSION: Leiomyomas are the most common benign tumors and are located frequently in the middle and lower third. Based on our experience, we feel that lower esophageal tumors are best approached by a laparoscopic transhiatal route and midesophageal tumors by a right thoracoscopic approach. CONCLUSIONS: Minimally invasive surgery for benign esophageal tumors is ideal, reducing the morbidity of conventional methods.	esophagus
Hybrid IMRT for treatment of cancers of the lung and esophagus.	PURPOSE: To report on a hybrid intensity-modulated radiation therapy (IMRT; static plus IMRT beams treated concurrently) technique for lung and esophageal patients to reduce the volume of lung treated to low doses while delivering a conformal dose distribution. METHODS: Treatment plans were analyzed for 18 patients (12 lung and 6 esophageal). Patients were treated with a hybrid technique that concurrently combines static (approximately two-thirds dose) and IMRT (approximately one-third dose) beams. These plans were compared with conventional three-dimensional (3D; non-IMRT) plans and all IMRT plans using custom four- and five-field arrangements and nine equally spaced coplanar beams. Plans were optimized to reduce V13 and V5 values. Dose-volume histograms were calculated for the planning target volume, heart, and the ipsilateral, contralateral, and total lung. Lung volumes V5, V13, V20, V30; mean lung dose (MLD); and the generalized equivalent uniform dose (gEUD) were calculated for each plan. RESULTS: Hybrid plans treated significantly smaller total and contralateral lung volumes with low doses than nine-field IMRT plans. Largest reductions were for contralateral lung V5, V13, and V20 values for lung (-11%, -15%, -7%) and esophageal (-16%, -20%, -7%) patients. Smaller reductions were found also for 3D and four- and five-field IMRT plans. MLD and gEUDs were similar for all plan types. The 3D plans treated much larger extra planning target volumes to prescribed dose levels. CONCLUSIONS: Hybrid IMRT demonstrated advantages for reduction of low-dose lung volumes in the thorax for reducing low dose to lung while also reducing the potential magnitude of dose deviations due to intrafraction motion and small field calculation accuracy.	esophagus
Ski/SnoN expression in the sequence metaplasia-dysplasia-adenocarcinoma of Barrett's esophagus.	Barrett's esophagus (BE) is a precancerous condition. However, the mechanisms underlying the transformation from metaplastic to dysplastic to adenocarcinomatous epithelium are still poorly understood. As loss of transforming growth factor-beta growth inhibition is considered a hallmark of several human neoplasms, we evaluated the expression of Ski and SnoN (proteins that antagonize transforming growth factor-beta signaling through physical interaction with Smad complex and by recruiting histone deacetylases), as markers of the transforming growth factor-beta signaling pathway, in BE with and without dysplasia. Biopsy samples from 37 patients (26 men, aged 60 +/- 8 years) with histologically proven BE were evaluated; 10 patients had concomitant low-grade dysplasia, 7 high-grade dysplasia (HGD), and 6 HGD associated with adenocarcinoma. Ski and SnoN expression was assessed immunohistochemically. Neither Ski nor SnoN was expressed in normal esophageal epithelium, but both were strongly expressed in BE tissue, with intense cytoplasmic positivity. Expression of these proteins decreased markedly in dysplastic areas in patients with low-grade dysplasia and was absent in those with HGD or HGD/adenocarcinoma. Ski and SnoN proteins are overexpressed in BE and may be involved in abnormal signaling elicited by transforming growth factor-beta in this epithelium, enhancing the tumorigenesis process. These observations might help to elucidate the molecular mechanisms involved in the BE tumorigenesis process.	esophagus
Appropriate routes of reconstruction following transthoracic esophagectomy.	BACKGROUND/AIMS: The effectiveness of reconstructive methods after esophagectomy remains controversial. METHODOLOGY: A total of 211 patients who underwent transthoracic esophagectomy and esophagogastric anastomosis using the gastric conduit were enrolled in this study. A retromediastinal approach was used in 79 patients and a retrosternal approach in 132. The surgical outcomes were compared between the two groups. RESULTS: In the retrosternal group, anastomotic leakage (26.5%), stenosis of the anastomosis (13.6%), and respiratory complications (18.2%) were frequently observed. Five patients died of aspiration pneumonia probably due to stenosis of the anastomotic site in the retrosternal group. In the retromediastinal group, two patients died from bleeding of a peptic ulcer in the gastric conduit. Partial resection of the manubrium significantly reduced the incidence of leakage in the retrosternal group (4/29 vs. 31/68, p=0.0305). Retrosternal approach and stage were independent prognostic factors for overall survival whereas only stage was an independent prognostic factor for disease-specific survival. CONCLUSIONS: Retrosternal reconstruction is suggested as the unwillingly adopted method of choice after palliative esophagectomy (R2) for the following radiotherapy. Partial resection of the bony structures can be used to prevent postoperative morbidity in this operative procedure. Retromediastinal reconstruction is the possible method of choice in patients receiving curative esophagectomy.	esophagus
Treatment options for esophageal strictures.	Esophageal strictures are a problem commonly encountered in gastroenterological practice and can be caused by malignant or benign lesions. Dysphagia is the symptom experienced by all patients, regardless of whether their strictures are caused by malignant or benign lesions. The methods most frequently used for palliation of malignant esophageal strictures are stent placement (particularly in patients with an expected survival of 3 months or less) and brachytherapy (in patients with a life expectancy of more than 3 months). Brachytherapy has been shown to be beneficial in patients with an expected survival of longer than 3 months with regard to (prolonged) dysphagia improvement, complications and quality of life. The mainstay of benign esophageal stricture treatment is dilation. Although dilation usually results in symptomatic relief, recurrent strictures do occur. In order to predict which types of strictures are most likely to recur, it is important to differentiate between esophageal strictures that are simple (i.e. focal, straight strictures with a diameter that allows endoscope passage) and those that are more complex (i.e. long (>2 cm), tortuous strictures with a narrow diameter). These complex strictures are considered refractory when they cannot be dilated to an adequate diameter. Novel treatment modalities for refractory strictures include temporary stent placement and incisional therapy.	esophagus
Quality of life and survival in patients treated with radical chemoradiation alone for oesophageal cancer.	AIMS: To report cancer-specific and health-related quality-of-life outcomes in patients undergoing radical chemoradiation (CRT) alone for oesophageal cancer. MATERIALS AND METHODS: Between 1998 and 2005, 56 patients with oesophageal cancer received definitive radical CRT, due to local disease extent, poor general health, or patient choice. Data from European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-30 and QLQ-OES24 were collected prospectively. Questionnaires were completed at diagnosis, and at 3, 6 and 12 months after CRT where applicable. RESULTS: The median follow-up was 18 months. The median overall survival was 14 months, with a 51, 26 and 13% 1-, 3- and 5-year survival, respectively. At 12 months after treatment there was a significant improvement compared with before treatment with respect to dysphagia and pain. Global health scores were not significantly affected. CONCLUSIONS: Considering the relatively short long-term survival for this cohort of patients, maximising the quality of those final months should be very carefully borne in mind from the outset. The health-related quality-of-life data reported herein helps to establish benchmarks for larger evaluation within randomised clinical trials.	esophagus
[Expression of ezrin and CD44-v6 in human esophageal squamous cell carcinoma and its clinical significance].	OBJECTIVE: To evaluate the expression of ezrin and CD44-v6 in esophageal squamous cell carcinoma, and to evaluate its relationship with lymph node metastasis (LNM) and histological grading. METHODS: The expression of ezrin and CD44-v6 in 71 patients with esophageal squamous cell carcinoma was studied using immunohistochemical (SP) method. The correlation of their expression with relevant clinical data was statistically analyzed. RESULTS: In normal esophageal squamous epithelia, the expression of ezrin was found in 33 cases among 71 cases and the expression of CD44-v6 in 18 cases among 71 cases. In esophageal squamous cell carcinoma, the expression of ezrin was found in 64 cases among 71 cases and CD44-v6 in 58 cases among 71 cases. The expression of ezrin was closely related to LNM. The positive rate of ezrin expression in LNM cases was significantly higher than that in cases without LNM. The expression of CD44-v6 had a close relation to tumor differentiation and LNM. The positive rate of CD44-v6 expression in LNM cases was significantly higher than that in patients without LNM. The expression of ezrin in CD44-v6 positive cases was significantly higher than that of CD44-v6 negative cases. The LNM rate was 60.0% in 48 patients with positive expression of both ezrin and CD44-v6, while none of lymph node metastasis was found in the 6 patients with both negative. CONCLUSION: The test of CD44-v6 and ezrin expression may have significant prognostic value for assessing the degree of malignancy and potential LNM probability of ESCC. Ezrin may become a new target in evaluation of tumor prognosis.	esophagus
Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus.	BACKGROUND & AIMS: The aim of this study was to compare magnified still images obtained with high-resolution white light endoscopy, indigo carmine chromoendoscopy, acetic acid chromoendoscopy, and narrow-band imaging to determine the best technique for use in Barrett's esophagus. METHODS: We obtained magnified images from 22 areas with the 4 aforementioned techniques. Seven endoscopists with no specific expertise in Barrett's esophagus or advanced imaging techniques and 5 international experts in this field evaluated these 22 areas for overall image quality, mucosal image quality, and vascular image quality. In addition, the regularity of mucosal and vascular patterns and the presence of abnormal blood vessels were evaluated, and this was correlated with histology. RESULTS: The interobserver agreement for the 3 features of mucosal morphology with white light images ranged from kappa = 0.51 (95% confidence interval [CI]: 0.46-0.55) to kappa = 0.53 (95% CI: 0.50-0.57) for all observers, from kappa = 0.43 (95% CI: 0.33-0.54) to kappa = 0.53 (95% CI: 0.41-0.64) for experts, and from kappa = 0.51 (95% CI: 0.15-0.33) to kappa = 0.64 (95% CI: 0.58-0.70) for nonexperts. The interobserver agreement in these groups did not improve by adding one of the enhancement techniques. The yield for identifying early neoplasia with white light images was 86% for all observers, 90% for experts, and 84% for nonexperts. The addition of enhancement techniques did not improve the yield neoplasia. CONCLUSIONS: The addition of indigo carmine chromoendoscopy, acetic acid chromoendoscopy, or narrow-band imaging to white light images did not improve interobserver agreement or yield identifying early neoplasia in Barrett's esophagus.	esophagus
Acetaldehyde-induced mutational pattern in the tumour suppressor gene TP53 analysed by use of a functional assay, the FASAY (functional analysis of separated alleles in yeast).	Chronic alcohol consumption is a major risk factor for upper aero-digestive tract cancers, including cancer of the esophagus. Whereas alcohol as such is not thought to be directly carcinogenic, acetaldehyde, its first metabolite, has been proven genotoxic and mutagenic in the HPRT gene. As mutations in the tumour suppressor gene TP53 are the most common genetic alterations involved in human cancers, especially esophageal tumours, the aim of this work was to establish the mutational pattern induced by acetaldehyde in vitro on the TP53 gene, and to compare this pattern with that found in human alcohol-related tumours. For this purpose, we used a functional assay in yeast, the FASAY (functional analysis of separated alleles in yeast), after in vitro exposure of human normal fibroblasts AG1521 to acetaldehyde. We noted 35 mutations, of which 32 were single-nucleotide substitutions including 2 nonsense and 30 missense mutations. The pattern showed that the main mutations were G>A transitions (n=23, of which 14 in CpG sites), followed by G>T transversions (n=4), A>G transitions (n=2) and A>T transversions (n=2). Other mutations were one-base insertion and two deletions, leading to frameshifts. Eleven mutations (31%) were located in TP53 hot-spots in codons 245, 248, 249 and 273. Finally, we compared this pattern with that found for esophageal cancers in humans. These results support the notion that acetaldehyde plays a role in TP53 mutations in esophageal cancers. The key feature of this approach is that mutagenesis is directly studied in a key gene in human carcinogenesis, allowing direct comparison of mutational patterns with those in human tumours.	esophagus