crossing96/oncoscreening huggingface dataset:
How does the number of resected lymph nodes influence TNM staging and prognosis for esophageal carcinoma?	BACKGROUND: It is proposed by International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) that at least 6 lymph nodes (LN) should be removed during resection of esophageal cancer for an accurate N classification. However, large series evidence is needed. The aim of this study is to assess the impact of total number of removed LNs during esophagectomy on UICC-TNM staging and long-term survival. MATERIALS AND METHODS: The clinicopathological data and follow-up results of 1098 patients with advanced esophageal carcinoma who underwent an esophagectomy were analyzed. RESULTS: The survival experience of group A (removed LNs <6) was worse than that of group B (removed LNs > or = 6). With the stratification analysis according to N and TNM stage, for patients with pN0 cancers, the survival in group A was worse than that in group B (P = .003), while in patients with 1 and > or = 2 positive LNs, the survival experience was similar (P = .919 and .182, respectively). A significant difference in survival in patients at stage IIa was observed between group A and group B (P = .005). However, the survival in patients at stage IIb and stage III was not different between the two groups (P = .302 and 0.108, respectively). CONCLUSIONS: For advanced esophageal carcinoma, if the number of resected LNs per operation is less than 6, an occult positive regional LN might be missed, resulting in an inaccurate N classification. The minimum of 6 LNs removed for esophageal cancer recommended by UICC and AJCC is rational and should be complied with.	esophagus
Endoscopic imaging for the detection of esophageal dysplasia and carcinoma.	Numerous endoscopic imaging modalities have been developed and introduced into clinical practice to enhance diagnostic capabilities. In the past, detection of dysplasia and carcinoma of the esophagus has been dependent on biopsies taken during standard white-light endoscopy. Recent important developments in biophonotics have improved visualization of these subtle lesions sufficiently for cellular details to be seen in vivo during endoscopy. These improvements allow diagnosis to be made in gastrointestinal endoscopy units, thereby avoiding the cost, risk, and time delay involved in tissue biopsy and resection. Chromoendoscopy, narrow-band imaging, high-yield white-light endoscopy, Fujinon intelligent color enhancement, and point enhancement such as confocal laser endomicroscopy are examples of enhanced imaging technologies that are being used in daily practice. This article reviews endoscopic-based imaging techniques for the detection of esophageal dysplasia and carcinoma from the perspective of routine clinical practice.	esophagus
Down-regulated expression of cytochrome P450 (CYP) involved in the development and progression of esophageal adenocarcinoma.	BACKGROUND/AIMS: To analyze the differential expression genes (DEGs) between esophageal adenocarcinoma (EAC) and para-cancerous tissue (PCT) and explore the target genes related to the development and progression of EAC. METHODOLOGY: The total RNAs of matched EAC and para-cancerous tissue of EAC patients were isolated using one step Trizol method. Matched RNAs were qualified using 10 g/L agarose gel electrophoresis. cRNAs were synthesized, fluorescence labeled and purified after total RNAs were purified. The RNAs of EAC and PCT were hybridized with Agilent oligomicroarray (30,968 probes). The fluorescence intensity features were detected by Agilent scanner and quantified by feature extraction software. RESULTS: (1)The total RNA, reverse transcription product and fluorescence labeled cRNA were all of high quality; (2)There were 212 up-regulated genes and 126 down-regulated genes am- ong 2-fold DEGs, including 16 genes related to cytochrome P450 (CYP). CONCLUSIONS: Many EAC-assoeiated genes were screened by the high-throughput gene chip method. The development and progression of EAC is a complicated process involving multigenes and multiprocedures. The down-regulated expression of CYP related genes and gene polymorphism of CYP2 subfamily may be involved in the onset and progress of EAC.	esophagus
[Analysis of the survival in patients after surgical resection of thoracic esophageal cancer].	OBJECTIVE: To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. METHODS: From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the number of lymph node metastases (0, 1 and > or = 2), a new modification of the TNM classification was suggested: stage IIa (T2N0M0 and T3N0M0), stage IIb [T1N1M0 and T2N1(1)M0], stage IIIa [T2N1 (2)M0 and T3N1 (1) M0] and stage IIIb [T3N1 (2) M0 and T4N any M0]. RESULTS: According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and > or = 2 positive metastatic lymph nodes was 59.1%, 32.0% and 8. 9%, respectively. The 5-year survival rate of the patients with stage T2N1 M0 and stage T3N1 M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P < 0.01). The 5-year survival rate of the modified stage IIa, IIb, IIIa and IIIb was 56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0.01). CONCLUSION: The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophagectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the 5-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, > or = 2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.	esophagus
Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma.	BACKGROUND & AIMS: There is controversy over the outcomes of esophageal adenocarcinoma with superficial submucosal invasion. We evaluated the impact of depth of submucosal invasion on the presence of metastatic lymphadenopathy and survival in patients with esophageal adenocarcinoma. METHODS: Pathology reports of esophagectomy samples collected from 1997 to 2007 were reviewed. Specimens from patients with esophageal adenocarcinoma and submucosal invasion were reviewed and classified as superficial (upper 1 third, sm1) or deep (middle third, sm2 or deepest third, sm3) invasion. Outcomes studied were presence of metastatic lymphadenopathy and overall survival. Variables of interest were analyzed as factors that affect overall and cancer-free survival using Cox proportional hazards modeling. A multivariate model was constructed to establish independent associations with survival. RESULTS: The study included 80 patients; 31 (39%) had sm1 carcinoma, 23 (29%) had sm2 carcinoma, and 26 (33%) had sm3 carcinoma. Superficial and deep submucosal invasion were associated with substantial rates of metastatic lymphadenopathy (12.9% and 20.4%, respectively). The mean follow-up time was 40.5 +/- 4 months and the mean overall unadjusted survival time was 53.8 +/- 4.1 months. Factors significantly associated with reduced survival time included the presence of metastatic lymph nodes (hazard ratio [HR], 2.89; confidence interval [CI], 1.13-6.88) and esophageal cancer recurrence (HR 6.39, CI 2.40-16.14), but not depth of submucosal invasion. CONCLUSIONS: Patients with sm1 esophageal carcinoma have substantial rates of metastatic lymphadenopathy. Endoscopic treatment of superficial submucosal adenocarcinoma is not advised for patients that are candidates for surgery.	esophagus
Two cases of acute coronary syndrome that occurred by preoperative discontinuation of antiplatelet therapy in the chronic phase after stent implantation.	After stent implantation in the coronary arteries, patients sometimes have to undergo invasive examination or treatments that mandate discontinuation of antiplatelet therapy for several days. We encountered two cases of acute coronary syndrome that occurred after preoperative discontinuation of antiplatelet agents in the chronic phase after stent implantation. In the first case, antiplatelet agents were temporarily stopped 5 months after the implantation of a bare metal stent (BMS) in preparation for a kidney transplant. In the second case, antiplatelet agents were stopped 1.5 months after BMS implantation in preparation for esophageal bypass surgery. In both cases, acute myocardial infarction occurred just after the invasive operation, despite the fact that they had continued dual antiplatelet therapy for the period recommended by the American Heart Association/American College of Cardiology guideline. This report provides a warning about the temporary discontinuation of antiplatelet agents even in the chronic stage of coronary stent implantation.	esophagus
TP53 mutation profile of esophageal squamous cell carcinomas of patients from Southeastern Brazil.	Esophageal cancer (EC) is among the 10 most common and fatal malignacies in the world, presenting a marked geographic variation in incidence rates between and within different countries. The TP53 tumor suppressor gene is highly mutated in esophageal tumors and its mutation pattern can offer clues to the etiopathology of the tumor. As Brazil presents one of the highest incidence areas in the West, a deeper knowledge of the molecular mechanisms related to EC development in the Brazilian population is needed. We analyzed the mutation profile of 110 esophageal squamous cell carcinomas (ESCC) of patients from Southeastern Brazil (Rio de Janeiro and São Paulo) and collected data regarding alcohol intake and tobacco smoking. We detected 41 mutations in tumor samples from 38 patients. There was no association between mutation frequency and tobacco smoking or alcohol drinking. The most frequently mutated codons were 179, 214, 220 and 248. Codons 179, 220 and 248 are hot-spots for ESCC, but codon 214 presents only 0.7% of the mutations registered in the IARC database. The mutation profile revealed a high percentage of mutations at A:T base pairs (34.1%) followed by deletions (17.1%). We concluded that the mutation profile detected in this study is different from that of patients from Southern Brazil but very similar to that previously seen in French patients, being characterized by a high frequency of mutations at A:T base pairs, which may be associated with acetaldehyde, the metabolic product of ethanol.	esophagus
Muco-epidermoid carcinoma of the oesophagus: a case report.	Muco-epidermoid carcinomas (MECs) are typically located in the salivary, lacrimal and tracheobronchial glands. However, they can also be present in the oesophagus. Primary MECs of the oesophagus account for 0.05% to 2.2% of all cases of primary oesophageal cancer. Treatment for this tumour has primarily been surgical resection. In this report we present the surgical and pathological findings of a primary MEC of the oesophagus in an 82-year-old woman and review the management options for this tumour.	esophagus
[Esophageal endoprosthesis by laparo-gastroscopy with transtumoral approach in advanced esophageal and esophagogastric cancer].	INTRODUCTION: Romania is part of the countries with low incidence of esophagus cancer (the mortality rate M/W at 100,000 peoples being 1.6/0.3), but the diagnosis of the disease, is most frequently incidental in stages that make any intention of radical treatment a desideratum frequently unattainable. MATERIAL AND METHOD: In the impossibillity of curative treatment we realised laparoscopic procedure of esophageal prosthesis (through traction not through pushing as in endoscopic procedures) at 60 patients with esophageal and esogastric cancer in advanced stages (distance metastasis, almost non-existing lumen, emaciation, severe decline of general state). The originality of the laparogastroscopic method has been international recognized. RESULTS AND DISCUSSIONS: This minimally invasive prosthetic original method presumes minimal agression, gastroscopic approach, the insertion of the prosthesis is made through traction not through pushing (transtumoral drilling, compresive and styptic insertion, etc.). The patient can eat at 8-12 hours after operation and the contact with the hospital is shorter, the hospitalization period was between 3 and 7 days. We had survivals between 5 months and 4 years. CONCLUSION: The method that we propose is simple and efficient is a solution for repairing the endoscopic failure, is an alternative for the crippling gastrostomy, or, for the cases when the preoperative most optimistic estimations might comply a sick person and unbalanced immunological, nutritional and psychological, to an intervention to vast in scope (anaesthetic and surgical), compared to the final solution, palliative, in fact.	esophagus
Endoscopic evaluation and treatment of esophageal cance.	Esophageal cancer is the sixth leading cause of cancer mortality. During the past twenty years the prevalence of adenocarcinoma, which is linked to gastroesophageal reflux and Barrett's metaplasia, has increased precipitously for unclear reasons. Endoscopic ultrasound (EUS) has revolutionized primary tumor (T) and nodal (N) staging. Additionally, the recent introduction of combined computed and positron emission tomography (CT-PET) promises to improve the detection of distant metastasis. While classic surgical approaches have significant morbidity and mortality, the recent widespread introduction of minimally invasive techniques including endoscopic mucosal resection and radiofrequency ablation offer new options to those with limited disease. Finally, endoscopically placed self expandable metal stents have become the primary mode of palliating dysphagia and there is a growing interest in the use of removable stents to optimize nutrition in neoadjuvant chemotherapy patients awaiting esophagectomy. In this article we will review the presentation, staging, and treatment of esophageal cancer with an emphasis on the evolving role of endoscopy to help accomplish these objectives.	esophagus
Relationship between the expression of hTERT and EYA4 mRNA in peripheral blood mononuclear cells with the progressive stages of carcinogenesis of the esophagus.	OBJECTIVE: To establish a relationship between esophageal squamous cell diseases and the expression of human telomerase reverse transcriptase (hTERT) and Eyes absent 4 (EYA4) mRNA in peripheral blood mononuclear cells. METHODS: Subjects were 50 patients with esophageal squamous cell carcinoma (ESCC), 50 with dysplasia (ESCD), 50 with basal cell hyperplasia (BCH) and 50 controls. All subjects were residents of Feicheng County, Shandong Province, China , diagnosed by histopathology. Expression of hTERT and EYA4 mRNA in peripheral blood was determined by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The hTERT and EYA4 mRNA positive expression increased according to disease severity. At the cut-off value of > or = 0.2, the positive expression rates of EYA4 were 14% for controls, 20.0% for BCH, 26% for ESCD and 52% for ESCC, respectively. At the cut-off value of > or = 0.8, the positive expression rates of hTERT in the four groups were 24%, 30.0%, 52% and 80%, respectively. Using a positive value of 0.47 for EYA4, the testing sensitivities in the ESCD and ESCC groups were 4% and 16%, respectively, and the testing specificity increased to 100%. Using a positive value of 1.0 for hTERT, the testing sensitivities in the ESCD and ESCC groups were 48% and 60%, respectively, and the testing specificity increased to 72%. The testing sensitivities in the predicting ESCD and ESCC in the discriminant model including EYA4 and hTERT and the five traditional risk factors (sex, age, smoking, alcohol drinking, and family history of esophageal cancer) were 70% and 80%, and testing specificities were 76% and 88% respectively. However, the testing sensitivities and specificities in the predicting ESCD and ESCC in the model only including the above five traditional risk factors were lower than that in the former case. CONCLUSION: EYA4 and hTERT mRNA expression increased with the severity of esophageal pathological changes and may be useful for identifying high-risk endoscopy candidates or for monitoring changes in premalignant esophageal lesions.	esophagus
Photofrin PDT for early stage oesophageal cancer: long term results in 40 patients and literature review.	BACKGROUND: Yorkshire Laser Centre experience of PDT in early oesophageal cancer (EOCa) to determine long survival at 3 and 5 years (absolute) and factors which might influence outcome. MATERIAL/METHOD: The records of patients who had PDT (1997-2009) for oesophageal cancer were reviewed and those with EOCa were studied and analysed. All patients had standard work up and staging. PDT was carried out using Photofrin 2 mg/kw bw, iv followed 24-72 h later by endoscopic illumination with 630 nm laser light. Results were assessed based on pathological response to treatment and survival at 3 and 5 years post-PDT. RESULTS: There were 40 patients with EOCa amongst 144 who had PDT for oesophageal cancer. 30 male and 10 female (mean age 77, range 48-84). 35 had adenocarcinoma and 5 squamous cell carcinoma. 20 of the former had Barrett's mucosa. There was no operative or 30-day mortality and no serious complications. Adverse effects were noted in 10 patients including 2 with skin photosensitivity and 3 with mild stricture requiring one dilatation. The median follow up was 76.1 (range 36-150 months). In this period 24 patients have died between 2 and 150 months (median 41 months). 16 patients are alive in between 36 and 110 months. 3 and >or=5 years or more survival (absolute) were 72.5% and 53.8%, respectively. CONCLUSION: Endoscopic PDT should be considered as the treatment of choice in patients with EOCa who are ineligible for surgical resection. We suggest that a carefully designed study of a cohort of patients with EOCa comparing surgical resection with endoscopic PDT is warranted.	esophagus
Study of abnormal chromosome regions in esophageal squamous cell carcinoma by comparative genomic hybridization: relationship of lymph node metastasis and distant metastasis to selected abnormal regions.	Squamous cell carcinoma of the esophagus (ESCC) has a poor prognosis among digestive tract cancers. Lymph node metastasis and distant metastasis are the major factors determining its prognosis. We used comparative genomic hybridization (CGH) to evaluate primary tumor lymph nodes and metastatic areas from ESCC patients in order to determine the relationship between abnormal chromosome regions and outcome. Tumor tissues and lymph nodes were collected from 51 patients with ESCC, and abnormal chromosome regions were detected by CGH. We searched for regions that were significantly more common in patients with lymph nodes metastases (n>/= 6) or distant metastases, and correlated those chromosomal changes with survival. Regions showing amplification in more than 65% of esophageal squamous cell cancers were as follows: 17q12 (90.2%), 17q21 (86.3%), 3q29 (82.4%), 3q28 (78.4%), 8q24.2 (76.5%), 22q12 (76.5%), 3q27 (74.5%), 8q24.3 (74.5%), 1q22 (70.6%), 5p15.3 (70.6%), 22q13 (70.6%), 3q26.3, 8q23, 8q24.1, 9q34, 11q13, 17p12, 17q25, 20q12, 20q13.1 (68.6%), 1q32, 1q42, and 20q13.2 (66.7%). Regions showing deletion in more than 50% of the tumors were as follows: Yp11.3 (62.7%), 3p26 (56.9%), Yq12 (54.9%), 13q21 (52.9%), 4q32 (51.0%), and 13q22 (51.0%). When Fisher's test was used to assess associations of these regions with metastases to lymph nodes, amplification at 2q12-14 (P= 0.012), 3q24-26 (P= 0.005), and 7q21-31 (P= 0.026) were significant. Survival was worse for patients with amplification at all 3 regions. In patients with distant organ metastases, amplification at 7p13-21 was significant (P= 0.008), and survival was worse. Chromosomal amplifications in ESCC at 2q12-14, 3q24-26, and 7q21-31 were associated with lymph node metastasis, while amplification at 7p13-21 was related to distant metastasis. Amplification at these regions correlated with worse survival. Genes involved in the phenotype of ESCC may exist in these regions. Identification of these genes is a theme for future investigation.	esophagus
A critical appraisal of circumferential resection margins in esophageal carcinoma.	BACKGROUND: In esophageal cancer, circumferential resection margins (CRMs) are considered to be of relevant prognostic value, but a reliable definition of tumor-free CRM is still unclear. The aim of this study was to appraise the clinical prognostic value of microscopic CRM involvement and to determine the optimal limit of CRM. METHODS: To define the optimal tumor-free CRM we included 98 consecutive patients who underwent extended esophagectomy with microscopic tumor-free resection margins (R0) between 1997 and 2006. CRMs were measured in tenths of millimeters with inked lateral margins. Outcome of patients with CRM involvement was compared with a statistically comparable control group of 21 patients with microscopic positive resection margins (R1). RESULTS: A cutoff point of CRM at < or = 1.0 mm and > 1.0 mm appeared to be an adequate marker for survival and prognosis (both P < 0.001). The outcome in patients with CRMs < or = 1.0 and > 0 mm was equal to that in patients with CRM of 0 mm (P = 0.43). CRM involvement was an independent prognostic factor for both recurrent disease (P = 0.001) and survival (P < 0.001). Survival of patients with positive CRMs (< or = 1 mm) did not significantly differ from patients with an R1 resection (P = 0.12). CONCLUSION: Involvement of the circumferential resection margins is an independent prognostic factor for recurrent disease and survival in esophageal cancer. The optimal limit for a positive CRM is < or = 1 mm and for a free CRM is >1.0 mm. Patients with unfavorable CRM should be approached as patients with R1 resection with corresponding outcome.	esophagus