• 대한기관식도과학회지
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• 제15권2호
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• pp.49-56
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• 2009

Purpose : To evaluate the treatment outcome for patients with locally advanced, unresectable esophageal cancer treated with relatively high dose radiation therapy(RT). Materials and Methods : From January 2000 to December 2008, 32 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated with radiation therapy(RT) with or without concurrent chemotherapy. Ten patients were excluded from analysis because of distant metastasis and drop off. Patient distributions according to AJCC stages II, III IVa were 7(31.8%), 12(54.6%), 3(13.6%) respectively. The locations of tumor were cervical/upper thorax 3 (13.6%), mid thorax 13(59.1%), and lower thorax/abdominal 6(27.3%), respectively. Eleven patients received RT only, and 11 patients received cisplatin based concurrent chemoradiotherapy(CCRT). Median radiation dose was 65 Gy(range 57.6~72 Gy). Results : The median follow-up was 9.1 months(range 1.9~43.8 months). The response rates for complete response, Partial response, stable disease and Persistent disease were 6(27.3%), 11(50.0%), 4(18.2%) and 1(4.5%), respectively. Two patients(9.1%) suffered from esophageal stenosis and stents were inserted. Two patients(9.1%) had Grade 3 radiation pneumonitis and one of them expired due to acute respiratory distress syndrome(ARDS) at 36 days after completion of radiation therapy. The recurrence rate was 11(50.0%). The patterns of recurrence were persistent disease and local progression in 5(22.7%), local recurrence 3(13.7%) and concomitant local and distant recurrence in 3(13.7%). The overall survival(OS) rate was 32.1% at 2 years and 21.4% at 3 years(median 12.0 months). Disease free survival(DFS) rate was 17.3% at 2 and 3 years. All patients who had no dysphagia at diagnosis showed complete response after treatment and 100% OS at 3 years(p=0.0041). The OS for above 64.8 Gy group and 64.8 Gy or below group at 3 years were 60.6% and 9.1%(p=0.1341). The response to treatment was the only significant factor affecting OS(p=0.004). Conclusion : Relatively high dose radiation therapy in unresectable esophageal cancer tended to have a better outcome without increased complication rate. Further study with more patients is warranted to justify improved result.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.103-110
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• 2012

Neoadjuvant chemotherapy for resectable esophageal carcinoma has been a focus of study, but no agreement has been reached on clinical randomized controlled trials and relevant systematic evaluation. The purpose of this study was to perform a meta-analysis on published randomized controlled trials (RCTs) that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Medline and manual searches was conducted in PubMed, ASCO (American Society of Clinical Oncology) meeting summary, Embase, the Cochrane Library (up to October 2010), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database. The selection contents were to identify all published and unpublished RCTs that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Sixteen RCTs which included 2,594 patients were selected. The risk ratio (RR) (95% confidence interval [CI]; P value), expressed as neoadjuvant chemotherapy and surgery versus surgery alone (treatment versus control), was 1.02 (0.95, 1.10; P=0.54) for 1-year survival, 1.29 (1.13, 1.47; P=0.0001) for 3-year survival, 1.31 (1.13, 1.51; P=0.0003) for 5-year survival, 1.00 (0.95, 1.04; P= 0.85) for rate of resection and 0.89 (0.64, 1.23; P=0.48) for operative mortality. The results showed that neoadjuvant chemotherapy for resectable esophageal carcinoma can raise the overall survival rate of patients with esophageal carcinoma, but it does not affect treatment-related mortality.

• Journal of Chest Surgery
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• 제31권11호
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• pp.1081-1084
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• 1998

연구배경 : 식도암은 근치율이 낮고, 광범위 림프절 절제후에도 그 성적이 나쁜 편이다. 따라서 경부 림프절 절제가 식도수술결과에 미치는 효과를 알아보고자 식도수술 환자에서 경부림프절 전이가 된 환자를 조사하였다 대상 및 방법 : 1994년부터 1996년 6월까지 본원에서 흉부식도암 수술을 받은 32명의 환자 중 고식적 수술을 시행받은 25명의 환자를 대상으로 하여 경부림프절 절제의 유무를 기준으로 두 그룹으로 나뉘어 연구하였다. 두 그룹 모두 흉부식도 전절제술과 동반하여 종격림프절과 복부림프절 절제를 시행하였으나 B그룹은 양측 경부림프절 절제를 추가하여 시행하였다. 결과 : 수술합병증은 두 그룹 사이에서 의미있게 차이가 나지않았다. t수술사망과 병원사망은 두 그룹 모두에서 보이지 않았다. 그러나 평균 마취시간은 B그룹에서 의밌게 더 길었다.(평균 마취시간 90분). B그룹에서 27%가 경부림프절 전이를 보였다 결론 : 그러므로 경부림프절 절제는 흉부식도암 수술에서 의미있는 수술방법이라고 할 수 있다. 장기생존율의 비교가 더 필요하리라고 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.3713-3716
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• 2012

Objective: Transmembrane protein 166 (TMEM166) expression in esophageal squamous cell carcinoma (ESCC) and remote normal esophageal tissues was examined to assess any role in tumour biology. Methods: TMEM166 mRNA expression in 36 cases with ESCC (36 tumour samples, 36 remote normal esophageal tissue samples) was detected by RT-PCR. TMEM166 protein expression was analysed in paraffin-embedded tissue samples from the same cases by immunohistochemistry. Results: Semi-quantitative analysis showed TMEM166 mRNA expression in ESCCs to be significantly lower than in remote normal esophageal tissues ($0.759{\pm}0.713$ vs. $2.622{\pm}1.690$, P=0.014). TMEM166 protein expression was also significantly reduced (69.4% vs. 94.4%, P<0.01). Conclusion: TMEM166 mRNA and protein expression demonstrated significant reduction in ESCCs compared with remote esophageal tissues, albeit with no correlation with tumour size, differentiation, stage, and lymph node metastasis, suggesting a role in regulating autophagic and apoptotic processes in the ESCC.

• 대한기관식도과학회지
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• 제15권2호
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• pp.36-41
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• 2009

Background : Controversy exists whether patients with esophageal carcinoma are best managed with classical Ivor Lewis esophagectomy(ILO) as combined thoracic and abdominal approach or transhiatal esophagectomy(THO). The THO approach is known to be superior with respect to operative time, morbidity and mortality, and length of stay, especially at poor pulmonary function patient, but may represent an inferior cancer operation due to inadequate mediastinal clearance compared with ILO. Accordingly, we estimated the THO role at esophageal cancer to compare each operative approach. Material and Method : From January 2002 to December 2007, we performed a retrospective review of all esophagectomies performed at Keimyung University Dongsan Medical Center; 36 underwent THO, and 11 underwent ILO. Result : There were all men and squamous cell carcinoma but 1 woman at ILO group, 2 women at THO group. There were no significant differences between THO and ILO with age, sex, location of tumor, mean tumor length. There were significant differences at preoperative pulmonary function test(In ILO group, average FEV1 is $2.65{\pm}0.6\;L/min$ and iIn THO group, average FEV1 is $2.07{\pm}0.7\;L/min$). The amount of blood transfusion, hospital stay, leak rates and respiratory complication, hospital mortality rate were not significantly different. Conclusion : There was no significant difference in the post-operative complication, hospital mortality rate, long-term survival of patients of both operative method. THO method had lower mobidity and mortality at poor pulmonary function patient than ILO method. Hence, THO is a valid alternative to ILO for patients with poor general condition or expected post-operative respiratory complication.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.1943-1948
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• 2014

Purpose: The prevalence of weight loss in esophageal carcinoma patients is high and associated with impairment of physical function, increased psychological distress and low quality of life. It is not known which factors may contribute to weight loss in patients with esophageal carcinoma during radiotherapy in China. The objective of this study was to identify the associated demographic and clinical factors influencing weight loss. Methods: We evaluated 159 esophageal carcinoma patients between August 2010 and August 2013 in a crosssectional, descriptive study. Patient characteristics, tumor and treatment details, psychological status, adverse effects, and dietary intake were evaluated at baseline and during radiotherapy. A multivariate logistic regression analyss was performed to identify the potential factors leading to weight loss. Results: 64 (40.3%) patients had weight loss ${\geq}5%$ during radiotherapy. According to logistic regression analysis, depression, esophagitis, and loss of appetite were adverse factors linked to weight loss. Dietary counseling, early stage disease and total energy intake ${\geq}1441.3$ (kcal/d) were protective factors. Conclusions It was found that dietary counseling, TNM stage, total energy intake, depression, esophagitis, and loss of appetite were the most important factors for weight loss. The results underline the importance of maintaining energy intake and providing dietary advice in EC patients during RT. At the same time, by identifying associated factors, medical staff can provide appropriate medical care to reduce weight loss. Further studies should determine the effect of these factors on weight loss and propose a predictive model.

• Journal of Chest Surgery
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• 제57권1호
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• pp.53-61
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• 2024

Background: In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis. Methods: A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020. Results: The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in longterm survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m², neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical nastomosis was the only significant risk factor among those with a colon conduit. Conclusion: Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4307-4309
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• 2014

Purpose: To calculate the probability of one person's life-time death caused by a malignant tumor and provide theoretical basis for cancer prevention. Materials and Methods: The probability of one person's death caused by a tumor was calculated by a probability additive formula and based on an abridged life table. All data for age-specific mortality were from the third retrospective investigation of death cause in China. Results: The probability of one person's death caused by malignant tumor was 18.7% calculated by the probability additive formula. On the same way, the life-time death probability caused by lung cancer, gastric cancer, liver cancer, esophageal cancer, colorectal and anal cancer were 4.47%, 3.62%, 3.25%, 2.25%, 1.11%, respectively. Conclusions: Malignant tumor is still the main cause of death in one's life time and the most common causes of cancer death were lung, gastric, liver, esophageal, colorectal and anal cancers. Targeted forms of cancer prevention and treatment strategies should be worked out to improve people's health and prolong life in China. The probability additive formula is a more scientific and objective method to calculate the probability of one person's life-time death than cumulative death probability.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.148-156
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• 2019

Esophagogastric junction (EGJ) cancer is a solid tumor entity with rapidly increasing incidence in the Western countries. Given the high proportion of advanced cancers in the West, treatment strategies routinely employed include surgery and chemotherapy perioperatively, and chemoradiation in neoadjuvant settings. Neoadjuvant chemoradiation and perioperative chemotherapy are mostly performed in esophageal cancer that extends to the EGJ and gastric as well as EGJ cancers, respectively. Recent trials have tried to combine both strategies in a perioperative context, which might have beneficial outcomes, especially in patients with EGJ cancer. However, it is difficult to recruit patients for trials, exclusively for EGJ cancers; therefore, the results have to be carefully reviewed before establishing a standard protocol. Trastuzumab was the first drug for targeted therapy that was positively evaluated for this tumor entity, and there are several ongoing trials investigating more targeted drugs in order to customize effective therapies based on tissue characteristics. The current study reviews the multimodal treatment concept for EGJ cancers in the West and summarizes the latest reports.

• Journal of Chest Surgery
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• 제41권1호
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• pp.74-81
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• 2008

배경: Fascin은 actin-bundling protein으로 세포막 돌출(cell membrane protrusion)을 야기하고 상피세포의 운동성(motility)을 증가시킨다고 알려져 있다. 식도암은 근치적인 수술 후에도 조기에 광범위한 국소침윤이나 국소 임파절의 전이를 자주 일으키는 치명적인 암의 하나이다. 본 연구의 목적은 식도암에 있어서 fascin에 대한 연구가 국내에서는 거의 없는 상황에서 면역조직화학 염색 방법을 이용하여 fascin의 발현 양상을 알아보고 발현여부에 따른 임상 및 병리학적 특성과 예후인자로서의 의의 등을 알아보고자 하였다. 대상 및 방법: 식도 편평 상피암으로 진단받고 수술을 시행 받은 76명의 한자의 암조직에서 fascin의 발현여부를 면역조직화학염색을 통해 조사하였다. Fascin에 대한 면역조직화학 염색에 대한 판독은 반정량적으로 2등급으로 나누었다. 발현양상에 따른 임상 및 병리학적 특성 및 예후분석을 시행하였다. 결과: 전체 76개의 암조직중 39예(51.3%)에서 Fascin의 발현이 양성이었다. Fascia의 발현은 임상병기가 진행될수록(p=0.030), T 인자가 높을수록(p=0.031) 양성률이 높게 나타났으며 추적기간 중 재발이 있었던 군(p=0.005)과 사망을 한 군(p=0.000)에서 양성 발현율이 통계적으로 유의하게 높았다. 각 임상병리학적 인자들의 예후인자로서 단변량 분석 결과 임파절의 전이유무, 림프판 혈관 침범(lymphovascular invasion)여부, 신경주위침범(perineural invasion)여부, 병기, fascin 발현 여부가 통계적으로 유의한 인자들로 나타났다. 다변량 분석에서는 림프관 혈관 침범(lymphovascula. invasion)여부, fascin 발현 여부가 예후인자로 유의하였다. 결론: Fascin은 식도암조직의 51.3%에서 발현되었으며 이의 양성 발현은 보다 진행된 종양 및 재발과 연관성이 있었다. Fascin의 음성발현군이 양성발현군에 비해 유의하게 예후가 좋았으며 Fascin의 발현 여부가 식도암의 예후 인자로서 유용할 수 있음을 알 수 있었다.