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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Histopathological characteristics and optimal treatment modality for superficial esophageal carcinoma were reevaluated by the way of nationwide questionnaires to the members of the Japanese Society for Esophageal Diseases. A questionnaire was designed for patients with preoperatively untreated superficial carcinoma of the esophagus who had undergone either surgical or endoscopic treatment between January 1, 1990 and December 30, 1994. As the results, the incidence of positive lymphatic invasion or lymphnode metastases tended to increase markedly as cancer infiltration reached the lamina muscularis mucosa. The majority of the cases with 0-I or 0-III components were sm. cancer. The indication of endoscopic mucosal resection (EMR) was limited to m1 and m2 superficial carcinoma in 76% of the institutions surveryed. Tumors measuring 2cm or more in diameter were resected piecemeal in 94% of the patients. The complications of EMR were observed in approximately 6.8% of patients, which denoted perforation, stenosis, and hemorrhage on most of the cases. As for the result of the treatment, almost all patients with m1 or m2 cancer survived. There was no significant difference in prognosis between m3 cancer and m1 or m2 cancer, but sm1 cancer showed worse prognosis than mucosal carcinoma. From this review, further study was advocated to refine the treatment strategy against m3 or sm1 cancer in the future.
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PMID:[Treatment of superficial carcinoma of the esophagus--a review of responses to questionnaire on superficial carcinoma of the esophagus collected at the 49th conference of Japanese Society for Esophageal Diseases]. 890 19

A total of 188 cases of nonresected esophageal cancer were categorized into the following groups based on T category. (1987 UICC) and radiological classification (Japanese Society of Esophageal Diseases); Group 1: superficial or early (T2 or less) tumorous type; Group 2: advanced tumorous type, early serrated or early spiral type; Group 3: others. The response to radiotherapy was significantly related to the group. According to the proportional hazard model, the important factors predicting long-term survival were T category, radiotherapy response at the end of treatment, and group. There was a tendency to obtain better local control in group 1 patients than in group 2 patients, but cause-specific survival was the same for both groups (mainly the appearance of distant metastases). Local control was poor in group 3. If the tumor response at 40Gy was excellent in group 2 patients, the main cause of death was distant metastases, much the same as in group 1 patients. However, if response at 40Gy was not excellent, the main cause of death was local failure even though final tumor response was excellent. It seemed that therapy that may improve local control is valuable for group 3 patient, and for group 2 patients whose tumor response at 40Gy was not excellent.
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PMID:[Radiotherapy of esophageal cancer: clinical usefulness of new grouping]. 912 76

TNM classification of esophageal carcinoma was first described in the supplement to the first edition of the TNM classification in 1973. In the second edition, the classification was changed based on the data of 1,000 cases from the Task Force on Esophagus of American Joint Committee. In this edition, only the clinical classification was described, but the third edition included both clinical and post-surgical histopathological classification. But the criteria for T and pT classification differed. Before the fourth edition, specialists from Japan and the United States met in Hawaii in 1984. Data of the Japanese Nationwide Registration, including 7,742 patients from 1969 to 1978, were presented. After discussion based on these data, T was classified according to the depth of invasion, and perigastric lymph nodes were included in Regional Nodes in the fourth edition. Then, the TNM Research Committee of ISDE collected patient data of esophageal carcinoma from seven countries, and they were studied according to many factors. Based on these data, two proposals were made to the UICC TNM Committee. First, T1 should be divided into two categories: T1a, Tumor invasion of lamina propria; and T1b, Tumor invasion of submucosa. Second, metastases to distant lymph nodes should be grouped into the N classification instead of M classification. The first was accepted in the TNM Supplement of 1993, and the second will be accepted in the Fifth Edition, which will appear in 1997. It is important to accumulate data on many patients using the uniform registration form and to follow these patients very closely in the discussion of revisions to the TNM classification.
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PMID:[TNM classification of carcinoma of the esophagus]. 917 May 33

Between 1980 and 1995, 91 (13.7%) out of 666 patients were determined by pathologic staging to have a superficial squamous-cell esophageal carcinoma of the thoracic esophagus. The male to female ratio was 3.3:1, and the mean age 60 years. Postoperative mortality was 4.3%. The median follow-up was 48 months (range 3-179). Survival was significantly decreased with increased depth of tumour invasion and presence of nodal metastases (P=0.03). Recurrent disease was prevalent in patients with submucosal tumours compared to those with mucosal tumours (P < 0.05). Only intra-epithelial and intramucosal carcinomas deserve the definition of 'early' tumours. Given the relative inaccuracy of current staging modalities and the low morbidity and mortality rates associated with surgical resection, surgery appears to be the mainstay of treatment of superficial squamous-cell esophageal cancer.
Dis Esophagus 1997 Jul
PMID:Prognosis of early squamous cell carcinoma of the esophagus after surgical therapy. 928 73

The E-cadherin-catenin complex is important for cell-cell adhesion of epithelial cells. Impairment of one or more components of this complex is associated with poor differentiation and increased invasiveness of carcinomas. Oesophageal adenocarcinomas causes early metastases, progress rapidly, and consequently have a poor prognosis. By means of immunohistochemistry, the expression of E-cadherin and alpha- and beta-catenin was studied in 65 oesophageal adenocarcinomas and 15 lymph node metastases. Expression of these proteins was evaluated with respect to clinico-pathological parameters and patient survival. Expression of the proteins was strongly correlated. In carcinomas, reduced expression of E-cadherin, alpha-catenin, and beta-catenin was found in 74, 60, and 72 per cent, respectively. Expression of E-cadherin and alpha-catenin correlated significantly with stage and grade of the carcinomas, whereas expression of beta-catenin correlated only with grade. Reduced expression of all three proteins correlated with shorter patient survival. In contrast to grade, E-cadherin and beta-catenin were significant prognosticators for survival, independent of disease stage. We conclude that in oesophageal adenocarcinomas, decreased expression of E-cadherin, alpha-catenin and beta-catenin are related events. Furthermore, expression of at least E-cadherin and beta-catenin is significantly correlated with poor prognosis.
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PMID:Reduced expression of the cadherin-catenin complex in oesophageal adenocarcinoma correlates with poor prognosis. 934 37

Staging criteria for thoracic malignancies are based on survival groupings that allow the stage groups to be used as prognosticators for cancer treatment. Definitive staging of esophageal cancer facilitates allocation of patients to appropriate treatment regimens according to each patient's stage. Existing noninvasive staging methods are imperfect in detecting abdominal and thoracic lymph node metastases in patients with esophageal cancer. Thoracoscopy is an excellent means for staging the chest and mediastinum. We have used thoracoscopic lymph node staging and laparoscopic lymph node staging for esophageal cancer since 1992. Thoracoscopy was performed in 45 patients with biopsy specimen-proved carcinoma of the esophagus. Laparoscopy was done in the last 20 patients. Laparoscopic-assisted feeding jejunostomies were performed in patients with obstructive symptoms. Directed liver biopsies were performed if lesions were present. Thoracoscopy was aborted in three patients because of adhesions. Thoracic lymph node stage was N0 in 40 patients and N1 in 3. Celiac lymph nodes were normal in 14 patients and abnormal in 6. Esophageal resection was performed in 30 patients after thoracoscopic lymph node staging; 18 of these underwent laparoscopic lymph node staging. Thoracoscopic staging showed N0 lymph node status in 28 patients and N1 in 2. Two of these N0 patients (7%) were found at resection to have paraesophageal lymph involvement (N1). Thoracoscopic lymph node staging was accurate in detecting the status of thoracic lymph nodes in 28 of 30 cases (93%). Laparoscopic staging found normal celiac nodes in 13 patients and abnormal lymph nodes in 5. After esophagectomy, final pathologic finding of the 13 N0 patients was N0 in 12 patients and N1 in 1 patient. Thus, laparoscopic lymph node staging was accurate in detecting lymph node status in 17 of 18 patients (94%). Six of 20 patients undergoing laparoscopy had unsuspected celiac axis lymph node involvement missed by standard noninvasive techniques. Three percent of thoracic lymph nodes and 17% of celiac lymph nodes were downstaged after preoperative chemoradiotherapy. Thoracoscopic and laparoscopic lymph node staging are more accurate than existing staging methods.
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PMID:Advances in staging of esophageal carcinoma. 943 99

The value of palliative intubation in the secondary malignant stricture of the thoracic esophagus is discussed. One hundred and eleven patients with secondary involvement of the esophagus due to primary inoperable (in 64) or recurrent bronchial tumor (after lobectomy or pneumonectomy in 34) and mediastinal tumor (in 9) or metastases after mastectomy of breast cancer (in 4) underwent a limited invasive surgical intubation with a personally designed, composite tube in the past 15 years. The distal part of the tube is detachable, which allows insertion of the tube only into the esophagus. The overall hospital mortality was 9.9%. Esophageal perforation and intraabdominal septic complication were never recorded. Nonfatal complication rate was low (5.4%). All survivors have resumed on oral soft diet. By this technique, all attempts of tube insertion were successful, although in 33% of the cases various esophageal axis deviations or tortuosity were present. Reintubation for tube dislodgement was necessary in 7.2% of the patients. Stenotic tracheobronchial invasion, vena cava superior syndrome, bronchial stump fistula as well as cardiac arrhythmias are the main contraindications of the palliative intubation in such cases. In the remaining group of patients with secondary invasion of the esophagus by intrathoracic malignancies, intubation may be considered a unique type of management with acceptable risk.
Dis Esophagus 1997 Oct
PMID:Particular aspects and limits of palliation of secondary malignant esophageal strictures. 945 49

This study assessed the clinical value of CYFRA 21-1 in comparison with squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) in patients with esophageal squamous cell carcinoma. In 112 primary cancer patients, the diagnostic sensitivity of CYFRA 21-1 (33.9%) was superior to SCC-Ag (28.6%), CEA (12.5%), and CA19-9 (6.3%). Levels of CYFRA 21-1 were closely correlated with TNM stage and wee below the cutoff value in all 21 patients with stage I disease. All 38 patients with a CYFRA 21-1 level over the cutoff value among the 80 patients who underwent esophagectomy had lymph node metastases (pN1). A correlation was found between CYFRA 21-1 levels and clinical response in serial measurements of 21 patients who received chemotherapy or chemo radiotherapy. Our findings suggest that CYFRA 21-1 is not useful for diagnosis, but that it is valuable for monitoring the efficacy of therapy.
Dis Esophagus 1998 Jan
PMID:CYFRA 21-1 as a tumor marker for squamous cell carcinoma of the esophagus. 959 30

Endoscopic mucosal resection (EMR) has recently been standardized for mucosal cancer of the esophagus. It may be hypothesized that EMR may be considered to be curative for superficial esophageal cancer (SEC), if the possibility of lymph node metastasis can be excluded beforehand. Ninety patients with p-T1 tumours who underwent esophagectomy were studied. Their primary lesions were stained with anti-Desmoglein 1 antigens using the ABC method. The p-T1 tumors were subdivided into three categories: carcinoma limited to the lamina propria mucosae (19 patients, SEC1), carcinoma invading the lamina muscularis mucosae or with invasion just into the submucosa (27 patients, SEC2), and carcinoma definitely invading the submucosa (44 patients, SEC3). Lymph node metastasis was not observed in the SEC1 patients but was observed in 19% of the SEC2 patients and 41% of the SEC3 patients. None of the SEC1 or SEC2 patients had lymph node metastasis when preserved Desmoglein 1 expression was obtained. The EMR appears to be appropriate therapy for SEC1. Our findings indicate that, for SEC2, preserved expression of Desmoglein 1 may be a helpful aid to exclude the possibility of lymph node metastases. Transthoracic esophagectomy with lymphadenectomy should be selected in the SEC3 patients.
Dis Esophagus 1998 Jul
PMID:Detection of lymph node metastasis using desmoglein 1 expression in superficial esophageal cancer in relation to the endoscopic mucosal resection. 984 96

The proliferative index detected immunohistochemically by monoclonal antibody MIB-1 from pre-treatment biopsy tissues of 33 patients with esophageal squamous cell carcinoma who underwent preoperative concurrent chemoradiotherapy was evaluated in relation to clinicopathologic features and chemoradiotherapeutic responses. The response to chemoradiotherapy was assessed both endoscopically and pathologically and classified as complete or partial response. Higher MIB-1 LI was significantly associated with lymph node metastases, suggesting that detection of MIB-1 LI from biopsy tissues may contribute to pre-treatment staging of tumors and prediction of persistence of lymph node involvement after chemoradiotherapy, which would permit the optimization of systemic treatment for individual patients. Statistically, significant correlation existed between higher MIB 1-LI and poor overall survival, implicating the prognostic significance of the MIB-1 LI in patients undergoing multimodality treatment. No significant relationship was found between the MIB-1 LI and either endoscopic or pathologic responses, although a trend for tumors with lower MIB-1 LI to have better responses was observed.
Dis Esophagus 1998 Oct
PMID:The utility of the proliferative index in pretreatment biopsy specimens of esophageal squamous cell carcinoma. 1007 1


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