Wang Jichang, Zhang Boxiang, Meng Jinying, Xiao Guodong, Li Xiang, Li Gang, Qin Sida, Du Ning, Zhang Jia, Zhang Jing, Xu Chongwen, Tang Shou-Ching, Liang Rui, Ren Hong, Sun Xin
Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
Department of Thoracic Surgery and Oncology, The Second Department of Thoracic Surgery, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
Exp Ther Med. 2017 Sep;14(3):2584-2594. doi: 10.3892/etm.2017.4835. Epub 2017 Jul 25.
Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results of the current study suggested that post-operative complications were more likely to occur in patients with diabetes, basic respiratory disease or lower serum albumin levels prior to surgery. Therefore, sufficient intensive peri-operative care, rigorous operative risk assessments, and the selection of the patients with early or mid-stage esophageal cancer, may decrease the risk of post-surgical complications in patients receiving radical resection of the esophagus. In addition, a high ratio of esophageal cancer stem-like cells was associated with cancer recurrence. These results suggest that an intensive surveillance strategy should be implemented in order to facilitate early detection of disease recurrence and improve the clinical management of these patients post-surgery.
评估接受食管癌根治性治疗患者的临床病理特征，可能有助于识别与术后并发症相关的模式和因素，并制定针对疾病复发风险较高的存活患者的监测策略。在本研究中，收集了579例行食管癌根治性切除术患者的临床资料。这些患者来自中国西北部的两家医疗中心，回顾性分析了有关基础慢性病的有无及术后结果的信息。测定了食管癌组织样本中所选干细胞标志物的水平，包括醛脱氢酶1、CD133、整合素亚基α6、整合素亚基β4和T细胞因子4，以确定这些标志物是否可能是疾病预后和复发的有用预测指标。接受食管癌根治性切除术患者的术后并发症包括呼吸系统并发症、心血管异常和食管吻合口瘘。糖尿病、基础呼吸系统疾病和术前血清白蛋白水平较低被观察为与术后并发症相关的个体危险因素，这些并发症包括急性呼吸衰竭和肺部感染等呼吸系统并发症、心房颤动和心律失常等心血管异常，以及食管吻合口瘘的发生。食管癌晚期诊断与吻合口瘘显著相关。通过免疫组织化学和免疫荧光染色试验实现了用于预后预测的干细胞标志物的分子检测。结果表明，癌组织中干细胞样细胞的存在与疾病预后不良和高复发率相关。总之，本研究结果表明，糖尿病、基础呼吸系统疾病或术前血清白蛋白水平较低的患者术后更易发生并发症。因此，充分的围手术期强化护理、严格的手术风险评估以及选择早期或中期食管癌患者，可能会降低接受食管癌根治性切除术患者的术后并发症风险。此外，食管癌干细胞样细胞比例较高与癌症复发相关。这些结果表明，应实施强化监测策略，以便于早期发现疾病复发并改善这些患者术后的临床管理。
