Endoscopic Diagnosis, Treatment, Follow-up And Multi-protein Analysis Of The Early Esophageal Cancer And Esophageal Precursor

Part I Diagnosis and Staging of Superficial Esophageal Neoplasm based on Pre-Endoscopic Resection System Comparable to Endoscopic ResectionBackground:Endoscopic resection (ER), which is advocated for the treatment of superficial gastroesophageal neoplasm, has also been a good strategy to diagnose and stage. But with the development of the endoscopic treatments, such as the ablation therapies, after which no specimens can be provided, we need establish a pre-ER evaluated system which should have a similar diagnostic and staging accuracy with the ER.Method:We retrospectively analyzed the217lesions from203patients who were treated with Endosopic Resection (ER) in our hospital from January2007to March2011. We analyzed the data before the endoscopic resection (pre-ER) and the post endoscopic diagnosis, aiming to compare the accuracy of the pre-ER and the post-ER data. We established a pre-ER system, which combined the Lugol’s staining, the Paris macroscopic type classification, the Endoscopic Ultrasonography (EUS) examination and the biopsy histological examination. We compared the accuracy of the pre-ER system, the ER diagnosis with the gold standard of the superficial esophageal cancer, respectively.The accuracy rate, the Receiver-Operating-Characteristic (ROC) curve and the Areas under each ROC curve (AUCs) were used to evaluate the accuracy of the pre-ER system and the ER diagnosis.Results:The diagnostic accuracy rate was91%based on the pre-ER system compared with the gold standard, while93%based on the ER diagnosis. We used the Chi-Square to test the difference between the pre-ER system and the ER. There was no significant difference between the biopsy, pre-ER system and ER (P>0.05). The AUC of the pre-ER system was0.963, while the ER examination was0.971. There was no significant difference between the latter two AUCs (p>0.05).Conclusion The pre-ER system can reach similar accuracy with ER specimens. This system can predict histological diagnosis and the stage of the lesions, and help to select treatment for the superficial esophageal neoplasm. Part II Outcomes of piecemeal endoscopic resection of the esophageal neoplasm and early esophageal squamous cancer:safety and efficacyBackground:The esophageal neoplasm and early esophageal cancer are being identified more frequently because of increased awareness, improved endoscopic skill and enhanced imaging. It was accepted that the endoscopic treatment of the esophageal neoplasm and early cancer can be treated by the piecemeal endoscopic resection (piecemeal-ER) and the endoscopic submucosa dissection (ESD). But more and more surgeon focus on the safty and the efficacy of the piecemeal-ER.Method:To evaluate the safety and effectiveness of the piecemeal-ER, we analyzed the patients with esophageal neoplasm and early esophageal cancer treated with the ER from January2007to January2013. There were355lesions included, with the13patients done the surgery after the ER and342patients followed by endoscopeResults:355lesions were operated the endoscopic mucosectomy containing13lesions operated with surgery after the EMR and342lesions followed by endoscope. A total of11patients (3.0%) presented with unexpected events during or after the procedure:0.8%perforation and2.2%bleeding. The local recurrence was detected in13/342(3.8%) esophageal neoplasia3to24months after ER, and was found to be more frequent with a large amount of esophageal wall occupied (P=0.01), with differentiation (P=0.03) and the deep invasion of the lesions (P<0.01), although the length and the differentiation failed to demonstrate statistical significance after the multivariate analysis.Conclusion:The esophageal precursor and the early squamous cancer can be treated with the piecemeal endoscopic resection safely and effectively. All the residue/recurrence found in2years can be eradicated by endoscope. The factors associated with a large amount of esophageal wall occupied and with differentiation of the lesion, but not the piecemeal resection of the lesions or the length of the lesion. The endoscopy follow-up is necessary for the endoscopic resection, especially in the first2years. Part Ⅲ Multi-protein analysis of the esophageal precursorObjective The development of esophageal squamous cell carcinoma (ESCC) progresses a multistage process, collectively known as precursor lesions, also called dysplasia (DYS) and carcinoma in situ (CIS), subsequent invasive lesions and final metastasis. In this study, we are interested in investigating the expression of a variety of functional classes of proteins dyspasia and the correlation of these proteins with precursor progression. Method Mutant p53, fascin, CK14, CK4, EMP1and CST1were analyzed using immunohistochemistry on the endoscopic resection tissue containing114LGIN,90MGIN and120HGIN. Try to find the difference between the different dysplasia, and to provide basis for the development of squamous cell carcinoma of the esophagus.Results (1) There was mutant p53protein accumulation in the dyaplasia with the obvious difference among the dysplasia (p<0.001), especially between the mild dysplasia and moderate dysplasia lesions and severe dysplasia lesion.(2) There was CK14overexpression in the dyaplasia with the obvious difference among the dysplasia (p<0.001).(3) There was CK4lower-expression in the dyaplasia with the obvious difference among the dysplasia (p<0.001).(4) There was Fascin overexpression in the dyaplasia with the obvious difference among the dysplasia (p<0.001).(5) There was CST1overexpression in the dyaplasia with the obvious difference among the dysplasia (p=0.033).(6) There was EMP1overexpression in the dyaplasia with the obvious difference among the dysplasia (p<0.001).Conclusion Mutant p53, Fascin, CK14, CK4, CST1and EMP1expressed in esophageal dysplasia lesions different level have obvious difference, for esophageal precursor early detection.