| The prognostic value of preoperative AFR and AGR in patients with esophageal squamous cell carcinoma patients after radical resection Objective:Systemic inflammation plays an important role in the occurrence and development of malignant tumors.Hypoalbuminemia in cancer patients not only indicates poor nutritional status,but also indicates chronic inflammation.Fibrinogen is not only an important component of coagulation cascade reaction,but also an important acute phase protein in inflammatory reaction.The purpose of this study was to evaluate the prognostic value of preoperative albumin to fibrinogen ratio(AFR)and albumin to globulin ratio(AGR)in patients with esophageal squamous cell carcinoma after radical resection.Methods:The clinicopathological and laboratory data of 612 patients with esophageal squamous cell carcinoma who underwent radical resection in Tumor Hospital of Tianjin Medical University from January 2005 to March 2013 were retrospectively analyzed.The patients were followed up by outpatient clinic,telephone and mail to know their survival.The ROC curve was used to determine the best cut-off points of inflammation-related indicators for evaluating prognosis of these patients and divide them into two groups.χ~2 test was used to analyze the relationship between AFR and AGR and clinicopathological parameters of patients with esophageal squamous cell carcinoma.Kaplan-Meier method was used for univariate survival analysis.Log-rank test was used for survival comparison and Cox proportional risk regression model was used for multivariate survival analysis.Results:The follow-up time of 612 patients with esophageal squamous cell carcinoma ranged from 3 to 144 months,and the median follow-up time was 36 months.The 1-,3-and 5-year survival rates were 82.0%,53.8%and 41.5%,respectively.The best cut-off point for AFR to evaluate the prognosis of patients was 15.295.AFR was closely related to the maximum diameter(P<0.001),depth of invasion(P<0.001)and TNM stage(P=0.001).The best cut-off point for AGR to evaluate the prognosis of patients was 1.786.AGR was closely related to gender(P=0.004),age(P<0.001),maximum diameter(P=0.006),depth of invasion(P<0.001)and TNM stage(P=0.003).The 5-year survival rates of the high-level AFR group and the low-level AFR group were 56.3%and 37.0%respectively,with statistical significance(χ~2=19.013,P<0.001).The 5-year survival rates of AGR high-level group and low-level group were 53.0%and 38.4%respectively,and the difference was statistically significant(χ~2=10.534,P=0.001).Univariate analysis showed that age,smoking history,maximum diameter,depth of invasion,lymph node metastasis,NLR,PLR,fibrinogen,albumin,AFR and AGR were risk factors for prognosis of esophageal squamous cell carcinoma(all P<0.05);multivariate analysis showed that preoperative AFR(HR:0.700,95%CI:0.503-0.973,P=0.034)was the independent prognostic factor of esophageal squamous cell carcinoma patients.Subgroup analysis showed that the survival of patients with high AFR level was significantly higher than that of patients with low AFR level(P=0.001 and 0.049),regardless of lymph node metastasis.Conclusions:Preoperative AFR and AGR are associated with malignant biological behavior in patients with esophageal squamous cell carcinoma.AFR is an independent risk factor affecting the prognosis of patients with esophageal squamous cell carcinoma and can be used as a useful indicator for predicting survival after radical resection.The prognostic value of intraoperative detected lymph nodes in patients with esophageal squamous cell carcinoma patients after radical resection Objective:Surgical resection plus regional lymph node dissection is the preferred treatment for resectable esophageal squamous cell carcinoma and it is an important factor affecting the prognosis of patients.The purpose of this study was to evaluate the prognostic value of intraoperative lymph node detection in patients with esophageal squamous cell carcinoma.Methods:The clinical and pathological data of 612 patients with esophageal squamous cell carcinoma who underwent radical resection in Tumor Hospital of Tianjin Medical University from January 2005 to March 2013 were collected.All patients underwent radical resection of right thoracic esophageal cancer and were followed up by outpatient service,telephone and letter.ROC curve was used to determine the best cut-off point of detected lymph nodes for evaluating the prognosis of patients.Kaplan-Meier method was used to draw survival curve and calculate survival rate.Log-rank test was used for univariate survival analysis and Cox proportional risk model was used for multivariate survival analysis.Results:A total of 10 919 lymph nodes were detected in this group.The average number of lymph nodes was 18(2~78)in each case.The best cut-off point of detected lymph nodes for evaluating survival was 16 lymph nodes.The 5-year survival rates of patients with lymph node detection<16 and≥16 were 37.0%and 45.2%,respectively,with statistical significance(χ~2=8.862,P=0.003).The 5-year survival rates of patients with lymph node detection<16,16~23,and>23 were 37.0%,41.0%and 50.8%,respectively,and the difference was statistically significant(χ~2=10.690,P=0.005).There was significant difference in the number of lymph nodes detected between<16 and 16~23 patients(χ~2=4.078,P=0.043).There was also no significant difference in the number of lymph nodes detected between 16~23 patients and>23 patients(χ~2=1.785,P=0.182).The survival of patients with detected lymph nodes>23 and≤23 had significant difference(χ~2=6.454,P=0.011).Univariate survival analysis showed that age,smoking history,BMI,tumor maximum diameter,depth of invasion,lymph node metastasis,NLR,PLR,fibrinogen,albumin,AFR,AGR and lymph node detection were the related factors affecting the prognosis of esophageal squamous cell carcinoma(P<0.05).Multivariate analysis showed that the number of lymph nodes detected(HR:0.715,95%CI:0.625-0.818,P<0.001)was an independent factor affecting the prognosis of this group patients.In patients with lymph node metastasis,the number of lymph nodes detected was 16-23,which was significantly different from that of>23 patients(χ~2=6.909,P=0.009).There was a significant difference in the number of lymph nodes detected between<23 and≥23 patients(χ~2=8.158,P=0.004).In patients without lymph node metastasis,there was no significant difference in the number of lymph nodes detected between 16~23and≥23 patients(χ~2=0.182,P=0.669);there was also no significant difference in the number of lymph nodes detected between<23 and≥23 patients(χ~2=1.607,P=0.205).Conclusions:Lymph node detection is an independent factor affecting the prognosis of patients with esophageal squamous cell carcinoma.It is recommended that at least 16 to 23lymph nodes be removed.For patients with lymph node metastasis,more than 23lymph nodes should be detected;for patients without lymph node metastasis,more than 23 extensive lymph node dissection can not significantly improve the prognosis of patients.The prognostic value of postoperative pathological Vav1 expression in patients with esophageal squamous cell carcinoma patients after radical resectionObjective:Vav1 has hematopoietic system-specific activity of GDP/GTP guanosine exchange factor.When it is ectopically expressed in normal hematopoietic system,it can be stimulated by various growth factors and promote the occurrence and development of malignant tumors.At present,the role of Vav1 in the occurrence and development of esophageal squamous cell carcinoma has not been reported.The purpose of this study was to investigate the expression of Vav1 in esophageal squamous cell carcinoma and its correlation with clinicopathological features and prognosis of esophageal squamous cell carcinoma.Methods:The expression of Vav1 mRNA and protein in fresh esophageal squamous cell carcinoma tissues and corresponding normal esophageal mucosa tissues was detected by qRT-PCR and Western blot.Immunohistochemical SP method was used to detect the expression of Vav1 in paraffin specimens of 112 patients with esophageal squamous cell carcinoma with complete clinical and pathological data.The relationship between Vav1 expression and clinical and pathological characteristics was examined byχ~2 test.Survival analysis was performed by Kaplan-Meier curve method.Survival rate was compared by log-rank test.Cox proportional risk model was used for multivariate survival analysis.Results:The results of qRT-PCR and Western blot showed that the relative expression level of Vav1 in fresh esophageal squamous cell carcinoma was significantly higher than that in normal esophageal mucosa adjacent to cancer.Immunohistochemical results showed that the high expression rate of Vav1 in esophageal squamous cell carcinoma was significantly higher than that in normal esophageal mucosa(61.6%vs.36.7%,P=0.014).The expression level of Vav1 protein was closely related to the maximum diameter(χ~2=5.940,P=0.015),depth of invasion(χ~2=5.135,P=0.023),lymph node metastasis(χ~2=7.119,P=0.008)and TNM stage(χ~2=15.660,P<0.001).The5-year survival rate of patients with high expression of Vav1 was significantly lower than that of patients with low expression of Vav1(18.4%vs.32.6%,P=0.014).Multivariate analysis showed that Vav1 expression(HR 1.660,95%CI 1.058~2.607,P=0.028)was an independent risk factor for the prognosis of 112 patients with esophageal squamous cell carcinoma.Conclusions:Vav1 is highly expressed in esophageal squamous cell carcinoma,and is associated with malignant biological behavior such as tumor infiltration and lymph node metastasis.Vav1 is a poor prognostic indicator.Vav1 may be a biological indicator reflecting the severity of esophageal squamous cell carcinoma and judging the prognosis of patients. |
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