Evaluation Of Endoscopic Resection For Early Esophageal Cancers And Precancerous Lesion And Expression Of Lgr5 In Them

Part 1:Evaluation of Endoscopic Resection for Early Esophageal Cancers and Precancerous LesionObjective:Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are now being increasingly used for the treatment of esophageal cancers. The clinical value of ESD and EMR for early esophageal cancer and precancerous lesions is compared.Methods:Cases with precancerous lesions and early stage esophageal cancer who accepted ESD or EMR in Shanghai Zhongshan hospital from Jan.2007 to Oct.2009 were retrospectively analyzed. Curability, complications and local recurrence were investigated.Results:One hundred and seventeen patients, with a total of 118 lesions were enrolled. The En bloc complete was achieved in 100% of ESD and 38.5% of EMR. Histological curative rate was 93.5% of ESD and 38.5% of EMR. Significance difference of histological curative rate showed between ESD and EMR (93.5% vs 38.5%, P=0.000).Average procedure time: ESD was (54.6±31.8) minutes and EMR (45.9±39.5) minutes. Three perforations (3.3%) and one delayed bleeding were encountered during ESD and were clamped by metal clips. Minor bleeding during ESD or EMR procedure is 20.9% and 34.6%. At a median follow-up period of ten month (range 1-26 months),85 patients were visited. There were 6 ESD recurrence (8.8%) and 4 EMR recurrence (52.9%). Postoperative stricture occurred in 11.8% ESD (8/68) and 52.9% EMR (9/17).Postoperative stricture is correlated with the method of resection (r=0.412, P=0.000) and circumferential sizes of therapy (r=0.405, P=0.000). Local recurrence is correlated with the tumor location (r=0.412, P<0.05) and the method of resection (r=0.183, P<0.05). Lesions treated by EMR had a significantly higher recurrence rate and postoperative stricture than lesions treated by ESD (P<0.001), especially for those lesions measured 20 mm or more in diameter (P<0.05).Conclusion:ESD has higher effective rate and low complication than EMR, especially for esophageal squamous cell carcinoma which measured 20 mm or more in diameter.Part 2:A Comparison Between Endoscopic Resection and Surgical Therapy for Early Esophageal CancerObjective:To compare the therapeutic result of endoscopic resection (ER) and surgical therapy for early esophageal cancer.Methods:Two hundred and five cases with early stage esophageal cancer in Shanghai Zhongshan hospital from Jan.2007 to Oct.2009 were retrospectively analyzed. Telephone follow-up visits were taken on to comprehend the situation of complication, recurrence, diversion and fatality.Results:A total of 205 cases were divided into two groups, with 60 cases in endoscopic resection group, and 145surgical therapy group. The en bloc resection rates were 68.3% and 99.3%. Postoperative pathology showed that lymphovascular involvement with surgical therapy is 11.7%(17/145), no nodal metastases was found in ml,7.6% (4/52) in m2 and m3,16.1%(13/81) in sml. There was a positive correlation between the depth of invasion and lymphovascular involvement (r=0.164, P<0.05).Median follow-up period was 36 and 38 months of endoscopic resection group and surgical therapy group respectively. No cases with ER died during follow-up period. In surgical resection group,4 cases died with death rate 2.8%(4/145); the 1-, 3-year survival rate is 95.0% and 92.0%. No statistic difference of recurrence/ diversion rate was found between two groups.Conclusion:The therapeutic result between endoscopic resection and surgical therapy for early esophageal cancer is similar. Part 3:Expression of Lgr5 in premalignant lesions and early stage of esophageal squamous cell carcinomaObjective:Lgr5, a Wnt target gene, which plays an important role in proliferation of cancer stem cells, is expressed in premalignant lesions including Barrett's esophagus (BE) and caners including colon cancer, ovarian cancer, and hepatocellular carcinoma. It was suggested Lgr5 has potential utility as a biomarker for BE-associated dysplasia and esophageal adenocacinoma. The expression of Lgr5 in premalignant lesions and early stage of esophageal squamous cell carcinoma (ESCC) and its clinical significance were analyzed.Methods:Twenty paraffin-embedded sections of BE, ESCC and the control group respectively were enrolled the test to exam the expression of Lgr5 by standard immunohistochemistry. Each immunostain was scored based on intensity of immunostaining and percentage of positive cells.Results:Expression of Lgr5 was higher in BE (3.65±1.95) than in the control group (2.55±1.70) (P<0.05). Its expression was significantly higher in cancerization area (5.39±0.61) than nearby mucosa (3.06±1.06) of early ESCC (P<0.001). No difference of the immunostain score of Lgr5 in intraepithelial carcinoma, intramucosal carcinoma and submucosal carcinoma (P=0.174).Conclusion:Lgr5 is expressed in Barrett's esophagus and early stage of ESCC. Farther study would be taken to evaluate the mechanisms.