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Objective: To investigate the expression of HOXA13 gene in stage-II(a esophageal squamous cell carcinoma(ESCC), and to evaluate its relationship with clinicopathological characteristics and prognosis., Methods: The expression of HOXA13 was examined by immunohistochemistry(IHC) in specimens from 39 patients with ESCC of stage-II(a, who underwent resection from 1995 to 2002. SPSS software was used to analyze the relationship between HOXA13 expression and clinicopathological characteristics and prognosis of patients., Results: The expression of HOXA13 protein was detected in ESCC tissue, and the positive rate was 61.5%. The median survival time of patients without HOXA13 expression(>72 months) was significantly longer than those with HOXA13 expression (24 months)( P=0.023). Multivariate analysis showed that HOXA13 expression was independent predictor of disease-free survival time of patients with ESCC., Conclusion: The expression of HOXA13 can be detected in ESCC and is a negative independent predictor of disease-free survival, which implies that HOXA13 might play a role in ESSC, and may be used as a clinical tumor marker of ESCC.

Objective: To evaluate the transhiatus esophagectomy for patients with esophageal cancer., Methods: Clinicopathological data of 46 patients with esophageal cancer undergone transhiatus esophagectomy by single surgeon team from May 2000 to July 2007 were analyzed retrospectively., Results: These 46 patients included 44 esophageal squamous cell carcinomas,1 esophageal adenocarcinoma and 1 esophageal carcinoid. The lesions of 11 patients located at neck segment, 21 at upper segment, 5 at middle segment, and 9 at lower segment. All the patients were classified according to UICC TNM stage classification: 3 cases as stage 0, 6 cases as stage I, 17 cases as stage II a, 2 cases as stage II b, 16 cases as stage III. Six patients received preoperative chemotherapy and pathological complete response was seen in 2 cases. Reconstruction with stomach was performed in 42 cases and with colon interposition in 4 cases.All the tumors were resected, and there was no perioperative death. All the resected margins were pathologically clear. Postoperative complications occurred in 12 cases and were successfully treated, including 2 cases of hoarseness, 3 cases of cardiac arrhythmia,1 case of bilateral pleural effusion, and 6 cases of small anastomotic leakage at neck., Conclusion: Transhiatus esophagectomy is an ideal choice in surgical treatment for patients with esophageal cancer, especially for the ones of aged, poor cardiac or pulmonary function, who can not afford the thoracotomy.

Objective: To identify whether HOX genes can be used as markers of esophageal cancer., Methods: The expression of 39 HOX genes in esophageal cancer cell lines was examined. Specific primers were designed and RT- PCR was performed for each HOX gene members in above esophageal cancer cell lines, EC109 and CAES., Results: Fifteen out of 39 HOX genes were expressed in esophageal cancer cell lines. They were HOXA2, HOXA7, HOXA9, HOXA10, HOXA13, HOXB7, HOXB9, HOXC4, HOXC5, HOXC6, HOXC8, HOXC9, HOXD9, HOXD10, and HOXD13 respectively. Of them. Eleven genes were overlapped with the ones detected in human esophageal squamous cell carcinoma(ESCC) in our former study., Conclusion: This study reconfirms our former that some HOX genes are deregulated expressed in ESCC, which provides more positive evidence for their roles in ESCC.

Objective: To evaluate the clinical significance and survival benefits of chest wall resection and reconstruction (CWRR) by multidisciplinary surgery for selected patients with locally advanced or recurrent breast cancer in order to address the importance of collaboration between ablative (breast surgery or/and thoracic surgery) and reconstructive teams during CWRR., Methods: The data of 44 patients who underwent multidisciplinary CWRR at The University of Texas M. D. Anderson Cancer Center between March 2001 and June 2004 were retrospectively analyzed, which included the CWRR techniques used, patient characteristics and treatment outcomes. Survival of patients with primary, recurrent or metastatic disease, and that of those with curative or palliative resection were also compared., Results: All patients were female aged 34-83 years with primary (n=19), recurrent (n=15) or metastatic breast cancer (n=10). The surgery modes included curative resection(n=36) and palliative (n=8) with a mean defect size of skin: 218.4 cm2; of bony chest wall: 113.9 cm2 (n=15). Immediate reconstruction (n=43) with prosthesis (n=10) or without (n=34) for most of these patients. All of them required soft tissue coverage with pedicled flap (n=37) or free flap (n=13). The average hospital and ICU stay was 6.6 days and 3.4 days (n=8), respectively. The morbidity was acceptable and no 30-day mortality happened. Neither was there difference in median survival (44.7 m vs. 36.0 m, P = 0.752) nor in 1-, 2-, and 3-year survival rates between primary breast cancer (78.4%, 78.4%, 39.2%) and recurrent one (70.9%, 70.9%, 70.9%, P > 0.05). However, both median survival (16.0 m) and the 1-, 2-, and 3-year survival rates (30.0%, 15.0%, 0) in patients with metastasis were much poorer than that in those with primary breast cancer (P = 0.003) or recurrence(P =0. 018). The survival of patients underwent curative resection (36.0 m, 71.5%, 65.7%, 65.7%) were much longer than those with palliative resection (15.1 m, 35.1%, 23.4%, 7.8%, P = 0.018)., Conclusion: With full control of systemic and local disease by up-front multidisciplinary strategy, chest wall resection and reconstruction could improve long-term survival if curative resection achieved or the quality of life if palliative resection done for breast cancer patients with tumor invading the chest wall or local recurrence. Ablative and reconstructive surgeons should be included in surgery team in order to guarantee the possibility of extensive resection and effective reconstruction in a single stage with high safety, good survival and minimal morbidity.

Background & Objective: Anyang in Henan Province of China is a hyperendemic area of esophageal cancer. The infection of human papillomavirus (HPV) is thought as an important pathogenesis of esophageal cancer in Anyang. This study was to detect infection rate and level of HPV-16 in esophageal squamous cell carcinoma (ESCC) patients from 3 different Chinese areas, and investigate its relationship with the pathogenesis of ESCC., Methods: Infection status of HPV-16 in 119 ESCC specimens (43 collected from Anyang, 43 from Beijing, and the rest 33 from Mongolia nationality of Inner Mongolia) was detected by in situ hybridization (ISH) technique with digoxin-labeled HPV-16 E6 probe., Results: HPV16 infection rates were 81.4%, 69.8%, and 63.6% in the specimens from Anyang, Beijing, and Inner Mongolia, respectively. Infection level of HPV-16 was significantly higher in Anyang group than in Beijing group (H=3.91, P<0.05) and Inner Mongolia group(H=4.22,P<0.05). There was no significant difference between the latter 2 groups. Furthermore, the proportion of strong expression of HPV16 (++ and +++) was significantly higher in Anyang group than in the other 2 groups(H=3.95, P<0.05)., Conclusions: HPV-16 infection rate is high in the esophageal specimens from the 3 different areas. Infection status of HPV16 is serious in Anyang.

Aim: To evaluate the expression of matrix metalloproteinase-9 (MMP-9) and its clinical significance in esophageal squamous cell carcinoma (ESCC)., Methods: The expression of MMP-9 in 208 cases of ESCC was detected by immunohistochemistry (IHC) and its clinical significance in ESCC especially the relationship with the clinicopathological parameters was analyzed., Results: The percentage of positive cases for MMP-9 detected by IHC was 49.0%. MMP-9 was mainly expressed in the cytoplasm of cancer cells especially in the invasive front. Only weak expression was detected in the stromal cells and no expression in non-cancerous mucosa. The expression of MMP-9 was positively correlated with poorer differentiation (P = 0.001<0.01), existence of vessel permeation (P = 0.027<0.05) and lymph node metastasis (P = 0.027<0.05)., Conclusion: The expression of MMP-9 correlates with the cancer cell differentiation, vessel permeation and lymph node metastasis. It may be a novel biomarker for the diagnosis and treatment of ESCC.

Background & Objective: Experimental study proved that the coexpression of p53 and vascular endothelial growth factor (VEGF) play an important role in angiogenesis of tumor. The aim of this study was to investigate the mechanism that p53 participate angiogenesis and the relationship between the expression of p53 and VEGF and clinical pathologic parameters and prognosis of esophageal squamous cell carcinoma (ESCC)., Methods: The expressions of p53 and VEGF in operative samples from 76 ESCC patients were detected by immunohistochemistry. The vascular endothelial cells in tumor tissue were labeled by F VIII factor antibody for counting microvessel density (MVD)., Results: The expression rates of p53 and VEGF were 60.5% and 56.5%; total expression rate was 42.1%. The expression rates of p53 and VEGF were strongly associated with distal metastasis and vascular infiltration of ESCC (P < 0.05, P < 0.01). Distal metastasis and vascular infiltration usually occurred in the patients whose mutant p53 and VEGF were both positive expression. The MVDs in p53(+) or VEGF(+) (31.7 +/- 11.5; 33.8 +/- 11.7) were both significantly higher than that in p53(-) or VEGF(-) (22.4 +/- 10.6; 21.2 +/- 9.3, P < 0.05). The MVD reached the maximum in the patients whose p53 and VEGF were both positive., Conclusion: Mutant p53 expression is closely associated with the angiogenesis and distal metastasis of ESCC; Expression of p53 and VEGF could be used as an important biological indices for evaluating the malignant degree of ESCC. Combined determination of p53 and VEGF expression has important clinical significance.

AIM:To detect the congenital expression patterns of mdr-1 gene in commonly encountered malignant tumors in clinic, and the relationship between the expression of mdr-1 gene and the prognostic morphology in esophageal carcinomas.METHODS:A total of 151 resected samples of malignant tumors without preoperative treatment were taken from Anyang City Tumor Hospital.The congenital expression of their mdr-1 gene was detected with reverse transcription polymerase chain reaction (RT-PCR) and was compared with each other.The positive incidence of mdr-1 gene in 46 samples of esophageal carcinoma was compared with their differentiated grades, TNM stages and macroscopic types, and the precautions and advantages of RT-PCR were evaluated.RESULTS:All the 151 samples were confirmed to be malignant histopathologically, including cancers of stomach and gastric cardia (n = 51), esophagus (n = 46), colorectum (n = 16),breast (n = 15), thyroid (n = 10), lung (n = 9) and uterine cervix (n = 24). The positive expression rate of their mdr-1 gene was 33.3%, 37%, 31.3%, 13.2%, 40%, 55%, and 0% respectively. All the 46 samples of esophageal carcinoma were pathologically confirmed to be squamous cell carcinoma. The total expression rate of their mdr-1 gene was 37% (17/46), 35% (6/17), 40% (8/20), and 33% (3/9) for differentiation grade I, II and III respectively. The expression rate of TNM classification was 33% (6/18), 40% (5/12) and 37% (6/16) in stage IIa, IIb andIII. The expression rate was 33% (3/9) in ulcerous type, 37% (3/8) in constrictive types, 33% (5/15) in fungoid types, and 40% (6/14) in medullary types.No statistically significant difference was found.CONCLUSION:Compared with other methods, RT-PCR is more simple, reliable and accurate in detecting mdr-1 gene expression in tissues of tumor. The overexpression of mdr-1 gene in these neoplasms suggested that cases should be handled differently for chemotherapy with rational use of drugs. Excision is the chief treatment for carcinoma of esophagus. The expression of mdr-1 gene in tissues of esophageal cancer is correlated with the parameters of tumor molecular biology which are independent of histopathological morphology.