Histological categorisation of the desmoplastic reaction is a predictor of patient prognosis in oesophageal squamous cell carcinoma Aims: Histological categorisation of the desmoplastic reaction (DR) is an independent prognostic factor in colorectal cancer. However, it is unknown whether DR categorisation is predictive of oesophageal squamous cell carcinoma (OSCC) outcomes. This study aimed to evaluate the prognostic value of DR categorisation in OSCC patients. Methods and results: Data were collected from 118 patients with OSCC who underwent a curative oesophagectomy with T2 or deeper wall invasion. The DR in each tumour was classified as mature, intermediate or immature based on the presence or absence of keloid-like collagen and myxoid stroma. We identified 49 mature DR tumours, 41 intermediate DR tumours and 28 immature DR tumours. The 5-year overall survival (OS) rate was highest in the mature DR group (42.8%), followed by the intermediate DR group (25.0%) and the immature DR group (19.9%) (P = 0.022, log-rank test; P = 0.006, log-rank trend test). The 5-year disease-specific survival (DSS) rate was also highest in the mature DR group (48.5%), followed by the intermediate DR group (30.8%) and the immature DR group (26.8%) (P = 0.031, log-rank test; P = 0.010, log-rank trend test, respectively). Multivariate analysis revealed that an immature DR was an independent poor prognostic factor of OS and DSS (P = 0.002 and P = 0.004). Conclusions: DR categorisation of OSCC stroma following oesophagectomy is a useful diagnostic tool and an independent prognostic marker.
Signal regulatory protein alpha (SIRPα) is a type I transmembrane protein that inhibits macrophage phagocytosis of tumor cells upon interaction with CD47, and the CD47‐SIRPα pathway acts as an immune checkpoint factor in cancers. This study aims to clarify the clinical significance of SIRPα expression in esophageal squamous cell carcinoma (ESCC). First, we assessed SIRPα expression using RNA sequencing data of 95 ESCC tissues from The Cancer Genome Atlas (TCGA) and immunohistochemical analytic data from our cohort of 131 patients with ESCC. Next, we investigated the correlation of SIRPα expression with clinicopathological factors, patient survival, infiltration of tumor immune cells, and expression of programmed cell death‐ligand 1 (PD‐L1). Overall survival was significantly poorer with high SIRPα expression than with low expression in both TCGA and our patient cohort (P < .001 and P = .027, respectively). High SIRPα expression was associated with greater depth of tumor invasion (P = .0017). Expression of SIRPα was also significantly correlated with the tumor infiltration of M1 macrophages, M2 macrophages, CD8+ T cells, and PD‐L1 expression (P < .001, P < .001, P = .03, and P < .001, respectively). Moreover, patients with SIRPα/PD‐L1 coexpression tended to have a worse prognosis than patients with expression of either protein alone or neither. Taken together, SIRPα indicates poor prognosis in ESCC, possibly through inhibiting macrophage phagocytosis of tumor cells and inducing suppression of antitumor immunity. Signal regulatory protein alpha should be considered as a potential therapeutic target in ESCC, especially if combined with PD‐1‐PD‐L1 blockade.
Spontaneous tumour rupture is a life-threatening complication of hepatocellular carcinoma (HCC). The reported incidence of HCC rupture is 3% to 26%, and HCC rupture is associated with a high rate of in-hospital death (1). Some studies have shown that staged hepatectomy for ruptured HCC leads to favourable surgical outcomes (1, 2). However, laparoscopic liver resection (LLR) has been accepted worldwide and expanded from minor resection to anatomical major resection still in an exploratory or learning phase (3). We herein report a case of pure laparoscopic left hepatectomy for ruptured HCC controlled after transcatheter arterial embolization (TAE). To our knowledge, this is the first case report of laparoscopic hepatic lobectomy for spontaneous ruptured HCC controlled after TAE.
Case ReportA 66-year-old man was transferred to our Institute because of abdominal pain and decreased consciousness. His vital signs were stable, but he had muscular guarding. Blood examination showed a low haemoglobin level (10.6 g/dl) and negativity for hepatitis B virus surface antigen and hepatitis C virus antibody. Enhanced computed tomography revealed a 6-cm mass with a high-low pattern in segment IV (S4) of the liver and fluid collection in the peritoneal cavity, especially around the liver. We diagnosed a ruptured HCC in S4 with massive intra-abdominal haemorrhage ( Figure 1A). Emergency angiographic examination showed that the middle hepatic artery and S4 branch of the left hepatic artery were the feeding arteries of the ruptured HCC. TAE with a gelatin sponge for both feeding arteries was performed and arrested haemorrhage. The patient developed no complications after TAE and was discharged on hospital day 6. 659
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