18 - World Journal of Gastroenterology

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Xu YH et al . Adult pri�ar� retroperitoneal etroperitoneal tu�or tu�or tu�or tu�or u�or 2621 Table 4 Factors affecting postoperative local recurrence (COX regression analysis results) B SE P RR RR95%CI Male 0.346 0.176 0.049 1.413 1.001-1.996 Malignant tumor 2.865 0.841 0.000 17.549 3.376-91.228 Completeness of tumor resection -0.493 0.182 0.007 0.611 0.427-0.873 Leiomyosarcoma 0.849 0.333 0.011 2.338 1.217-4.493 Liposarcoma 0.806 0.287 0.005 2.239 1.276-3.929 Malignant hemangioendothelioma 0.817 0.446 0.067 2.264 0.944-5.426 above provided more accurate information for further surgical procedures. In our report, 29 patients (20.2%) underwent multiple organ resections and 7 underwent vessel reconstruction. One-hundred and twenty-two patients (85.3%) were subjected to complete tumor resection. Previous reports showed the most important reason for incomplete resection was vascular invasion. In our experience, if the inferior vena cava was obstructed or had collateral circulation, reconstruction was not necessary after resection, otherwise the reconstruction needed to be performed. As a result, sufficient preoperative preparation, positive multiple organ resections, vessel reconstruction all contributed to a higher complete resection rate. The retroperitoneal space is deep with sufficient blood circulation, and the tumors are complicated. Thus, the operative field should be completely exposed, easy to anatomize and easy to perform hemostasis. Large surgical incision, sufficient exposure and favorable surgical visual field are important for successful operation, reduction of complications and higher safety. The pseudomembrane of the tumor should be identified before the anatomy of the tumor. Separating along the pseudomembrane provides less bleeding and prevents accidental injury. Operation of the tumor should be performed gradually, which means easier parts should be dealt with first. Surgeons should control proximal blood flow before separating the tumor, and they should have the techniques to handle injured vessels and to reconstruct after vascular resection. Complete resection of retroperitoneal tumors refers to the complete resection of a tumor which can be seen by the naked eye, including the pseudomembrane of the tumor. This does not include the incisal margin or tumor residue of the tumor bed under microscopy [5,6] . This is the best condition for surgical therapy of a retroperitoneal tumor. If necessary, resection of the whole mass of the retroperitoneal tumor can be performed. This includes the resection of the tumor and the organ tissue that can not be separated because of tumor invasion. This can assure complete resection of the tumor with a sufficient amount of normal tissue. Incomplete resection of PRT is proper for those patients who have widespread metastasis in the abdominal cavity or whose tumors can not be completely excised even with great efforts because of invasion to vessels and/ or multiple organs. The purpose of this operation is to reduce the tumor burden and relieve pressing symptoms. Complete resection was not available in some cases in this group. Five cases were because of vascular invasion, 6 cases due to metastasis in the abdominal cavity and 5 cases because of adjacent organ invasion. It was reported that local recurrence varies from 40% to 82% and the median recurrence time ranges from 15 to 44 mo [7,8] . The recurrent rate of tumors is high for malignant tumors. Until now, operations are still the best treatment. Re-operations are needed when constitution is good and resection is effective. Among the 95 cases followed up, 28 cases (29.47%) had local recurrence, 26 cases of which underwent re-operation. In these cases, the results showed longer survival time and improved quality of life. We suggest that post-operative ARPT patients should have a physical examination every 3 mo. CT and MRI should be done as soon as abdominal mass, abdominal pain and other symptoms are found. To those without symptoms, followup by CT scans or MRI at 6-mo intervals can be valuable for early diagnosis to improve survival. Postoperative follow-up ranged from 1 mo to 5 years. The 1-year, 3-year and 5-year survival rates were obviously higher than those in incomplete resection patients. COX multi-various regression analysis revealed that completeness of tumor resection, sex and histologic types were associated with local recurrence. This is similar with other reports [9] . In summary, the steps to improve therapeutic effectiveness include: (1) Complete resection; (2) early finding, early diagnosis, and early surgical intervention. REFERENCES 1 Chiappa A, Zbar AP, Bertani E, Biffi R, Luca F, Crotti C, Testori A, Lazzaro G, De Pas T, Ugo P, Andreoni B. Primary and recurrent retroperitoneal soft tissue sarcoma: prognostic factors affecting survival. J Surg Oncol 2006; 93: 456-463 2 Wendtner CM, Abdel-Rahman S, Krych M, Baumert J, Lindner LH, Baur A, Hiddemann W, Issels RD. Response to neoadjuvant chemotherapy combined with regional hyperthermia predicts long-term survival for adult patients with retroperitoneal and visceral high-risk soft tissue sarcomas. J Clin Oncol 2002; 20: 3156-3164 3 Scibe R, Massa M, Verdolini R, Marmorale C, Landi E. Retroperitoneal tumors. Ann Ital Chir 1999; 70: 731-736; discussion 736-738 4 Schwarzbach MH, Hormann Y, Hinz U, Leowardi C, Bockler D, Mechtersheimer G, Friess H, Buchler MW, Allenberg JR. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg 2006; 44: 46-55 5 Stojadinovic A, Yeh A, Brennan MF. Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg 2002; 194: 436-447 6 Neuhaus SJ, Barry P, Clark MA, Hayes AJ, Fisher C, Thomas JM. Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg 2005; 92: 246-252 7 Heslin MJ, Lewis JJ, Nadler E, Newman E, Woodruff JM, Casper ES, Leung D, Brennan MF. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997; 15: 2832-2839 8 Bautista N, Su W, O'Connell TX. Retroperitoneal soft-tissue sarcomas: prognosis and treatment of primary and recurrent disease. Am Surg 2000; 66: 832-836 9 O u y a n g X H , K o n g G C . C l i n i c a l s t u d y o f p r i m a r y retroperitoneal tumor in 66 cases. Zhongguo Putong Waike Zazhi, 1996, 5: 327-328 S- Editor Wang J L- Editor Ma JY E- Editor Wang HF www.wjgnet.com
PO Box 2345, Beijing 100023, China World J Gastroenterol 2007 May 14; 13(18): 2622-2625 www.wjgnet.com World Journal of Gastroenterology ISSN 1007-9327 wjg@wjgnet.com © 2007 The WJG Press. All rights reserved. RAPID COMMUNICATION Expression level of beta-catenin is associated with prognosis of esophageal carcinoma Lv Ji, Xiu-Feng Cao, He-Ming Wang, Yi-Sheng Li, Bin Zhu, Jian Xiao, Dan Wang Lv Ji, Xiu-Feng Cao, He-Ming Wang, Yi-Sheng Li, Bin Zhu, Jian Xiao, Dan Wang, Affillted Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China Correspondence to: Xiu-Feng Cao, Affillted Nanjing First Hospital Oncology Center, Nanjing Medical University, Changle Road, Nanjing 230032, Jiangsu Province, China. cxf551101@sina.com Telephone: +86-25-52271474 Fax: +86-25-52269924 Received: 2007-01-16 Accepted: 2007-03-23 Abstract AIM: To examine the association of beta-catenin with the clinicopathologic features and prognosis of esophageal squamous cell carcinoma (ESCC). METHODS: Beta-catenin mRNA expression level in 40 ESCC patients (28 males and 12 females, age range 38-82 years, median 60 years) was analyzed by realtime PCR. Beta-catenin mRNA expression levels in tumor cells were categorized as weaker (level 1) or equal to or stronger (level 2) than those in endothelial cells. We examined the correlation between the beta-catenin expression and the clinicopathological factors and prognosis of ESCC patients. RESULTS: Level 2 beta-catenin expression was found in 29 patients. ESCC with level 2 expression had a higher rate of lymphnode metastasis (0.0776 ± 0.0369 vs 0.3413 ± 0.1803, P < 0.001) and deeper tumor invasion (0.0751 ± 0.0356 vs 0.3667 ± 0.1928, P < 0.001), and a poorer survival rate (P = 0.0024) than ESCC with level 1 expression. CONCLUSION: Beta-catenin expression in ESCC is of great importance. © 2007 The WJG Press. All rights reserved. Key words: Beta-catenin; mRNA expression level; Esophageal carcinoma; Prognosis Ji L, Cao XF, Wang HM, Li YS, Zhu B, Xiao J, Wang D. Expression level of beta-catenin is associated with prognosis of esophageal carcinoma. World J Gastroenterol 2007; 13(18): 2622-2625 http://www.wjgnet.com/1007-9327/13/2622.asp www.wjgnet.com INTRODUCTION Esophageal squamous cell carcinoma (ESCC) shows a poor prognosis because of the occurrence of systemic metastasis, mainly via lymphatic vessels [1–6] . Detection of ESCC at its early stage is possible by X-ray and endoscopic examinations [7,8] , but there might be occult micrometastases at the time of surgery even in such cases [9,10] . In this respect, an assessment of metastatic potential is important to establish appropriate therapeutic modalities for ESCC. Previous studies have shown the prognostic significance of several clinicopathologic factors for ESCC, such as tumor size, age at diagnosis, and primary site [11,12] . Among them, depth of cancer invasion in the esophageal wall and lymph node metastasis are the main factors for ESCC recurrence [5,6,11] , and these two factors as well as distant metastasis have been included in the pathological tumornode-metastasis (pTNM) staging for ESCC [12] . However, the prognosis of ESCC, even in cases of early-stage disease (pT1), is heterogeneous, and a strategy to establish appropriate therapeutic modalities for each patient has yet to be formulated. Several biological indices for predicting the prognosis of ESCC, a number of indices, such as aberrant expression or mutation of the tumor suppressor p53, adhesion molecule Ecadherin, and cell-cycle-related molecules such as p27, have been proposed [3,13,11] . However, the utility of these factors for predicting the prognosis of ESCC is controversial [15] . Recently, beta catenin and elements of the Wnt signaling pathway have been found to play an important role in the pathogenesis of human cancers including ESCC. In the present study, we analyzed beta-catenin mRNA expression level in 40 patients with ESCC and evaluated its correlation with the clinicopathologic features and survival of these patients. MATERIALS AND METHODS Patients In the present study, 40 patients underwent surgery for ESCC at the Nanjing First Hospital Affiliated to Nanjing Medical University from July 1999 to February 2000 were selected. There were 28 males and 12 females (age range 38-82 years, median 60 years). An endoscopic examination of esophageal lesions was performed, and a histologic diagnosis of ESCC was made based on biopsy specimens obtained before surgery. Preoperative
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18 - World Journal of Gastroenterology

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