We investigated clinical and treatment-related factors as predictors of pleural effusion in esophageal cancer patients after concurrent chemoradiation therapy (CCR). Materials/Methods: Consecutive primary esophageal cancer patients treated with CCR between 2001 and 2010 were retrospectively reviewed from our treatment record. Inclusion criteria were as follows: newly diagnosed and first treatment for esophageal cancer except for EMR; disease including thoracic esophagus; follow-up 6 months; conventional fractionation and irradiated 50 Gy; World Health Organization (WHO) performance status 2; available CT data to analyze dose volume of pericardium and lungs; intact of malignant pleural disease. Adverse events were graded according to the CTCAE version 4.0. Symptomatic effusion was defined as effusion grade2. Radiation treatment planning performed by two-dimensional planning was reconstructed to three-dimensional treatment planning to analyze dose-volume parameters without modification. Pleural effusion was reviewed on follow-up chest computed tomography. Percent volume irradiated 5 to 60 Gy (V5-V60) and mean dose of pericardium and both lungs were evaluated by dose volume histogram. The following clinical factors were investigated for associations with the risk of pleural effusion: age, gender, performance status, main tumor location, clinical stage, histology, smoking, hypertension, alcohol, cardiovascular disease, and diabetes. Treatment-related factors including radiation dose, treatment planning method, CCR regimen, neoadjuvant chemotherapy, salvage surgery, mean dose of the lungs and mean dose of the pericardium. Associating clinical and treatment-related risk factors for pleural effusion were detected by univariate and multivariate analyses. Results: Overall 157 patients were met the criteria. The median follow up was 29 (ranged 6 to 121) months. Pleural effusion in any grade was observed in 58 (37%). Symptomatic pleural effusion developed in 12 (8 %) patients. Onset of pleural effusion ranged 1 to 94 months. Dosimetric analyses revealed the value of V5 to V60 of pericardium and mean dose of pericardium were significantly higher in patients with symptomatic pleural effusion than those with asymptomatic pleural effusion and without pleural effusion. Multivariate analysis identified mean pericardial dose as the strongest risk factor for both pleural effusion in any grade and symptomatic effusion. Clinical stage was also detected as significant risk factor. Conclusion: Pleural effusion after CCR for esophageal cancer is relatively common adverse event. Pericardial dose-volume relationship has a large impact on any patient, irrespective of whether pleural effusion is present or absent, symptomatic or asymptomatic.

No abstract

The association of high mobility group box 1(HMGB1) expression with clinicopathological significance and prognosis in colorectal carcinoma (CRC) remains controversial. The purpose of this study is to conduct a meta-analysis and literature review to identify the role of HMGB1 in the development of CRC and as a potential target for therapy. Materials/Methods: All eligible studies about the association between HMGB1 protein expression in tissue with clinicopathological significance and prognosis in CRC published up to January 2015 were identified by searching PubMed, Web of Science, CNKI and WanFang database. Analysis of pooled data was performed, odds ratio (OR) with 95% confidence interval (CI) was calculated and summarized to evaluate the strength of this association in fixed-or random-effects model. Results: The expression level of HMGB1 protein in CRC tissues was much higher than in normal colorectal tissues (ORZ 26.57, 95% CI 9.07e77.79, p< 0.00001). There was no relation between the HMGB1 expression and sex, age, tumor size and location (colon or rectum cancer). However, a significant relation was detected between the HMGB1 expression and clinical stage (AJCC7), lymph node metastasis, distant metastasis, tumor invasion depth, differentiation rate (pZ 0.01, pZ 0.0006, p< 0.0001, p< 0.00001, pZ 0.02, respectively). Conclusion: In this meta-analysis, our results illustrated significant relationships of HMGB1 protein overexpression in tissues with clinicopathological characteristics and prognosis of CRC. Thus, HMGB1 may be a promising marker in predicting the clinical outcome of patients with CRC. However, more well-designed studies of large sample size are warranted to validate the findings of current study.