Surgery is one of the first choices in treating esophageal cancer. Anemia, impaired immunity, and infection caused by malnutrition play important roles in the subsequent occurrence of infection, trauma, and organ failure after surgery. Pre-operative nutri-tional risk assessment and reasonable choice of postoperative nutritional approach can significantly improve the nutritional status and re-duce the possibility of the occurrence of infection, electrolyte imbalance, and organ failure. Enteral nutrition is recommended for those who can tolerate nutritional administration through this manner rather than parenteral nutrition because it is simple, economic, secure, and causes significantly few complications. Parenteral nutrition is adapted when enteral nutrition alone cannot meet the need for nutri-ent supply. In this article, the applications of postoperative nutritional support in esophageal cancer patients are summarized.

Esophageal cancer treatment mode has currently been transformed from surgery alone to multidisciplinary treatment mo-dalities based on the standardization of operation in combination with the reasonable application of perioperative radiotherapy, che-motherapy, and other comprehensive treatment. Although controversies concerning accurate preoperative staging, surgical approach, extent of lymph node dissection, and perioperative chemotherapy regimens still exist, a multidisciplinary team can provide an optimal mode of diagnosis and treatment. A multidisciplinary approach embodies individualized tumor treatment and standardization princi-ple to the maximum extent, as well as prolongs patients' survival time and improves the quality of life.

The FOXO gene, which is a member of the Forkhead box (Fox) gene family, is found in drosophila and is widespread in the eukaryotes of many organisms, including yeast and mammals. This gene transcripts the FOXO protein family, which has impor-tant roles in metabolism, cellular proliferation, stress resistance, and apoptosis. Activation of cell survival pathways, such as phos-phoinositide-3-kinase/AKT or RAS/mitogen-activated protein kinase, phosphorylates FOXOs at different sites, thus regulating the nu-clear localization or degradation of FOXOs. A growing number of evidence indicates that FOXO acts as a tumor suppressor in a wide variety of tumors. Scientists have focused on the correlation between tumors and FOXO. In combination with other chemo-or radiother-apy treatments, drugs designed to increase or restore FOXO activity may constitute a potential strategy in cancer treatment. This review summarizes details on the regulation of FOXO and the latest research progress of FOXO as a molecule therapeutic target.

In contrast to the decreasing prevalence of gastric cancer and esophageal cancer,there has been an alarm rise in the incidence and prevalence of adenocarcinoma of esophagogastric junction during recent literatures.Many discrepancies exists in the current literature,however,regarding the etiology,classification and surgical treatment of the tumor.This confusion is due to a lack of clear current UICC recommendation for the classification and staging.Consequently,the selection of the surgical procedure for tumor is controversial.A clear definition and classification is,therefore,the prerequisite for a discussion of the optimal surgical approach.This review give a detailed description of the related concept and recent advances in treatment of adenocarcinoma of the esophagogastric junction.

Esophageal cancer is a highly aggressive malignant tumor of the digestive tract. Despite the continuous development of sur-gical techniques and multidisciplinary treatments, the prognosis and overall survival of esophageal cancer patients is still poor. In re-cent years, the development of new molecular targeted therapy has become well advanced. Drugs that target tumor-related signal pathways and block the transmission of downstream signals can inhibit the growth and metastasis of tumor cells. Currently, esopha-geal cancer-targeted drugs are rarely approved officially. HER-2 inhibitor represents these types of drugs because of its positive expres-sion of metastatic adenocarcinoma. However, studies on the preparation of new drugs are not extensive. In this paper, the research progress of a new targeted therapy for metastatic esophageal cancer is reviewed.

Obesity has rapidly become a pandemic and is associated with increased carcinogenesis, especially esophageal adeno-carcinoma (EA). Adipose tissue is considered an endocrine organ because of its capacity to secrete a variety of adipokines, such as leptin, adiponectin, and resistin. Adipokines have recently been found to be associated with different types of chronic esophageal diseas-es, including gastro-esophageal reflux diseases, Barrett esophagus, and carcinogenesis. First-hand evidence supporting the inhibitory and/or active function of adipokines has been collected on human EA. This review aims to provide important insights into the potential mechanisms of adipokines in EA progression.

Apoptosis disorders have an important function in the development of gastrointestinal cancer. BNIP3 is a member of the BH3-only subfamily of the bcl-2 family, which contains a BH3 domain and a transmembrane domain, and belongs to the mitochon-drial pro-apoptotic proteins. BNIP3 induces cell death via the caspase-independent mitochondrial apoptotic pathway and mediates au-tophagic cell death. BNIP3 expression is regulated by hypoxia and other factors. BNIP3 expression in tumors exhibits tissue specificity;BNIP3 is highly expressed in some tumors, including breast, lung, and cervical tumors. In pancreatic, gastric, and colorectal cancers, BNIP3 is epigenetically silenced. The absence of BNIP3 in the tumors can cause tumor cells to tolerate hypoxia and may be associated with chemotherapy and radiotherapy resistance. A comprehensive understanding of the spectrum of BNIP3 expression in a various tu-mors is necessary to use BNIP3 as a marker in clinical applications to treat tumors and as a new target in tumor prognosis.

Objective To investigate the correlation between different clinicopathological factors and the recurrence and metastasis of advanced adenocarcinoma of the esophagogastric junction after curative resection,and to analyze the effects of the factors on the prognosis of these patients.Methods The clinical data of 385 patients with advanced adenocarcinoma of the esophagogastric junction who received curative resection at the Affiliated Hospital of Tianjin Medical University from January 2000 to January 2007 were retrospectively analyzed.There were 228 patients did not have tumor recurrence and metastasis (non-recurrence and metastasis group) and 157 patients had tumor recurrence and metastasis (recurrence and metastasis group).Risk factors which might influence postoperative recurrence and metastasis were analyzed using univariate analysis (chi-square test) and multivariate analysis (Logistic regression model).All patients were followed up via out-patient examination or phone call.The survival curve was drawn by Kaplan-Meier method,and the survival analysis was done by Log-rank test.Results The median time for follow-up was 36 months (range,3-108 months).A total of 157 patients had postoperative tumor recurrence and metastasis,and the mean time of tumor recurrence was 17.9 mouths.The results of univariate analysis showed that tumor type,differentiation degree,invasion depth,number of positive and negative lymph nodes,TNM staging were risk factors for the postoperative recurrence and metastasis of adenocarcinoma of the esophagogastric junction after curative resection (x2=5.248,13.493,12.319,18.315,9.704,10.281,P ＜ 0.05).The results of multivariate analysis showed that differentiation degree,invasion depth,number of positive and negative lymph nodes were the independent risk factors influencing the recurrence and metastasis of adenocarcinoma of the esophagogastric junction after curative resection (OR =1.805,1.809,1.520,0.763,P ＜0.05).The numbers of positive lymph nodes in the non-recurrence and metastasis group and the recurrence and metastasis group were 3.86 ± 0.28 and 6.89 ± 0.58,with a significant difference (t =5.118,P ＜ 0.05).The number of negative lymph nodes in the non-recurrence and metastasis group and the recurrence and metastasis group were 14.04 ±0.54 and 10.53 ±0.56,with a significant difference between the 2 groups (t =4.386,P ＜0.05).The 5-year survival rates of patients with the numbers of positive lymph nodes of 0,1-2,3-6 and more than 7 were 46.4％,43.8％,27.1％ and 7.2％,respectively,and the corresponding median survival time were 53,47,35 and 26 months.There was a significant difference in the 5-year survival rate among patients with different numbers of positive lymph nodes (x2 =54.783,P ＜ 0.05).The 5-year survival rates of patients with the number of negative lymph nodes under 9,between 10 and 15 and more than 16 were 22.1％,21.5％ and 45.5％,respectively,and the corresponding median survival time were 28,34,47 months.There was a significant difference in the 5-year survival rate among patients with different numbers of negative lymph nodes (x2=22.814,P ＜ 0.05).Conclusions Tumor type,invasion depth,number of positive and negative lymph nodes are independent risk factors of postoperative recurrence and metastasis of adenocarcinoma of the esophagogastric junction,and the number of positive and negative lymph nodes are important for the prognosis of patients with adenocarcinoma of the esophagogastric junction.

Objective To investigate the expression of Krüppel-like factor 4 (KLF4) protein in esophageal squamous cell carcinoma (ESCC) tissues and to explore its correlation with clinical pathological features as well as prognosis.Methods The expression of KLF4 protein in cancer tissues and normal esophageal tissues from surgical paraffin specimens of 98 thoracic ESCC cases with complete clinical,pathological and follow-up date were detected by immunohistochemistry.The expression of KLF4 at protein level in 20 freshly surgical esophageal cancer tissues and normal esophageal mucous tissues were examined by Western blot.The relation between the expression of KLF4 protein,clinicopathological characteristics and prognosis was analyzed,t-test was used for measurement data analysis.Chi-square test was performed to analyze the correlation between KLF4 protein expression and clinicopathological features.Survival analysis was analyzed by the Kaplan-Meier method.The comparisons of survival rates were analyzed by Log-rank test.Results The positive rate of KLF4 protein expression in normal esophageal tissues and ESCC tissues was 82.7％ (81/98) and 43.9％ (43/98),respectively,the difference was statistically significant (x2=31.701,P＜0.01).The expression of KLF4 at protein level in 20 cases of fresh esophageal cancer tissues and normal esophageal mucosa tissues was 0.576±0.050 and 0.684 ± 0.095,respectively,the difference was statistically significant (t =4.932,P＜0.01).The expression of KLF4 at protein level was correlated with lymph node metastasis and TNM stage (x2 =10.871 and 6.482,P=0.001 and 0.039),however not correlated with gender,age,location,tumor size,degree of differentiation and the depth of invasion (x2=0.214,3.442,5.748,0.891,0.013 and 1.479,P=0.644,0.064,0.056,0.345,0.911 and 0.477).In 98 patients,the 5-year survival rate of cases with KLF4 protein positive expression and negative expression was 48.8％ and 25.5％ and the median survival period was 55 months and 26 months,the differences were statistically significant (x2 =5.747 and 4.493,P=0.017 and 0.034).Conclusion KLF4 as a tumor suppressor gene may play an important role in the genesis,development and metastasis of ESCC,and may become a biological indicator of the severity and prognosis in ESCC.

Objective To investigate the tumor diameter on the prognosis of patients with advanced esophageal squamous cell carcinoma(ESCC) after Ivor-Lewis surgical resection.Methods The clinical data of 254 patients with advanced ESCC who received Ivor-Lewis surgical resection at the Affiliated Hospital of Tianjin Medical University from January 2005 to December 2008 were retrospectively analyzed.All the patients were followed up via outpatient examination,telephone interview and correspondence till December 2013.Survival curve was drawn by the Kaplan-Meier method,and survival rate was analyzed using the Log-rank test.Receiver-operating-characteristic (ROC) curve analysis was used to determine the appropriate cutoff value of tumor size.Univariate and multivariate analysis were done using the chi-square test and COX regression model.Results Of 254 patients,223 patients were followed up for a median time of 30 months (range,3-108 months) with a follow-up rate of 87.80％ (223/254).The median total survival time was 27 months,and the 1,3,5-year overall survival rates were 72.7％,42.2％ and 31.3％,respectively.ROC analysis showed that the appropriate cutoff value of tumor diameter was 3.5 cm.The median survival time and 5-year survival rate were 36 months and 39.3％ in patients with tumor diameter ≤ 3.5 cm and 18 months and 25.4％ in patients with tumor diameter ＞ 3.5 cm,respectively,with a significant difference (x2 =9.494,P ＜ 0.05).The results of univariate analysis showed that the age,tumor diameter,depth of tumor invasion,lymph node metastasis and postoperative adjuvant therapy were related factors affecting the prognosis of patients with advanced ESCC after Ivor-Lewis surgical resection (x2=4.459,9.494,6.993,10.382,5.507,P ＜ 0.05).The results of multivariate analysis showed that tumor diameter ＞ 3.5 cm,lymph node metastasis and no postoperative adjuvant therapy were the independent factors affecting the prognosis of patients with advanced ESCC after Ivor-Lewis surgical resection (HR =1.631,1.681,0.677,95％ confidence interval:1.151-2.312,1.198-2.358,0.487-0.942,P ＜ 0.05).Of 159 patients without postoperative lymph node metastasis,median survival time and 5-year accumulated survival rate were 49 months and 46.4％ in patients with tumor diameter ≤ 3.5 cm and 23 months and 32.0％ in patients with tumor diameter ＞ 3.5 cm,respectively,with a significant difference (x2 =6.412,P ＜ 0.05).Conclusions The tumor diameter ＞ 3.5 cm,lymph node metastasis and no postoperative adjuvant therapy are the independent factors affecting the prognosis of patients with advanced ESCC after Ivor-Lewis surgical resection,meanwhile there is an assessed value of tumor diameter on the prognosis of patients without lymph node metastasis.