Tumor marker expression is predictive of survival in patients with esophageal cancer.
BACKGROUND
This study was designed to determine the prognostic value of immunohistochemical tumor marker expression in a population of patients with node-negative esophageal cancer treated with complete resection alone.


METHODS
Resection specimens were collected from 61 patients with node-negative T1 (n = 31), T2 (n = 14), and T3 (n = 16) esophageal cancer. A panel of 10 tumor markers was chosen for immunohistochemical analysis, based on associations with differing oncologic mechanisms: apoptosis (p53), growth regulation (transforming growth factor-alpha, epidermal growth factor receptor, and Her2-neu), angiogenesis (factor VIII), metastatic potential (CD44), platinum resistance (p-glycoprotein and metallothionein), 5-fluorouracil resistance (thymidylate synthetase), and carcinogenic detoxification (glutathione S-transferase-pi).


RESULTS
Complete resection was performed in all patients (44 adenocarcinoma, 17 squamous cell carcinoma), with no operative deaths. Multivariable analysis demonstrated a significant relationship between cancer-specific death and the following variables: low-level P-gp expression (p = 0.004), high-level expression of p53 (p = 0.04), and low-level expression of transforming growth factor-alpha (p = 0.03). In addition, the number of involved tumor markers present was strongly predictive of negative outcome (p = 0.0001).


CONCLUSIONS
This study supports the prognostic value of immunohistochemical tumor markers, specifically the expression pattern of P-gp, p53, and transforming growth factor-alpha, in patients with esophageal carcinoma treated with complete resection alone.
Aloia
T A
TA
Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Harpole
D H
DH
Reed
C E
CE
Allegra
C
C
Moore
M B
MB
Herndon
J E
JE
D'Amico
T A
TA
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000032:analysis; D000230:Adenocarcinoma / Q000737:chemistry / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000401:mortality* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000032:analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D016211:Transforming Growth Factor alpha / Q000032:analysis; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D016211:Transforming Growth Factor alpha; D016159:Tumor Suppressor Protein p53