title: REG I expression predicts long-term survival among locally advanced thoracic squamous cell esophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by esophagectomy.
abstract: BACKGROUND
  The prognosis for patients with locally advanced thoracic esophageal cancer is extremely unfavorable. We have been administering neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy to these patients and studying whether REG I expression in untreated endoscopic biopsy specimens is predictive of patient responsiveness to CRT and/or survival after treatment.
  
  
  METHODS
  Between 1992 and 2003, 47 patients with T4 (direct invasion of adjacent organs) thoracic esophageal cancers were administered neoadjuvant CRT followed by esophagectomy. REG I expression was assessed in untreated endoscopic biopsy specimens and correlated with clinical and histological responses and survival in 37 patients who had also undergone curative surgery.
  
  
  RESULTS
  Among the 37 cases that received CRT followed by surgery, the therapeutic response rate for neoadjuvant CRT was 68%, and a complete histological response in resected specimens from the primary lesion was achieved in 8 (22%) patients. These clinical and histological responses to neoadjuvant CRT did not significantly correlate with survival, however. By contrast, 9 patients were judged REG-positive based on analysis of their untreated endoscopic biopsy specimens, and their cumulative survival rate was significantly higher than that of the 28 REG-negative patients (P = 0.0073). Univariate analysis showed REG I expression to be a prognostic factor (P = 0.0386) that increased the risk of death 8.4-fold.
  
  
  CONCLUSIONS
  Evaluation of REG I expression in untreated endoscopic biopsy specimens may provide a basis for new treatments of locally advanced thoracic squamous cell esophageal cancers.
authors.affiliation: Department of Surgery, Akita University School of Medicine, Akita, Japan. motoyama@doc.med.akita-u.ac.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Motoyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Ueno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takasawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nanjo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Kiyotomi
authors.initials: K
authors.lastname: Maruyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Okuyama
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D051847:Lithostathine / Q000378:metabolism*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate
chemical_list: D051847:Lithostathine; C497617:REG1A protein, human