title: Low expression of Bax predicts poor prognosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy.
abstract: OBJECTIVE
  The present study evaluated the prognostic significance of apoptosis-related proteins, p53, Bcl-2, Bax, and galectin-3 in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy.
  
  
  METHODS
  A total of 63 patients with locally advanced esophageal cancer (squamous cell carcinoma: 62; adenocarcinoma: 1; stages II-IV) were treated with definitive chemoradiotherapy using 5-fluorouracil and cisplatin combined with radiotherapy. Pretreatment tumor biopsy specimens were analyzed for p53, Bcl-2, Bax, and galectin-3 expression by immunohistochemistry.
  
  
  RESULTS
  High expression of Bax, p53, Bcl-2, and galectin-3 was observed in 67%, 47%, 24%, and 29% of patients, respectively. The median overall survival (OS) of total patients was 14 months with 16% of 3-year OS. High expression of p53, Bcl-2, and galectin-3 did not show correlation with clinicopathologic characteristics, including patient outcome. Low expression of Bax was significantly correlated with lack of clinical complete response (P=0.023). Low expression of Bax was also associated with poor OS (median, 8 months versus 16 months; P=0.0008) in univariate analysis. In multivariate analysis, low expression of Bax was the most significant independent predictor of poor OS (P=0.009), followed by low dose intensity of cisplatin and lack of clinical complete response.
  
  
  CONCLUSIONS
  Low expression of Bax was significantly associated with the poor survival of patients with locally advanced esophageal cancer treated with chemoradiotherapy using 5-fluorouracil and cisplatin. Immunohistochemical staining for Bax with a pretreatment biopsy specimen might be useful to select the optimal treatment options for these patients.
authors.affiliation: Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Seok Yun
authors.initials: SY
authors.lastname: Kang
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Kwang Jae
authors.initials: KJ
authors.lastname: Lee
authors.forename: Jin-Hyuk
authors.initials: JH
authors.lastname: Choi
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Park
authors.forename: Hyoung Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Hyun-Woo
authors.initials: HW
authors.lastname: Lee
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Jang
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
authors.forename: Hugh Chul
authors.initials: HC
authors.lastname: Kim
authors.forename: Seunghee
authors.initials: S
authors.lastname: Kang
authors.forename: Young Taek
authors.initials: YT
authors.lastname: Oh
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
authors.forename: Jang Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Sheen
authors.forename: Ho-Yeong
authors.initials: HY
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017209:Apoptosis; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D051028:bcl-2-Associated X Protein / Q000235:genetics*
chemical_list: D000970:Antineoplastic Agents; D009363:Neoplasm Proteins; D051028:bcl-2-Associated X Protein