title: Patients with ERCC1-negative locally advanced esophageal cancers may benefit from preoperative chemoradiotherapy.
abstract: OBJECTIVE
  To assess the significance of excision repair cross-complementation group 1 (ERCC1) expression as a predictive marker, we analyzed the effects of preoperative chemoradiotherapy on survival relative to ERCC1 status in patients with locally advanced operable esophageal cancer.
  
  
  METHODS
  Paraffin-embedded pretreatment tumor specimens, collected by endoscopic biopsy from patients treated with surgery alone or with preoperative chemoradiotherapy followed by surgery, were immunohistochemically assayed for ERCC1 expression.
  
  
  RESULTS
  Of the 175 patients, 152 biopsy specimens were available for immunohistochemical analysis. Based on a median ERCC1 expression score of 1, we divided the samples into ERCC1-positive (score >1; 71 patients, 47%) and ERCC1-negative (score </=1; 81 patients, 53%) groups. No differences in patient and disease characteristics were observed between the two groups. However, among patients with ERCC1-negative tumors, those who received preoperative chemoradiotherapy had longer overall survival (OS) and event-free survival (EFS) than those treated with esophagectomy alone (median OS, 59.2 versus 25.4 months, P = 0.057; median EFS, 50.7 versus 19.7 months, P = 0.042). This difference was not observed among patients with ERCC1-positive tumors. In multivariate analysis, treatment modality was the major determinant of both EFS (P = 0.006) and OS (P = 0.008) for patients with ERCC1-negative tumors, whereas Eastern Cooperative Oncology Group performance status was the only significant predictor of outcome among ERCC1-positive patients. Among patients who received esophagectomy alone, those with ERCC1-positive tumors had a tendency toward longer OS and EFS (P = 0.085 and 0.094, respectively).
  
  
  CONCLUSIONS
  Patients with ERCC1-negative operable esophageal tumors show a greater benefit from preoperative chemoradiotherapy followed by esophagectomy than those who undergo esophagectomy alone.
authors.affiliation: Division of Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Gui Young
authors.initials: GY
authors.lastname: Kwon
authors.forename: Seung-Il
authors.initials: SI
authors.lastname: Park
authors.forename: Yong Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Hwoon Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
mesh_terms: D000368:Aged; D001706:Biopsy; D003131:Combined Modality Therapy / Q000379:methods; D004268:DNA-Binding Proteins / Q000096:biosynthesis*; D004720:Endonucleases / Q000096:biosynthesis*; D004938:Esophageal Neoplasms / Q000378:metabolism* / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004268:DNA-Binding Proteins; C071447:ERCC1 protein, human; D004720:Endonucleases