title: Cyclin D1 expression predicts postoperative distant metastasis and survival in resectable esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  We aim to identify esophageal squamous cell carcinoma patients with increased risk of postoperative metastases.
  
  
  RESULTS
  A high level of cyclin D1 expression, together with poor tumor cell differentiation and advanced tumor stages, increased risk of postoperative metastasis and decreased distant metastasis-free survival in ESCC in both cohorts. A high level of cyclin D1 expression also decreased overall survival in the training cohort (p < 0.01) but not in the validation cohort (p = 0.415). However, when the two cohorts of patients were pooled to obtain a larger case number, a high level of cyclin D1 expression was again demonstrated as an independent predictor that decreased overall survival (p < 0.01).
  
  
  METHODS
  We used data from two institutions to establish training (n = 319) and validation (n = 164) cohorts. Tissue microarrays were generated for immunohistochemical evaluation. The correlation among cyclin D1 expression, clinicopathologic variables, postoperative distant metastases, overall survival, and distant metastasis-free survival were analyzed. Multivariate analyses were used to test the independent factors impacting postoperative distant metastases and survival. The outcomes generated from the training cohort were then tested using the validation cohort and pooled dataset.
  
  
  CONCLUSIONS
  High level of cyclin D1 expression increased distant metastasis, decreased overall survival and distant metastasis-free survival in resectable ESCC. Using a combination of cyclin D1 expression, tumor cell differentiation grade, and tumor stages, identifying patients with increased risk of postoperative metastases becomes possible.
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.|Guangdong Esophageal Cancer Institute, Guangzhou City, Guangdong Province, China.
authors.forename: Run-Bin
authors.initials: RB
authors.lastname: Liang
authors.affiliation: Department of Thoracic Surgery, Linzhou Esophageal Cancer Hospital, Yaocun Town, Linzhou City, Henan Province, China.
authors.forename: Jin-Chang
authors.initials: JC
authors.lastname: Wei
authors.affiliation: Institute of Medical Statistics and Epidemiology, Sun Yat-sen University Medical College, Guangzhou City, Guangdong Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.|Guangdong Esophageal Cancer Institute, Guangzhou City, Guangdong Province, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Fu
authors.affiliation: Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.
authors.forename: Rong-Zhen
authors.initials: RZ
authors.lastname: Luo
authors.affiliation: Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.
authors.forename: Jie-Hua
authors.initials: JH
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.
authors.forename: Lan-Jun
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.|Guangdong Esophageal Cancer Institute, Guangzhou City, Guangdong Province, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
authors.affiliation: Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China.|Guangdong Esophageal Cancer Institute, Guangzhou City, Guangdong Province, China.
authors.forename: Hao-Xian
authors.initials: HX
authors.lastname: Yang
mesh_terms: D014408:Biomarkers, Tumor / Q000096:biosynthesis / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D019938:Cyclin D1 / Q000096:biosynthesis* / Q000235:genetics; D004938:Esophageal Neoplasms / Q000235:genetics / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011184:Postoperative Period; D011237:Predictive Value of Tests; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; C530104:CCND1 protein, human; D019938:Cyclin D1
keywords: cyclin D1; esophageal neoplasm; esophageal squamous cell carcinoma; metastasis; surgery