Expression of osteopontin in oesophageal squamous cell carcinoma

Osteopontin is a prognostic circulating biomarker in patients with neuroendocrine neoplasms

PURPOSE

Osteopontin (OPN), also called secreted phosphoprotein 1 (SPP1) is a matricellular glycoprotein whose expression is elevated in various types of cancer and which has been shown to be involved in tumorigenesis and metastasis in many malignancies. Its role in neuroendocrine neoplasms (NEN) remains to be established. The aim of the study was to analyze plasma concentrations of OPN in patients with NEN and to explore its diagnostic and prognostic value as a clinical biomarker.

METHODS

OPN plasma concentrations were measured in a total of 38 patients with histologically proven NEN at three different time points during the course of disease and therapy (at the start of the study, after 3 and 12 months, respectively) as well as in healthy controls. Clinical and imaging data as well as concentrations of Chromogranin A (CgA) and Neuron Specific Enolase (NSE) were assessed.

RESULTS

OPN levels were significantly higher in patients with NEN compared to healthy controls. High-grade tumors (grade 3) showed the highest OPN levels. OPN levels were neither different between male and female patients nor between different primary tumor sites. OPN correlated significantly with corresponding NSE levels, while there was no correlation with Chromogranin A. High OPN levels above a cutoff value of 200 ng/ml at initial analysis predicted a worsened prognosis with significantly shorter progression-free survival of patients with NEN, which also held true within the subgroup of well-differentiated G1/G2 tumors.

CONCLUSION

Our data indicate that high baseline OPN levels in patients with NEN are predictive of an adverse outcome with shorter progression-free survival, even within the group of well differentiated G1/G2 tumors. Therefore, OPN may be used as a surrogate prognostic biomarker in patients with NEN.

Serum anti-SPP1 autoantibody as a potential novel biomarker in detection of esophageal squamous cell carcinoma

Background

Esophageal squamous cell carcinoma (ESCC) has poor prognosis mainly due to lacking of effective diagnostic biomarkers. Aberrant expression of secreted phosphoprotein 1 (SPP1) protein has been observed in several cancers. The purpose of this study is to assess the feasibility of serum autoantibody to SPP1 in detection of ESCC.

Methods

The SPP1 protein levels in 108 ESCC tissues and 72 adjacent normal tissues were analyzed by immunohistochemistry. Discovery group containing 62 serum samples from ESCC patients and 62 serum samples from normal controls (NC) were used to detect the levels of anti-SPP1 autoantibody by enzyme-linked immunosorbent assay (ELISA). Validation group containing another 100 ESCC and 100 NC serum samples were tested to confirm the levels of autoantibody to SPP1. Western blotting was performed to further confirm the results of ELISA.

Results

SPP1 protein was significantly overexpressed in ESCC tissues compared to adjacent normal tissues. ELISA results showed that serum autoantibody to SPP1 was significantly increased in ESCC compared to NC in both discovery and validation groups. Autoantibody to SPP1 could discriminate patients with ESCC from NC with the area under curve (AUC) values of 0.653 and 0.739 in discovery and validation group, respectively. The results of ELISA and the occurrence of immunoreactivity to SPP1 in ESCC sera were confirmed by western blotting.

Conclusion

Our study indicated the potential significance of anti-SPP1 autoantibody as a novel biomarker for detection of ESCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10012-9.

Identification of four genes and biological characteristics of esophageal squamous cell carcinoma by integrated bioinformatics analysis

BACKGROUND

Esophageal squamous cell carcinoma (ESCC) has become one of the most serious diseases affecting populations worldwide and is the primary subtype of esophageal cancer (EC). However, the molecular mechanisms governing the development of ESCC have not been fully elucidated.

METHODS

The robust rank aggregation method was performed to identify the differentially expressed genes (DEGs) in six datasets (GSE17351, GSE20347, GSE23400, GSE26886, GSE38129 and GSE77861) from the Gene Expression Omnibus (GEO). The Search Tool for the Retrieval of Interacting Genes (STRING) database was utilized to extract four hub genes from the protein-protein interaction (PPI) network. Module analysis and disease free survival analysis of the four hub genes were performed by Cytoscape and GEPIA. The expression of hub genes was analyzed by GEPIA and the Oncomine database and verified by real-time quantitative PCR (qRT-PCR).

RESULTS

In total, 720 DEGs were identified in the present study; these genes consisted of 302 upregulated genes and 418 downregulated genes that were significantly enriched in the cellular component of the extracellular matrix part followed by the biological process of the cell cycle phase and nuclear division. The primary enriched pathways were hsa04110:Cell cycle and hsa03030:DNA replication. Four hub genes were screened out, namely, SPP1, MMP12, COL10A1 and COL5A2. These hub genes all exhibited notably increased expression in ESCC samples compared with normal samples, and ESCC patients with upregulation of all four hub genes exhibited worse disease free survival.

CONCLUSIONS

SPP1, MMP12, COL10A1 and COL5A2 may participate in the tumorigenesis of ESCC and demonstrate the potential to serve as molecular biomarkers in the early diagnosis of ESCC. This study may help to elucidate the molecular mechanisms governing ESCC and facilitate the selection of targets for early treatment and diagnosis.

Inhibition of osteopontin overcomes acquired resistance to afatinib in EGFR-mutant non-small-cell lung cancer

Background

We aimed to explore a novel therapeutic strategy to conquer acquired resistance to second generation EGFR-TKI afatinib in EGFR-mutant NSCLC.

Methods

Firstly, we established afatinib-resistant cell lines using increasing concentrations of afatinib. Secondly, we over-expressed or silenced the expression of osteopontin (OPN) using in-vitro transfection. Further, western blot analysis was used to detect the expressions of OPN and epithelial-mesenchymal transition (EMT) biomarkers. Finally, cell proliferation was evaluated by MTT assay.

Results

Afatinib (≤5.0 µmol/L)-resistant H1650 (H1650-AR) and H1975 (H1975-AR) cells were successfully established, and grew faster compared with both parental cells at the same time interval. Western blot analysis revealed that afatinib significantly promoted the expressions of OPN and EMT biomarkers in H1975-AR and H1650-AR cells. Gain and loss assays validated that OPN over-expression promoted acquired resistance to afatinib, and induced the expressions of EMT biomarkers in H1650-AR and H1975-AR cells. Conversely, silencing of OPN not only significantly sensitized resistant cells to afatinib, but also suppressed EMT progression in H1650-AR and H1975-AR cells.

Conclusions

These results demonstrated that OPN was required for acquired resistance of EGFR-mutant NSCLC cells to afatinib.

Prognostic value of osteopontin expression in esophageal squamous cell carcinoma: A meta-analysis

OBJECTIVE

To explore the prognostic role of osteopontin (OPN) overexpression in esophageal squamous cell carcinoma (ESCC).

METHODS

The PubMed, EMBASE, The Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Data (CBM) and VIP databases were searched from the establishment dates of the databases to March 31, 2019, for potentially related studies. Stata 12.0 software was used for statistical analyses, and the hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to assess the correlation of OPN overexpression with the overall survival (OS) and progression-free survival (PFS) of ESCC patients.

RESULTS

A total of 8 studies involving 811 patients from China or Japan were included. OPN overexpression was demonstrated to be significantly associated with poor OS (HR = 1.86, 95% CI: 1.22-2.83, P = 0.004), with high heterogeneity (I² = 61.2%, P = 0.012), and poor PFS (HR=1.63, 95% CI: 1.08-2.47, P = 0.020), without heterogeneity (I² = 0.0%, P = 0.839). Subgroup analysis results were similar to the pooled results.

CONCLUSION

OPN overexpression might serve as a promising independent prognostic risk factor in Chinese and Japanese ESCC patients. However, more well-designed studies enrolling more patients are still needed to verify our findings.

Osteopontin Expression Is Associated with the Poor Prognosis in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Preoperative Chemoradiotherapy

Background

The osteopontin has been involved in therapeutic resistance in a variety of cancers. But, the significance of osteopontin expression on the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy is unclear.

Methods

In 80 patients with locally advanced ESCC receiving preoperative chemoradiotherapy between 1999 and 2012, osteopontin expression was evaluated by immunohistochemistry and correlated with treatment outcome. The functional role of osteopontin in ESCC cell lines was determined by osteopontin-mediated siRNA.

Results

Osteopontin expression and clinical T4 classification were significantly associated with poor pathological complete response. Univariate analyses demonstrated that osteopontin overexpression and clinical T classification, T4, were significantly associated with worse overall survival and disease-free survival. In multivariate comparison, osteopontin overexpression and clinical T classification, T4, represented the independent adverse prognosticator. In ESCC cell lines, endogenous osteopontin depletion by osteopontin-mediated siRNA increased sensitivity to cisplatin. Osteopontin expression is independently correlated with the response of chemoradiotherapy and prognosis of patients with locally advanced ESCC receiving preoperative chemoradiotherapy.

Conclusions

Our results suggest that osteopontin may be a potential therapeutic target for patients with ESCC treated with preoperative chemoradiotherapy.

Osteopontin is Critical for Hyperactive mTOR-Induced Tumorigenesis in Oral Squamous Cell Carcinoma

Mechanistic target of rapamycin (mTOR) plays a critical role in the development of oral squamous cell carcinoma (OSCC), but the underlying mechanisms remain poorly understood. Here we have demonstrated that the expression of osteopontin (OPN) was dramatically up-regulated in OSCC tissues and cell lines. Moreover, reduction of OPN suppressed cell proliferation, colony formation, and in vivo tumorigenic ability of OSCC cell lines Tca8113. In addition, there was a strong positive correlation between mTORC1 activity and OPN expression in OSCC tissues and cell lines. Furthermore, mTOR complex 1 (mTORC1) enhanced OPN expression through up-regulation of ERRα. Therefore, OPN is a downstream target of mTORC1 and is crucial for OSCC development. mTORC1, ERRα, and OPN may be potential targets for treatment of OSCC with aberrant mTORC1 signaling.

Gene expression profiling in bladder cancer identifies potential therapeutic targets

Despite advances in management, bladder cancer remains a major cause of cancer related complications. Characterisation of gene expression patterns in bladder cancer allows the identification of pathways involved in its pathogenesis, and may stimulate the development of novel therapies targeting these pathways. Between 2004 and 2005, cystoscopic bladder biopsies were obtained from 19 patients and 11 controls. These were subjected to whole transcript-based microarray analysis. Unsupervised hierarchical clustering was used to identify samples with similar expression profiles. Hypergeometric analysis was used to identify canonical pathways and curated networks having statistically significant enrichment of differentially expressed genes. Osteopontin (OPN) expression was validated by immunohistochemistry. Hierarchical clustering defined signatures, which differentiated between cancer and healthy tissue, muscle-invasive or non-muscle invasive cancer and healthy tissue, grade 1 and grade 3. Pathways associated with cell cycle and proliferation were markedly upregulated in muscle-invasive and grade 3 cancers. Genes associated with the classical complement pathway were downregulated in non-muscle invasive cancer. Osteopontin was markedly overexpressed in invasive cancer compared to healthy tissue. The present study contributes to a growing body of work on gene expression signatures in bladder cancer. The data support an important role for osteopontin in bladder cancer, and identify several pathways worthy of further investigation.

Osteopontin Involves Cisplatin Resistance and Poor Prognosis in Oral Squamous Cell Carcinoma

Background. Osteopontin (OPN) is a multifunctional cytokine involved in cell survival, migration, and adhesion. However, its role in chemosensitivity in locally advanced oral squamous cell carcinoma (OSCC) in humans has not yet been investigated. Methods. We enrolled 121 patients with locally advanced stage IVA/B OSCC receiving cisplatin-based IC followed by CCRT from January 1, 2006, through January 1, 2012. Immunohistochemistry was used to assess OPN expression in OSCC patients' biopsy specimens from paraffin blocks before treatment. In addition, MTT/colony formation assay was used to estimate the influence of OPN in an oral cancer cell line treated with cisplatin. Results. Of the 121 patients, 94 had positive OPN findings and 52 responded to IC followed by CCRT. Positive osteopontin immunostaining also correlated significantly with positive N status/TNM stage/male gender and smoking. Univariate analyses showed that patients whose tumors had a low expression of OPN were more likely to respond to chemotherapy and have a significantly better OS than those whose tumors had a high expression of OPN. Multivariate analysis revealed that prolonged survival was independently predicted for patients with stage IVA disease, negative lymph nodes, and negative expressions of OPN and for those who received chemotherapy with Docetaxel/cisplatin/fluorouracil (TPF). An oral cancer line stimulated with OPN exhibited a dose-dependent resistance to cisplatin treatment. Conversely, endogenous OPN depletion by OPN-mediated shRNA increased sensitivity to cisplatin. Conclusions. A positive expression of OPN predicts a poor response and survival in patients with locally advanced stage IVA/B OSCC treated with cisplatin-based IC followed by CCRT.

OPN -Revisited

Osteopontin (OPN), a matrix extracellular glyco-phosphoprotein is found in various tissues such as epithelium lined tissues, kidney, bone and teeth .It is also detected in all body fluids including blood and breast milk. OPN plays role in a number of physiological and pathologic events such as cell adhesion, migration and cell survival, angiogenesis, apoptosis, inflammation and wound healing. This review summarizes the current data of the biological activities of OPN in the development of tumour, its progression and metastasis.

Prognostic factors in esophageal squamous cell carcinoma patients treated with neoadjuvant chemoradiation therapy

BACKGROUND

Definitive evaluation of surgical specimens obtained after neoadjuvant chemoradiation therapy (CRT) is important for assessing additional treatment or prognosis in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the histological prognostic factors for ESCC patients treated with CRT and determined an appropriate strategy for their evaluation.

PATIENTS AND METHODS

The present study involved 38 consecutive ESCC patients who underwent CRT followed by curative operation. CRT consisted of 5-fluorouracil plus cisplatin and 40 Gy of radiation. We examined histological variables as follows: CRT effect on primary tumor (T-effect: T-effective/T-ineffective), tumor depth (pT), lymph node metastases (pN: pN0/N1), number of lymph node metastases (number-pN), lymphatic invasion, and venous invasion. Univariate and multivariate analyses were performed to examine the independent prognostic factors. Survivals and mode of recurrence were then evaluated according to the independent prognostic factors.

RESULTS

In the univariate analyses, T-effect, pN, number-pN, lymphatic invasion, and venous invasion were found to be prognostic factors with p < 0.01, and pT was a factor with p < 0.05. In the multivariate analysis, pN and T-effect were independent prognostic factors. The five-year survival rate of pN0 patients was more than 75%, even though the T-effect was poor. The 5-year survival rate of patients judged as pN1/T-effective was 50%, whereas all of the pN1/T-ineffective patients died within 2 years with relapse disease.

CONCLUSION

The evaluation method using both pN status and T-effect is useful for assessing prognosis of ESCC patients treated with neoadjuvant CRT.

Clinicopathological significance of BMP7 expression in esophageal squamous cell carcinoma

Background

Bone morphogenetic proteins (BMPs) are secreted signaling molecules belonging to the transforming growth factor-β (TGF-β) superfamily of growth factors. Recent studies have shown that the influence of the expression of BMP7 was altered in several tumors. The purpose of the current study was to examine the expression of BMP7 in esophageal squamous cell carcinoma and to clarify the clinical impact of BMP7 expression in esophageal squamous cell carcinoma (ESCC).

Methods

A total of 180 patients with ESCC who underwent surgical resection from 1991 to 2004 were eligible for this study. The expression of BMP7 in esophageal tumor tissues was examined immunohistochemically.

Results

BMP7 expression was found in the cytoplasm of cancer cells. BMP7 positivity was observed in 61.7% of tumors. The BMP7-positive group had deeper progression, more advanced stages, and greater venous invasion than those without BMP7 expression (p < 0.001, p < 0.005, and p < 0.0005, respectively). In addition, expression of BMP7 correlated with poorer prognosis (p < 0.0005). Multivariate analysis showed that BMP7 expression status was an independent prognostic factor (p < 0.05).

Conclusions

Patients with expression of BMP7 in ESCC had high malignant potential. BMP7 could be a useful prognostic marker for patients with ESCC.

Plasma decorin predicts the presence of esophageal squamous cell carcinoma

Using a microarray technique, we found decorin to be underexpressed, but osteopontin (OPN) to be overexpressed, in esophageal squamous cell carcinoma (ESCC). This study aims to examine whether plasma decorin and OPN plus personal substances use (tobacco, alcohol and areca) can serve as suitable clinical markers to predict the presence of ESCC. In total, 570 archived plasma specimens (275 patients and 295 controls) were collected from 2 medical centers in Taiwan between 2000 and 2008. Decorin and OPN protein levels were measured by ELISA. Means and standard deviation of plasma decorin were 5.6 + or - 3.6 ng/ml in case patients, which were significantly lower than those in controls (7.8 + or - 3.1, p < 0.0001). Plasma OPN levels in case patients were not significantly different from controls (p = 0.33). When compared to subjects with the lowest quartile of plasma decorin, those with the highest quartile one had a significantly lower risk to have ESCC (Adjusted OR = 0.03, p < 0.001). Receiver operator characteristic (ROC) analysis was performed for the combination of plasma decorin and 3 substances use (smoke, alcohol and areca) for the patients compared with the controls. The area under the curve was 88.6% and the optimal cut-point of ROC curve (any 3 factors) had 73.5% sensitivity and 90.2% specificity with approximately 82% of corrected classification. Plasma decorin, but not OPN, is a potential clinical marker for the detection of ESCC. When plasma decorin plus the use of the 3 substances are combined, this factor cluster could be used to detect the presence of ESCC.

The implication of osteopontin (OPN) expression and genetic polymorphisms of OPN promoter in oral carcinogenesis

Osteopontin (OPN) is an extracellular matrix protein in hard tissues. The polymorphism in promoter region of OPN gene correlates to different gene expression and might implicate potential roles in tumor progression and metastasis. Immunohistochemistry (IHC) was utilized to detect the OPN expression in 58 oral squamous cell carcinoma (OSCC) tissues and adjacent normal oral mucosa. The differential OPN expression was further analyzed in relation to clinico-pathological features. Genomic DNA was obtained from isolated leukocytes of blood samples of OSCC patients (n=100), and healthy individuals (n=97) from Taiwan. The OPN gene polymorphism was analyzed by direct sequencing. Our result showed OPN expression was significantly higher in OSCC tissues than in the paired adjacent normal tissues (p<0.01). The expression of OPN was significantly associated with nodal metastasis and the more advanced clinical stage (p<0.05). More prevalent -156 insGG/insGG genotype and -443 T/T genotype was found in OSCC patients (p<0.05). A significant difference in -443T/-156GG/-66T and -443C/-156G/-66T haplotypes between OSCC and controls (p<0.05) was also noted. The OPN expression in tumor tissues significantly correlated with -156 insGG/insGG and -156 G/G+insGG/G genotypes (p<0.05). The conclusion is tissue OPN expression correlates to OSCC progression. -156 insGG/insGG genotype is associated with OSCC susceptibility and higher OPN expression.

Osteopontin expression correlates with invasiveness in cervical cancer

AIM

Osteopontin is a secreted, integrin-binding glycophosphoprotein that is overexpressed in many types of cancers and appears to be involved in carcinogenesis and cancer progression. To understand the role of osteopontin in carcinogenesis of cervical cancer, this study was designed to determine whether osteopontin is expressed in cervical cancer and carcinoma in situ (CIS) tissue as well as in normal cervical tissue.

METHODS

The expression of osteopontin was immunohistochemically analysed from 68 normal cervix, 55 CIS and 52 invasive cervical cancer tissues using a paraffin-embedded tissue array. Immunostaining was evaluated by intensity and the percentage of stained cells.

RESULTS

Osteopontin expression in normal, CIS and cervical cancer tissues was two of 68 (2.9%), 43 of 55 (78.2%) and 46 of 52 (88.4%), respectively (P < 0.01). High intensity (strong positive)/high proportion (more than 50%) staining seen in CIS and cervical cancer tissue samples was 45 of 55 (81.8%)/22 of 55 (40.0%) and 50 of 52 (96.2%)/31 of 52 (59.7%), respectively (P = 0.029 and P = 0.054). There was no significant correlation between the immunostaining score and stage and the immunostaining score and survival.

CONCLUSION

Osteopontin may have a potential use as a diagnostic factor for cervical cancer and osteopontin expression is closely correlated with carcinogenesis and invasion of cervical cancer.

Comprehensive study on the prognostic role of osteopontin expression in oral squamous cell carcinoma

Osteopontin is a tumor-associated protein that promotes tumor development and metastasis. The preoperative blood samples of 94 oral squamous cell carcinoma (OSCC) patients and 28 healthy individuals were analyzed for plasma osteopontin levels, and another 256 paraffin-embedded OSCC specimens were analyzed by osteopontin immunostaining. The patients with advanced tumor (T) stage (T3/T4 vs. T1/T2) and positive nodal (N) status had significantly higher plasma levels of osteopontin (both p<0.001). Positive osteopontin immunostaining also correlated significantly with advanced T stage (p<0.001), positive N status (p<0.001), advanced TNM stage (p<0.001) and male gender (p=0.016). Unfavorable cumulative 5-year overall survival rates correlated significantly with positive osteopontin immunostaining (p<0.001), advanced T stage (p<0.001), positive N status (p<0.001) and advanced TNM stage (p<0.001). However, Cox regression analysis revealed that T stage and N status were independent prognostic factors for survival (both p<0.001) and osteopontin immunostaining was marginally significant for survival (p=0.056). The present study demonstrated that high expression level of osteopontin in either the plasma or the tumor of the patients with OSCC was associated with tumor progression, suggesting that osteopontin expression is an important prognostic factor for OSCC.

Osteopontin expression in squamous cell cancer of the esophagus

BACKGROUND

The purpose of this study was to better understand the role of osteopontin (OPN) in esophageal squamous cell carcinoma (ESCC) by comparing the OPN mRNA level in ESCC tumor tissue and matched normal tissue and by determining the prognostic significance of the gene expression.

METHODS

Initially, by an oligo-nucleotide microarray hybridization technique, OPN expressions were found to consistently elevate at least twofold in three ESCC tissues compared with their adjacent normal ones. Subsequently, the expression of OPN mRNA was detected by real-time QRT-PCR among the 58 fresh surgical ESCC specimens. The clinical information was obtained by chart review.

RESULTS

OPN mRNA expression was detectable in 58 of 58 (100%) tumor specimens and 57 of 58 (98.3%) nonmalignant esophageal specimens. OPN expression was higher in tumor tissue than in the matched normal tissue in 54 of 58 (93.1%) individual cases. The overall median mRNA expression level of OPN was approximately 8.8-fold higher in tumor tissues (4.1; range: 0.02-247) compared with matched normal esophageal tissues (0.5; range, 0.0-21.4; p < 0.001). Overexpression of OPN mRNA was significantly associated with clinical stage (p = 0.01). The more severe the clinical stage (from I-II, III, to IV) was the higher frequency of overexpression of OPN mRNA. No significant associations were found between overexpression of OPN mRNA and the patients' survival (p = 0.27).

DISCUSSION

Our findings suggest OPN is associated with esophageal tumorigenesis and progression, but not patients' survival.

Clinical significance of osteopontin expression in T1 and T2 tongue cancers

BACKGROUND

Osteopontin (OPN) is considered to be a tumor-related protein associated with tumor aggressiveness and metastasis.

METHODS

Immunohistochemistry was used to study the clinical significance of OPN expression in T1 and T2 tongue cancers.

RESULTS

Positive OPN expression significantly correlated with higher tumor classification (T) (p = .004), positive nodal classification (N) (p < .001), greater tumor thickness (p < .001), and presence of tumor necrosis (p = .016), respectively. The unfavorable cumulative 5-year disease-free survival rate significantly correlated with positive OPN expression (p < .001), T2 (p = .024), positive N (p < .001), greater tumor thickness (p = .023), and positive tumor necrosis (p = .003). However, taking CD105 into consideration, only CD105 expression was the independent prognostic factor for survival by Cox's regression analysis.

CONCLUSION

Overexpression of OPN in the tumors implicated a more aggressive tumor behavior and was an important factor for survival. In addition, there might be relationship between OPN and CD105 expressions in angiogenesis.

Protein alterations in ESCC and clinical implications: a review

Esophageal squamous cell carcinoma (ESCC) is the predominant histological subtype of esophageal cancer in Asia, characterized by high incidence and mortality rate. Although significant progress has been made in surgery and adjuvant chemoradiotherapy, the prognosis of the patients with this cancer still remains poor. Investigation into protein alterations that occurred in tumors can provide clues to discover new biomarkers for improving diagnosis and guiding targeted therapy. Hundreds of papers have appeared over the past several decades concerning protein alterations in ESCC. This review summarizes all the dysregulated proteins investigated in the disease from 187 published papers and analyzes their contributions to tumor development and progression. We document protein alterations associated with tumor metastasis and the transition from normal esophageal epithelia to dysplasia in order to reveal the most useful markers for prediction of clinical outcome, early detection, and identification of high-risk patients for targeted therapies. In particular, we discuss the largest and most rigorous studies on prognostic implications of proteins in ESCC, in which cyclin D1, p53, E-cadherin and VEGF appeared to have the strongest evidence as independent predictors of patient outcome.