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Murakami K, Yoshida N, Taniyama Y, Takahashi K, Toyozumi T, Uno T, Kamei T, Baba H, Matsubara H. Maximum standardized uptake value change rate before and after neoadjuvant chemotherapy can predict early recurrence in patients with locally advanced esophageal cancer: a multi-institutional cohort study of 220 patients in Japan. Esophagus 2022; 19:205-213. [PMID: 34993673 DOI: 10.1007/s10388-021-00896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) followed by esophagectomy can improve the prognosis of locally advanced esophageal cancer (LAEC). However, LAEC reportedly recurred in 17-21% of patients within 6 months post surgery. Thus, current treatment strategies may be inadequate for LAECs with poor prognosis. Preoperative identification of patients with poor prognosis might aid in modification of treatment strategies. This study aimed to evaluate the usefulness of the maximum standardized uptake value change rate (ΔSUVmax) in predicting treatment effects on the primary lesion, prognosis, and LAEC recurrence. METHODS This study involved 220 esophageal cancer patients who underwent esophagectomy after NAC at three facilities in Japan. The optimal cut-off point for ΔSUVmax in predicting tumor regression grade (TRG) was calculated and used to assess the correlation between ΔSUVmax and postoperative survival. RESULTS The optimal cut-off point for ΔSUVmax was 0.5. The 5-year overall survival rate in patients with ΔSUVmax ≥ 0.5 was significantly higher than that in patients with ΔSUVmax < 0.5 (71.5% vs. 50.5%, P = 0.001). Multivariate analysis identified ΔSUVmax (hazards ratio, 0.496; P = 0.004) as an independent prognostic factor. Among 199 patients evaluated for recurrence, 24 (12.1%) showed recurrence within 6 months post surgery. Univariate analysis revealed ΔSUVmax as the only predictor for early recurrence (odds ratio, 0.222; P = 0.004). CONCLUSION ΔSUVmax before and after NAC is clinically useful as it could help predict TRG, survival outcome, and early recurrence within 6 months post esophagectomy and is easily obtainable in general clinical practice. We believe that it may also help determine suitable treatment strategies for LAEC.
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Affiliation(s)
- Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Taniyama
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kozue Takahashi
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Zhang Y, Gao J, Zheng A, Yang H, Li J, Wu S, Zhao J, Meng P, Zhou F. Definition and risk factors of early recurrence based on affecting prognosis of esophageal squamous cell carcinoma patients after radical resection. Transl Oncol 2021; 14:101066. [PMID: 33744728 PMCID: PMC7985560 DOI: 10.1016/j.tranon.2021.101066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 01/28/2023] Open
Abstract
21 months was defined as the optimal threshold of RFS for dividing patients into early and late recurrence according to the influence on OS by minimum P-value method. Primary tumor location, pathological T stage, positive lymph nodes, and TLNs were shown to be independently associated with early recurrence. For the late recurrent patients, there was a significant survival advantage after recurrence for concurrent chemoradiotherapy than sequential chemoradiotherapy and radiotherapy alone.
Early recurrence after surgery could affect cancerous patients’ prognosis, but the definition of early recurrence and its risk factors for esophageal squamous cell carcinoma (ESCC) patients are still unclear. This study analyzed the clinical data of 468 post-surgery recurrent ESCC patients retrospectively. A minimum p-value approach was used to evaluate the optimal cut-off value of recurrence free survival (RFS) to define early recurrence. Risk factors of early recurrence were developed based on a Cox model. The optimal cut-off value of RFS to distinguish early recurrence was 21 months (p <0.001). Independent risk factors for early recurrence included tumor locations (HR=0.562, p <0.001), pathological T stage (HR=1.829, p <0.001), tumor diameter (HR=1.344, p = 0.039), positive lymph nodes (HR=1.361, p <0.001), and total resected lymph nodes (HR=1.271, p = 044). For the late recurrent patients, there was a much more significant survival advantage for recurrence after concurrent chemoradiotherapy than that after sequential chemoradiotherapy and radiotherapy alone (p = 0.0066). In conclusion, this study defined 21 months of RFS as early recurrence and also identified its risk factors. Concurrent chemoradiotherapy was suggested as preferred post-relapse treatment for late recurrent ESCC patients.
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Affiliation(s)
- Yaowen Zhang
- Department of Radiation Oncology, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang 455000, China
| | - Junhui Gao
- Shanghai Zhangjiang Institute of Medical Innovation, Biotecan Pharmaceuticals co., ltd., Shanghai 201204, China.
| | - Anping Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang 455000, China.
| | - Haijun Yang
- Department of Radiation Oncology, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang 455000, China
| | - Jian Li
- Department of Radiation Oncology, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang 455000, China
| | - Shouxin Wu
- Shanghai Zhangjiang Institute of Medical Innovation, Biotecan Pharmaceuticals co., ltd., Shanghai 201204, China.
| | - Jiangman Zhao
- Shanghai Zhangjiang Institute of Medical Innovation, Biotecan Pharmaceuticals co., ltd., Shanghai 201204, China.
| | - Peng Meng
- Shanghai Zhangjiang Institute of Medical Innovation, Biotecan Pharmaceuticals co., ltd., Shanghai 201204, China.
| | - Fuyou Zhou
- Department of Radiation Oncology, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang 455000, China.
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Takashi S, Satoshi Y, Akihiko O, Naoya Y, Yusuke T, Kentaro M, Yu O, Yasuaki N, Koichi Y, Takashi F, Ryo O, Isamu H, Chikara K, Kosuke N, Yasuhiro T, Kazuhiko Y, Hideaki S. Clinical impact of preoperative serum p53 antibody titers in 1487 patients with surgically treated esophageal squamous cell carcinoma: a multi-institutional study. Esophagus 2021; 18:65-71. [PMID: 32715348 DOI: 10.1007/s10388-020-00761-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the clinicopathological significance of serum p53 antibodies (s-p53-Abs) in esophageal cancer have been evaluated previously, previous reports only analyzed around 100-200 patients. This study was a multi-institutional study promoted by the Japan Esophageal Society to evaluate the clinical significance of preoperative s-p53-Ab status and antibody titers in 1487 esophageal cancer patients without neoadjuvant therapy. METHODS A total of 1487 patients with esophageal squamous cell carcinoma surgically treated between 2008 and 2016 in 15 hospitals in Japan were enrolled. The cut-off value to classify the patients into s-p53-Ab positive and negative groups was 1.30 U/ml. A receiver operating characteristic curve was constructed to assess the s-p53-Abs cut-off levels to differentiate poor prognosis among the s-p53-Ab positive group. Univariate and multivariate analyses were used to evaluate the clinicopathological and prognostic significance of s-p53-Ab status and titers. RESULTS Although s-p53-Ab status was significantly associated with tumor depth (P = 0.002), nodal status (P = 0.027), and pathological stage (P = 0.002). The s-p53-Ab positive status was not significantly associated with poor overall survival (P = 0.699). Using 9.82 U/ml as a cut-off, the high s-p53-Ab titer group showed a significantly worse overall survival than the low s-p53-Ab titer group (P = 0.038). However, the difference was not significant in the multivariate analysis. CONCLUSION The presence of s-p53-Abs was associated with tumor progression. Although high s-p53-Ab titers more than 9.82 U/ml, might be associated with poor prognosis for patients with esophageal squamous cell carcinoma, it was not an independent risk factor.
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Affiliation(s)
- Suzuki Takashi
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Yajima Satoshi
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Okamura Akihiko
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Yoshida Naoya
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Taniyama Yusuke
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Murakami Kentaro
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Ohkura Yu
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Nakajima Yasuaki
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Yagi Koichi
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Fukuda Takashi
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Ogawa Ryo
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Hoshino Isamu
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Kunisaki Chikara
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Narumiya Kosuke
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Tsubosa Yasuhiro
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Yamada Kazuhiko
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan
| | - Shimada Hideaki
- Japan Esophageal Society Promotion Research: p53 Antibody Multicenter Research Group, Tokyo, Japan.
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Suzuki T, Yajima S, Ishioka N, Nanami T, Oshima Y, Washizawa N, Funahashi K, Otsuka S, Nemoto T, Shimada H. Prognostic significance of high serum p53 antibody titers in patients with esophageal squamous cell carcinoma. Esophagus 2018; 15:294-300. [PMID: 29959634 DOI: 10.1007/s10388-018-0629-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/20/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The p53 protein overexpression that usually results from genetic alterations reportedly induces serum antibodies against p53. However, little information is available about the prognostic significance of perioperative serum p53 antibody (s-p53-Abs) titers in patients with esophageal squamous cell carcinoma. METHODS In this study, we retrospectively evaluated the clinical significance of perioperative s-p53-Abs in 135 patients with esophageal squamous cell carcinoma. Of these, 58 patients received neoadjuvant chemotherapy comprising 5-FU and CDDP. While the cutoff level at 1.3 U/ml indicated seropositive patients, level of 13.4 U/ml was used to identify high-titer patients. We monitored serum titers seropositive patients after surgery and evaluated the prognostic significance by the univariate and multivariate analyses. RESULTS In this study, 29 patients (21.5%) were positive for s-p53-Abs before treatment. The frequency of both seropositive patients and high-titer patients (> 13.4 U/ml) was not significantly associated with tumor progression. While seropositive patients did not demonstrate significant poor overall survival, high-titer patients demonstrated significant poor overall survival based on the multivariate analysis (P < 0.001). Moreover, the s-p53-Abs titer did not correlate with the response to neoadjuvant chemotherapy. Among seropositive patients, the negative conversion of s-p53-Abs more likely led to be long-term survival. CONCLUSIONS This study determined that the high-titer of s-p53-Abs was an independent risk factor to reduce the overall survival of patients with esophageal cancer patients. The negative conversion of s-p53-Abs could be a good indicator of favorable prognosis.
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Affiliation(s)
- Takashi Suzuki
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Satoshi Yajima
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Nobuki Ishioka
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Toho University, Tokyo, Japan
| | - Tatsuki Nanami
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Yoko Oshima
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Naohiro Washizawa
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Kimihiko Funahashi
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Seiko Otsuka
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan
| | - Tetsuo Nemoto
- Department of Pathology, School of Medicine, Toho University, Tokyo, Japan
| | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 142-8541, Japan.
- Department of Clinical Oncology, Graduate School of Medicine, Toho University, Tokyo, Japan.
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5
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Hiyoshi Y, Yoshida N, Watanabe M, Kurashige J, Baba Y, Sakamoto Y, Baba H. The Presence of Serum p53 Antibody Predicts the Pathological Tumor Response to Neoadjuvant Chemotherapy with Docetaxel, Cisplatin and Fluorouracil (DCF) in Esophageal Squamous Cell Carcinoma. World J Surg 2017; 41:480-486. [PMID: 27637603 DOI: 10.1007/s00268-016-3649-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Docetaxel, cisplatin and fluorouracil (DCF) is a candidate neoadjuvant chemotherapy (NAC) regimen for esophageal squamous cell carcinoma (ESCC). Although the efficacy and safety of DCF have been reported, the markers that predict the patient's response are still unknown. The aim of this study was to identify the predictive markers for a response to NAC with DCF in patients with ESCC. METHODS A total of 79 patients who received preoperative DCF followed by esophagectomy between August 2008 and December 2014 were enrolled in this study. All of the patients completed 2 preoperative courses of DCF. The clinical and pathological responses to DCF were investigated, and the associations between the pathological response, the clinicopathological factors and the prognosis were retrospectively analyzed. RESULTS Among the 79 patients, the pathological response to DCF (evaluated according to the Japanese Classification of Esophageal Cancer) was grade 3 (complete pathological response) in 7 patients (8.9 %), grade 2 in 13 patients (16.5 %), grade 1b in 8 patients (10.1 %) and grade 1a in 51 patients (64.6 %). A good pathological response (grade 2-3) was significantly associated with both favorable disease-free survival (P = 0.0051) and favorable cancer-specific survival (P = 0.0366). A multivariate analysis revealed that a good clinical response (HR 13.743, 95 % CI 2.455-76.917) and the presence of serum p53 antibody before treatment (HR 3.987, 95 % CI 1.103-14.416) were independent predictors of good pathological response. CONCLUSIONS The presence of serum p53 antibody can be used as a novel, noninvasive predictor of the pathological tumor response to NAC with DCF in ESCC patients.
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Affiliation(s)
- Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masayuki Watanabe
- Esophageal Surgery, Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of JFCR (Japanese Foundation for Cancer Research), Koto, Japan
| | - Junji Kurashige
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Hontani K, Tsuchikawa T, Hiwasa T, Nakamura T, Ueno T, Kushibiki T, Takahashi M, Inoko K, Takano H, Takeuchi S, Dosaka-Akita H, Kuwatani M, Sakamoto N, Hatanaka Y, Mitsuhashi T, Shimada H, Shichinohe T, Hirano S. Identification of novel serum autoantibodies against EID3 in non-functional pancreatic neuroendocrine tumors. Oncotarget 2017; 8:106206-106221. [PMID: 29290942 PMCID: PMC5739727 DOI: 10.18632/oncotarget.22175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/14/2017] [Indexed: 12/16/2022] Open
Abstract
Pancreatic neuroendocrine tumors (pNETs) are relatively rare heterogenous tumors, comprising only 1–2% of all pancreatic neoplasms. The majority of pNETs are non-functional tumors (NF-pNETs) that do not produce hormones, and as such, do not cause any hormone-related symptoms. As a result, these tumors are often diagnosed at an advanced stage because patients do not present with specific symptoms. Although tumor markers are used to help diagnosis and predict some types of cancers, chromogranin A, a widely used tumor marker of pNETs, has significant limitations. To identify novel NF-pNET-associated antigens, we performed serological identification of antigens by recombinant cDNA expression cloning (SEREX) and identified five tumor antigens (phosphatase and tensin homolog, EP300-interacting inhibitor of differentiation 3 [EID3], EH domain-containing protein 1, galactoside-binding soluble 9, and BRCA1-associated protein). Further analysis using the AlphaLISA® immunoassay to compare serum antibody levels revealed that antibody levels against the EID3 antigen was significantly higher in the patient group than in the healthy donor group (n = 25, both groups). In addition, higher serum anti-EID3 antibody levels in NF-pNET patients correlated with shorter disease-free survival. The AUC calculated by ROC analysis was 0.784 with moderate diagnostic accuracy. In conclusion, serum anti-EID3 antibody levels may be useful as a tumor marker for prediction of tumor recurrence in NF-pNETs.
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Affiliation(s)
- Koji Hontani
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Chiba University, Chuo Ku, Chiba 260-8670, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Takashi Ueno
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Toshihiro Kushibiki
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Mizuna Takahashi
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Kazuho Inoko
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Satoshi Takeuchi
- Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Yutaka Hatanaka
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Tomoko Mitsuhashi
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, Ota-ku, Tokyo 143-8541, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Yamashita H, Takenaka R, Omori M, Imae T, Okuma K, Ohtomo K, Nakagawa K. Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study. Radiat Oncol 2015; 10:171. [PMID: 26269033 PMCID: PMC4554303 DOI: 10.1186/s13014-015-0482-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/07/2015] [Indexed: 12/14/2022] Open
Abstract
Background This retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy. Methods We assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014. Between 2000 and 2011, ENI was used for all cases excluding high age cases. After Feb 2011, a prospective study about IFRT was started, and therefore IFRT was used since then for all cases. Concurrent chemotherapy regimen was nedaplatin (80 mg/m2 at D1 and D29) and 5-fluorouracil (800 mg/m2 at D1-4 and D29-32). Results Of the 239 consecutive patients assessed (120 ENI vs. 119 IFRT), 59 patients (24.7 %) had stage IV disease and all patients received at least one cycle of chemotherapy. The median follow-up time for survivors was 34.0 months. There were differences in 3-year local control (44.8 % vs. 55.5 %, p = 0.039), distant control (53.8 % vs. 69.9 %, p = 0.021) and overall survival (34.8 % vs. 51.6 %, p = 0.087) rates between ENI vs. IFRT, respectively. Patients treated with IFRT (8 %) demonstrated a significantly lower risk (p = 0.047) of high grade late toxicities than with ENI (16 %). IFRT did not increase the risk of initially uninvolved or isolated nodal failures (27.5 % in ENI and 13.4 % in IFRT). Conclusions Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryousuke Takenaka
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mami Omori
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kuni Ohtomo
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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8
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Yamashita H, Omori M, Takenaka R, Okuma K, Kobayashi R, Ohtomo K, Nakagawa K. Involved-field irradiation concurrently combined with nedaplatin/5-fluorouracil for inoperable esophageal cancer on basis of (18)FDG-PET scans: a phase II study. Radiother Oncol 2014; 113:182-7. [PMID: 25466372 DOI: 10.1016/j.radonc.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/23/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE A prospective study was performed on chemoradiotherapy (CRT) for esophageal cancer using involved-field radiation therapy (IFRT) based on 18-fluorodeoxyglucose positron-emission tomography. The goal of this phase II study was to evaluate the efficacy of the IFRT procedure in newly diagnosed esophageal cancer. PATIENTS AND METHODS Eligible patients were adults with newly diagnosed untreated, inoperable esophageal cancer in stages I-IV with lymph node metastases. Patients received nedaplatin 80mg/m(2) per day on day 1, 5-fluorouracil 800mg/m(2) on days 1-4 intravenously repeated every 28days for 2-4 cycles, and combined IFRT. Elective nodal irradiation was not performed. Irradiation was applied only to the primary tumor and positive lymph nodes. RESULTS From September 2009 to July 2012, of the 63 patients enrolled, 58 were evaluable for response. The primary end point of isolated out-of-field loco-regional nodal recurrence was seen in only two patients. The expectant rate was assumed to be less than 5%. The threshold value was set as 10% to calculate the number of registrations. Progression-free and overall survival rates at 36months were 47.7% and 51.1%, respectively. The median progression-free survival was 34.6months, and overall survival was 38.4months. Salvage surgery was tried for 11 patients (17.5%) due to residual or recurrent disease. CONCLUSION The primary end point of the trial was demonstrated, indicating the efficacy of IFRT in the treatment of inoperable esophageal cancer mostly of squamous cell carcinoma.
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Affiliation(s)
| | - Mami Omori
- Department of Radiology, University of Tokyo Hospital, Japan
| | | | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, Japan
| | - Reiko Kobayashi
- Department of Radiology, University of Tokyo Hospital, Japan
| | - Kuni Ohtomo
- Department of Radiology, University of Tokyo Hospital, Japan
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Shimada H, Nagata M, Nabeya Y, Yajima S, Oshima Y, Itami M. Paradoxical changing of serum p53 antibody titers during chemotherapy for a stage IV esophageal squamous cell carcinoma. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-014-0153-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Davies AR, Pillai A, Sinha P, Sandhu H, Adeniran A, Mattsson F, Choudhury A, Forshaw MJ, Gossage JA, Lagergren J, Allum WH, Mason RC. Factors associated with early recurrence and death after esophagectomy for cancer. J Surg Oncol 2013; 109:459-64. [DOI: 10.1002/jso.23511] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/06/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew R. Davies
- Department of Surgery; St Thomas' Hospital; London United Kingdom
- Department of Surgery; Royal Marsden Hospital; London United Kingdom
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
- Division of Cancer Studies; King's College London; London United Kingdom
| | - Andrew Pillai
- Department of Surgery; St Thomas' Hospital; London United Kingdom
| | - Pranab Sinha
- Department of Surgery; St Thomas' Hospital; London United Kingdom
| | | | - Amina Adeniran
- Department of Surgery; St Thomas' Hospital; London United Kingdom
| | - Fredrik Mattsson
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Asif Choudhury
- Department of Surgery; Royal Marsden Hospital; London United Kingdom
| | | | - James A. Gossage
- Department of Surgery; St Thomas' Hospital; London United Kingdom
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Jesper Lagergren
- Department of Surgery; St Thomas' Hospital; London United Kingdom
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
- Division of Cancer Studies; King's College London; London United Kingdom
| | - William H. Allum
- Department of Surgery; Royal Marsden Hospital; London United Kingdom
| | - Robert C. Mason
- Department of Surgery; St Thomas' Hospital; London United Kingdom
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
- Division of Cancer Studies; King's College London; London United Kingdom
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11
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Long-term monitoring of serum p53 antibody after neoadjuvant chemotherapy and surgery for esophageal adenocarcinoma: report of a case. Surg Today 2013; 44:1957-61. [PMID: 24241479 DOI: 10.1007/s00595-013-0787-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/13/2013] [Indexed: 02/07/2023]
Abstract
We monitored serum p53 antibody (s-p53-Ab) titers in a 76-year-old man with esophageal adenocarcinoma, clinical stage III (T2N2M0), for over 4 years, including during the perioperative period and throughout follow-up after surgery. Screening tests for CA19-9 (205 IU/ml) and s-p53-Abs (381 U/ml) were positive before treatment. After neoadjuvant chemotherapy with 5-FU and cisplatin, CA19-9 decreased to the normal range, but the s-p53-Ab titer remained positive (224 U/ml). Pathological findings of surgically resected specimens showed stage T1b disease and no lymph node metastases. After surgery, s-p53-Ab titers consistently decreased, with no disease recurrence. Although the s-p53-Ab titer remained positive even after 4 years, it decreased to 8.66, 3.59, 2.38, and 1.92 U/ml, 1, 2, 3, and 4 years after surgery, respectively. Thus, monitoring perioperative changes in s-p53-Ab titers proved useful for detecting the presence of residual cancer cells in a patient with superficial esophageal adenocarcinoma.
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13
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Blanchard P, Quero L, Pacault V, Schlageter MH, Baruch-Hennequin V, Hennequin C. Prognostic significance of anti-p53 and anti-KRas circulating antibodies in esophageal cancer patients treated with chemoradiotherapy. BMC Cancer 2012; 12:119. [PMID: 22448886 PMCID: PMC3338390 DOI: 10.1186/1471-2407-12-119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 03/26/2012] [Indexed: 12/20/2022] Open
Abstract
Background P53 mutations are an adverse prognostic factor in esophageal cancer. P53 and KRas mutations are involved in chemo-radioresistance. Circulating anti-p53 or anti-KRas antibodies are associated with gene mutations. We studied whether anti-p53 or anti-KRas auto-antibodies were prognostic factors for response to chemoradiotherapy (CRT) or survival in esophageal carcinoma. Methods Serum p53 and KRas antibodies (abs) were measured using an ELISA method in 97 consecutive patients treated at Saint Louis University Hospital between 1999 and 2002 with CRT for esophageal carcinoma (squamous cell carcinoma (SCCE) 57 patients, adenocarcinoma (ACE) 27 patients). Patient and tumor characteristics, response to treatment and the follow-up status of 84 patients were retrospectively collected. The association between antibodies and patient characteristics was studied. Univariate and multivariate survival analyses were conducted. Results Twenty-four patients (28%) had anti-p53 abs. Abs were found predominantly in SCCE (p = 0.003). Anti-p53 abs were associated with a shorter overall survival in the univariate analysis (HR 1.8 [1.03-2.9], p = 0.04). In the multivariate analysis, independent prognostic factors for overall and progression-free survival were an objective response to CRT, the CRT strategy (alone or combined with surgery [preoperative]) and anti-p53 abs. None of the long-term survivors had p53 abs. KRas abs were found in 19 patients (23%, no difference according to the histological type). There was no significant association between anti-KRas abs and survival neither in the univariate nor in the multivariate analysis. Neither anti-p53 nor anti-KRas abs were associated with response to CRT. Conclusions Anti-p53 abs are an independent prognostic factor for esophageal cancer patients treated with CRT. Individualized therapeutic approaches should be evaluated in this population.
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Affiliation(s)
- Pierre Blanchard
- Radiation Oncology Department, Hôpital Saint Louis, AP-HP, Paris, France
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Dong J, Zeng BH, Xu LH, Wang JY, Li MZ, Zeng MS, Liu WL. Anti-CDC25B autoantibody predicts poor prognosis in patients with advanced esophageal squamous cell carcinoma. J Transl Med 2010; 8:81. [PMID: 20813067 PMCID: PMC2941748 DOI: 10.1186/1479-5876-8-81] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 09/03/2010] [Indexed: 12/29/2022] Open
Abstract
Background The oncogene CDC25B phosphatase plays an important role in cancer cell growth. We have recently reported that patients with esophageal squamous cell carcinoma (ESCC) have significantly higher serum levels of CDC25B autoantibodies (CDC25B-Abs) than both healthy individuals and patients with other types of cancer; however, the potential diagnostic or prognostic significance of CDC25B-Abs is not clear. The aim of this study is to evaluate the clinical significance of serum CDC25B-Abs in patients with ESCC. Methods CDC25B autoantibodies were measured in sera from both 134 patients with primary ESCC and 134 healthy controls using a reverse capture enzyme-linked immunosorbent assay (ELISA) in which anti-CDC25B antibodies bound CDC25B antigen purified from Eca-109 ESCC tumor cells. The clinicopathologic significance of CDC25B serum autoantibodies was compared to that of the tumor markers carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment antigen 21-1(CYFRA21-1). Results Higher levels of CDC25B autoantibodies were present in sera from patients with ESCC (A450 = 0.917, SD = 0.473) than in sera from healthy control subjects (A450 = 0.378, SD = 0.262, P < 0.001). The area under the receiver operating characteristic (ROC) curve for CDC25B-Abs was 0.870 (95% CI: 0.835-0.920). The sensitivity and specificity of CDC25B-Abs for detection of ESCC were 56.7% and 91.0%, respectively, when CDC25-Abs-positive samples were defined as those with an A450 greater than the cut-off value of 0.725. Relatively few patients tested positive for the tumor markers CEA, SCC-Ag and CYFRA21-1 (13.4%, 17.2%, and 32.1%, respectively). A significantly higher number of patients with ESCC tested positive for a combination of CEA, SCC, CYFRA21-1 and CDC25B-Abs (64.2%) than for a combination of CEA, SCC-Ag and CYFRA21-1 (41.0%, P < 0.001). The concentration of CDC25B autoantibodies in serum was significantly correlated with tumor stage (P < 0.001). Although examination of the total patient pool showed no obvious relationship between CDC25B autoantibodies and overall survival, in the subgroup of patients with stage III-IV tumors, the cumulative five-year survival rate of CDC25B-seropositive patients was 6.7%, while that of CDC25B-seronegative patients was 43.4% (P = 0.001, log-rank). In the N1 subgroup, the cumulative five-year survival rate of CDC25B-seropositive patients was 13.6%, while that of CDC25B-seronegative patients was 54.5% (P = 0.040, log-rank). Conclusions Detection of serum CDC25B-Abs is superior to detection of the tumor markers CEA, SCC-Ag and CYFRA21-1 for diagnosis of ESCC, and CDC25B-Abs are a potential prognostic serological marker for advanced ESCC.
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Affiliation(s)
- Jun Dong
- The Second Affiliated Hospital of Guangzhou Medical University, Gyangzhou, China
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Shimada H, Kagaya A, Shiratori T, Nomura F, Takiguchi M, Matsubara H, Hiwasa T. Detection of anti-CUEC-23 antibodies in serum of patients with esophageal squamous cell carcinoma: a possible new serum marker for esophageal cancer. J Gastroenterol 2009; 44:691-6. [PMID: 19407926 DOI: 10.1007/s00535-009-0060-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 03/16/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Serological identification of antigens by recombinant cDNA expression cloning (SEREX) is an established method for detecting new tumor-specific antigens. Antibodies to SEREX antigens may be useful for the detection of esophageal squamous cell carcinoma (SCC). METHODS A phage cDNA library of a human esophageal SCC cell line was screened using sera of patients with esophageal SCC. The presence and levels of serum antibodies to SEREX antigens were established by Western blotting and enzyme-linked immunosorbent assay (ELISA) using purified recombinant antigen proteins, respectively. RESULTS The newly identified esophageal SCC antigen is encoded by a novel gene located on chromosome 1, here designated CUEC-23. Serum CUEC-23-antibodies (s-CUEC-23-Abs) were detected in 14 of 54 patients with esophageal SCC (26%) by Western blot analysis. Esophageal SCCs were positive for s-CUEC-23-Abs together with CEA, SCC-Ag or CYFRA21-1 in 44, 41 and 52% of cases, respectively. There was no detectable association between the presence of s-CUEC-23-Abs and clinicopathological variables. ELISA showed that the levels of s-CUEC-23-Abs were significantly higher in patients with esophageal SCC than in healthy volunteers (17% in the former using the mean+3 SD of s-CUEC-23-Abs in healthy controls as the cutoff). CONCLUSION A new tumor antigen, CUEC-23, was identified by SEREX screening. s-CUEC-23-Abs might be a useful serum marker to detect esophageal SCC.
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Affiliation(s)
- Hideaki Shimada
- Department of Gastroenterological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuou-ku, Chiba, 260-8717, Japan.
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Wang H, Zhong L, Wang JF, Zhang XG. Research and application of tumor markers in esophageal squamous cell carcinoma. Shijie Huaren Xiaohua Zazhi 2009; 17:1842-1848. [DOI: 10.11569/wcjd.v17.i18.1842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC), the main type of esophageal cancer, is one of the most common gastrointestinal malignant cancers. Tumor markers detection are easy, economical, fast and non-invasive. Some tumor markers can be expressed before morphological changes occurred in tissues and organs; therefore, they can be used for the diagnosis of disease in the asymptomatic stage, thus making the research into tumor marker discovery even more meaningful. This paper summarizes several known tumor makers' expression detected in ESCC in recent years, and illustrates them from the aspects of genes, proteins, autoimmune antibodies, antigens and prognostic factors.
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Perioperative changes of serum p53 antibody titer is a predictor for survival in patients with esophageal squamous cell carcinoma. World J Surg 2009; 33:272-7. [PMID: 19052812 DOI: 10.1007/s00268-008-9821-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the presence of serum p53 antibody (s-p53-Abs) before treatment has been shown to correlate with poor prognosis and lymph node metastasis in esophageal cancer, there has been little information about postoperative s-p53-Abs titer and perioperative changes of s-p53-Abs titers in patients with esophageal carcinoma. METHODS A highly specific enzyme-linked immunosorbent assay was used to analyze s-p53-Abs in 110 patients with esophageal squamous cell carcinoma before and 1 month after surgery. The cutoff level of 1.3 U/ml was used to indicate seropositive patients. Impact of postoperative s-p53-Abs titer and perioperative changes of s-p53-Abs on survival was evaluated. RESULTS Forty (36%) of 110 patients were positive for s-p53-Abs before surgery and 35 patients (32%) were positive after surgery. s-p53-Abs titer generally decreased after surgery. Among sero-positive patients, the patients who remained sero-positive after surgery (n = 28) had a worse prognosis than patients who showed sero-conversion (P = 0.02). Among sero-positive patients, the nondecreased titer group showed significantly unfavorable survival (P < 0.01). Multivariate analysis revealed that postoperative s-p53-Abs was an independent risk factor for worse overall survival (adjusted hazard ratio = 3.05; 95% confidence interval = 1.11-8.33; P = 0.03). CONCLUSIONS Perioperative monitoring of s-p53-Abs titers was useful to identify patients with esophageal cancer with a high risk for tumor recurrence and a poor prognosis. Continuous sero-positive patients and/or nondecreased titer group, even after surgery, showed significantly unfavorable survival.
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