Clinical impact of preoperative serum p53 antibody titers in 1487 patients with surgically treated esophageal squamous cell carcinoma: a multi-institutional study.

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.

Улаан хоолойн хорт хавдрын эмчилгээний стратегийн орчин үеийн ололт / Шинэ санаа Шинэ нээлт

Recent advances in both diagnostic and therapeutic technologies have caused dramatic changes in treatment strategy for esophageal cancer patients. In this lecture, we will introduce the advances in multimodal treatment for esophageal cancer, based on our own experiences. 1. Neoadjuvant chemotherapy (NAC) with Docetaxel/Cisplatin/5-fluorouracil (DCF) for node-positive esophageal cancer. Recently, in Japan, an efficacy of NAC for resectable advanced squamous cell carcinoma of the esophagus has been reported. DCF is expected to be a powerful alternative to cisplatin/5-fluorouracil. Our experience on neoadjuvant or induction DCF will be demonstrated. 2. Efficacy and safety of salvage esophagectomy after dCRT. Salvage esophagectomy is an almost only method to cure the patients with local failure after dCRT, although high mortality and morbidity rates have been reported. We performed 40 cases of salvage esophagectomy during the last 7 years and no hospital mortality has been experienced. Benefit of salvage surgery and procedures to decrease surgical risk will be discussed. 3. Basic research for individualized treatment. If an individualized treatment strategy can be established based on some predictive markers, both improved survival and preserved quality of life will be realized. We will demonstrate the possibility of epigenetic analysis (e.g., LINE-1 methylation level) as biomarkers to predict patient prognosis.