[Histological and molecular prognostic factors in esophageal cancer]

The prognostic impact of new histological and molecular parameters was tested retrospectively in a series of 149 patients with esophageal squamous cell carcinoma (SCC) who underwent potentially curative resection therapy (no distant metastases, no residual tumor, no radio- or chemotherapy). This analysis was performed in order to identify patients with increased risk for tumor-related death in spite of being treated by standard therapy and thus being candidates that most likely profit from postoperative adjuvant therapy. Additionally, the prognostic value of various molecular markers was investigated in a group of 38 patients with locally advanced esophageal SCC that have been treated with combined therapy modalities (radiochemotherapy and optionally surgery). Among surgically treated carcinomas, the following morphological parameters proved to be prognostically significant in univariate survival analysis and multivariate survival analysis: pattern of invasion, inflammatory response and lymphatic-vessel invasion. In contrast, the tumor grading according to the criteria of WHO and tumor cell proliferation did not show significant prognostic impact. Concerning the prognostic influence of molecular parameters strong expression of the proliferation-regulating molecule p21WAF1 and weak expression of the apoptosis-regulating molecule Bcl-XL were predictors of poor survival in univariate and multivariate survival analysis. No prognostic impact could be shown in relation to the expression of the proliferation-regulating molecule p53 and the apoptosis regulating-molecules Bcl-2 and Bax. Among multimodally treated esophageal cancer patients, again strong expression of p21WAF1 as well as accumulation of p53 were predictors of poor survival, whereas expression of Bcl-2, Bax and Bcl-XL did not show any prognostic influence. In conclusion, morphological and molecular parameters may provide important prognostic information for esophageal cancer patients.