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Eur J Cardiothorac Surg 2004;26:419-424
© 2004 Elsevier Science NL
a Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital and National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan, ROC
b Department of Pathology, Taipei-Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
c Department of Medical Research, China Medical College Hospital, and Institute of Medical Research, China Medical College, Taichung, Taiwan, ROC
Received 3 February 2004; received in revised form 15 March 2004; accepted 22 March 2004.
* Corresponding author. Tel.: +886-2-2875-7546; fax: +886-2-2873-1488
e-mail: lswang{at}vghtpe.gov.tw
Objectives: Tumor recurrence and metastasis are major causes of treatment failure in esophageal squamous cell carcinoma (ESCC). Recently, nm23, originally considered to be an anti-metastatic gene, has been reported to associate with various roles in different human cancers. We therefore investigated the clinical significance of nm23-H1 expression in ESCC. Methods: Pathological sections were immunohistochemically stained with monoclonal antibody that was specific to nm23-H1. Expression of positive nm23-H1 staining was further confirmed by Western blot and reverse transcription-polymerase chain reaction (RT-PCR). The relationship between nm23-H1 expression and clinicopathological variables was examined by statistical analysis. Except for 11 (7%) surgical morality, the remaining 145 patients entered the prognostic analysis. The cisplatin-based chemotherapy was established for the patients with tumor stages at or beyond IIb, or with tumor recurrence. Survival difference between groups was compared by log rank test. Results: Immunohistochemically, nm23-H1 expression was detected in 39.3% (57/145) of the pathological sections. It was positively correlated with tumor stage (P=0.002), evident lymphovascular invasion (P<0.001) and tumor recurrence (P=0.02). Survival of nm23-H1 positive group was statistically superior to nm23-H1 negative group (P<0.0001). By multivariate survival analysis, tumor stage, the number of lymph node metastasis and expression of nm23-H1 were the independent prognostic factors for ESCC patients. Conclusions: Our study demonstrated that nm23-H1 expression was associated with disease progression in ESCC. However, survival of nm23-H1 positive group was superior to nm23-H1 negative group. This paradoxical result could suppose that nm23-H1 expression might increase cisplatin chemosensitivity and hence improve survival. Screening for nm23-H1 expression in tumor cells may be a potential therapeutic strategy in ESCC patients.
Key Words: nm23 • Esophageal carcinoma • Chemosensitivity
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