Predicting factors of oesophageal cancer (an IHC study)

Purpose: Analysis of predicting factors related to proliferation, vascularization and cellular apoptosis of oesophageal cancer.

Material and method: The records of 56 patients with oesophageal cancer undergoing radio-chemotherapy according to the Neuheim protocol followed by surgical resection at were evaluated. Hystiological analysis of praeoperative biopsy was followed by immunohystochemical workup by VEGF (vascular epithelial growth factor), Ki-67 Ag, CD-34 and anti-bcl-e antibodies. The biologic response to neoadjuvant therapy was evaluated. Three patient groups were established: responder group with full remission of the disease, a group of partial responders with down-staging, and a group of non-responders including those with progression of disease.

Results: The male/female distribution was 48 to 8, with a median age of 62 years. Out of 42 planocellular cancer and 14 adenocarcinomas we found 14 (25%) responders, 19 (34%) partial responders and 23 (41%) non-responders. The proliferation index (PI) was significantly higher than 40% in the group of responders, in which the VEGF-index showed significant negative correlation with PI. The MIB-1/VEGF ratio was higher than 6:1 (p<0.05) in this group. CD-34 index correlated proportionally to VEGF index, but bcl-2 showed no significant difference in any group, though figured higher values in adenocarcinomas. The prognosis of survival was favorable in the responder group (60% of patients survived 48 months at the time of this study. Survival was significantly higher in this group, if MIB-1 >40%

Summary: 25% of patients undergoing neoadjuvant therapy becomes responder, with a MIB-1 index higher than 40% and a PI: VEGF ratio higher than 6:1. These factors prove to be valuable tools in determining prognosis with further prospective.