Systematic review and meta-analysis of tumor biomarkers in predicting prognosis in esophageal cancer

Abstract

BackgroundEsophageal cancer (EC) is a frequently occurring cancer with poor prognosis despite combined therapeutic strategies. Many biomarkers have been proposed as predictors of adverse events. We sought to assess the prognostic value of biomarkers in predicting the overall survival of esophageal cancer and to help guide personalized cancer treatment to give patients the best chance at remission.MethodsWe conducted a systematic review and meta-analysis of the published literature to summarize evidence for the discriminatory ability of prognostic biomarkers for esophageal cancer. Relevant literature was identified using the PubMed database on April 11, 2012, and conformed to the REMARK criteria. The primary endpoint was overall survival and data were synthesized with hazard ratios (HRs).ResultsWe included 109 studies, exploring 13 different biomarkers, which were subjected to quantitative meta-analysis. Promising markers that emerged for the prediction of overall survival in esophageal squamous cell cancer included VEGF (18 eligible studies, n = 1476, HR = 1.85, 95% CI, 1.55-2.21), cyclin D1 (12 eligible studies, n = 1476, HR = 1.82, 95% CI, 1.50-2.20), Ki-67 (3 eligible studies, n = 308, HR = 1.11, 95% CI, 0.70-1.78) and squamous cell carcinoma antigen (5 eligible studies, n = 700, HR = 1.28, 95% CI, 0.97-1.69); prognostic markers for esophageal adenocarcinoma included COX-2 (2 eligible studies, n = 235, HR = 3.06, 95% CI, 2.01-4.65) and HER-2 (3 eligible studies, n = 291, HR = 2.15, 95% CI, 1.39-3.33); prognostic markers for uncategorized ECs included p21 (9 eligible studies, n = 858, HR = 1.27, 95% CI, 0.75-2.16), p53 (31 eligible studies, n = 2851, HR = 1.34, 95% CI, 1.21-1.48), CRP (8 eligible studies, n = 1382, HR = 2.65, 95% CI, 1.64-4.27) and hemoglobin (5 eligible studies, n = 544, HR = 0.91, 95% CI, 0.83-1.00).ConclusionsAlthough some modest bias cannot be excluded, this review supports the involvement of biomarkers to be associated with EC overall survival.

p53 is an independent prognostic factor in operable esophageal squamous cell carcinoma: a large-scale study with a long follow-up

“…This protein has been proven to play an important role in the development of EC [25] and represents an attractive target for the development of anti-cancer therapies [26]. Moreover, polymorphisms have been associated with the risk of ESCC [27].…”

Association Between Smoking and p53 Mutation in Oesophageal Squamous Cell Carcinoma: A Meta-analysis

“…Pharoah et al [46] reviewed 16 published studies and concluded that p53 gene mutation is an independent prognostic factor for breast cancer. A previous study supported the involvement of p53 mutation with ESCC overall survival [47]. Wang et al [48] reviewed 27 random controlled trials and showed that p53 was a poor prognosis biomarker for oesophageal cancer gene diagnosis.…”

Multimodal Treatment for Cancer of the Esophagus

“…Outcomes in esophageal cancer are often poor [16]. The best and most eicient surgical method in patients without evidence of spread to other parts of the body is the combination between esophagectomy and reconstruction surgery [7].…”