Assessment of the predictive value of clinical and histopathological factors as well as the immunoexpression of p53 and bcl-2 proteins in response topreoperative chemotherapy for esophageal squamous cell carcinoma

The aim of the study was to determine the predictive value of selected clin ical and histopathological factors as well as the immunohistochemical expre ssion of p53 and bcl-2 proteins in the prediction of the pathological respo nse to preoperative chemotherapy in esophageal squamous cell carcinoma. Thi rty-four patients with advanced squamous cell carcinoma of the thoracic eso phagus (T2-4 N0-1 M0), who underwent one cycle of cisplatin and 5-fluoroura cil therapy followed by subtotal esophagectomy, were studied. All clinical factors (tumor longitudinal diameter in a computed tomographic scan, invasi on depth, the presence of Lymph node metastasis and clinical tumor staging) were evaluated before the onset of the therapy, The histopathological feat ures (grade of differentiation, degree of keratinization, nuclear polymorph ism, mitotic index, pattern of cancer invasion and inflammatory response), and the expression of p53 and bcl-2 proteins were also estimated in prechem otherapy endoscopic biopsy specimens. Pathological response to chemotherapy was assessed in surgically resected specimens. Of 34 patients, two (5.9%) showed complete response (CR), six patients (17.6%) exhibited major histolo gical changes (partial response 1; PR1), 24 (70.6%) showed minor histologic al changes (partial response 2; PR2), and two patients (5.9%) exhibited no response to chemotherapy (stable disease; SD). There were no significant re lationships between the response to preoperative chemotherapy(CR + PR1 vs. PR2 + SD) and the majority of the clinical and all the histopathological fe atures. Deeper cancer invasion before chemotherapy was the only factor that tended to worsen the therapy effect (p < 0.01), The pathological response to treatment had no significant associations with the expression of p53 and bcl-2 proteins in esophageal squamous cell carcinoma. It should be noted, however, that both patients in CR were p53 and bcl-2 protein-negative.