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Open Access Research article

Overexpression of Cystatin SN positively affects survival of patients with surgically resected esophageal squamous cell carcinoma

You-Fang Chen12, Gang Ma13, Xun Cao13, Rong-Zhen Luo14, Li-Ru He15, Jie-Hua He14, Zhi-Liang Huang12, Mu-Sheng Zeng1 and Zhe-Sheng Wen12*

Author Affiliations

1 State Key Laboratory of Oncology in South China, Cancer Center, Sun Yet-Sen University, No.651, Dongfeng Road East, Guangzhou, China

2 Department of Thoracic Oncology, Cancer Center, Sun Yet-Sen University, No.651, Dongfeng Road East, Guangzhou, China

3 Department of Critical Care Medicine, Cancer Center, Sun Yet-Sen University, No.651, Dongfeng Road East, Guangzhou, China

4 Department of Pathology, Cancer Center, Sun Yet-Sen University, No.651, Dongfeng Road East, Guangzhou, China

5 Department of Radiation Oncology, Cancer Center, Sun Yet-Sen University, No.651, Dongfeng Road East, Guangzhou, China

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BMC Surgery 2013, 13:15  doi:10.1186/1471-2482-13-15

Published: 28 May 2013

Abstract

Background

Cystatin SN is a secreted protein and a cysteine proteinase inhibitor. It has been considered to be a tumor marker for gastrointestinal tract cancer in several functional researches. However, the clinicopathological and prognostic significance of Cystatin SN expression in esophageal squamous cell carcinoma (ESCC) has not been elucidated.

Methods

In our study, the expression of Cystatin SN was detected in 209 surgically resected ESCC tissues and 170 peritumoral normal esophageal mucosae by immunohistochemistry. The prognostic significance of Cystatin SN expression was analysed with Kaplan-Meier plots and the Cox proportional hazards regression models.

Results

The results showed that the immunostaining of Cystatin SN in ESCC tissues was less intense than that in the normal control tissue (P < 0.001). Compared with patients with low tumoral Cystatin SN expression, ESCC patients with tumors high-expression Cystatin SN exhibited increased disease-free survival (DFS) and overall survival (OS) (P < 0.001 and P < 0.001, respectively). Furthermore, the expression level of Cystatin SN could further stratify the ESCC patients by survival (DFS and OS) in the stage II subgroup (P < 0.001 and P < 0.001, respectively). Multivariate analyses showed that Cystatin SN expression, N status and differentiation were independent and significant predictors of survival.

Conclusions

We concluded that ESCC patients whose tumors express high levels of Cystatin SN have favourable survival compared with those patients with low Cystatin SN expression. Tumoral Cystatin SN expression may be an independent predictor of survival for patients with resectable ESCCs.

Keywords:
Esophageal squamous cell carcinoma; Cystatin SN; Immunohistochemistry; Prognosis