Ralationship Between Survivin, Caspase-3 And DFF45 Expression With The Prognosis Of Radiotherapy In Esophageal Carcinoma

Objective: To investigate relationship between expression of Survivin, Caspase-3, DFF45 and radiotherapy result in esophageal carcinoma.Methods: From January 2002 to January 2003, 28 specimens of esophageal squamous cell carcinoma(ESCC) were collected. Each patient received definitive radiotherapy. Among them, male 17, female 11, median age 65(50~74y), local lesion length less than 5.0㎝ in 7 cases, 5.1~7.0㎝ in 10 cases, 7.1~10.0㎝ in 9 cases, more than 10.0㎝in 2 cases. The cases of stageⅠ,Ⅱ,Ⅲ and Ⅳ were 1, 15, 9 and 3 respectively according to the criteria of tumor status in esophageal carcinoma. 14 patients accepted conventional radiotherapy (CRT), 2Gy per day, 5 fractions per week, radiotherapy was given with 6MV-X ray, and other 14 patients accepted later hyperfractionated radiotherapy (LHART), single doses was 1.5Gy, 2 fractions per day, interval 6 hours, 5 fractions per week, total doses of 54~68Gy, median doses of 60 Gy. Survivin, Caspase-3 and DFF45 protein was measured in 28 ESCC specimens with immunohistochemistry.Results: (1) The evaluation in short result after radiotherapy of esophageal carcinoma: CR, 21.43% (6/28), PR, 79.57%(22/28), CR+PR , 100%. The 1-year survival rate and median were 46.43% and 13 months respectively. The expression of Survivin, Caspase-3 and DFF45 did not significantly effect on the short result of esophageal carcinoma. (2) The effect of Survivin, Caspase-3 and DFF45 expression for prognosis of ESCC: the positive rates of Survivin, Caspase-3 and DFF45 expression were 28.57%,53.57% and 42.86% respectively. Single parameter asalysis showed that patients who had negative expression of Survivin , DFF45 and positive expression of Caspase –3 had a longer survival (P=0.024,0.031,0.023). (3) The relationship of Survivin, Caspase-3 and DFF45 expression: there was positive correlation between Survivin and DFF45 expression (P=0.002), but was not significantly correlation with Caspase –3 expression. (4) The relationship between clinical stage and prognosis of ESCC: the patients who had T1-2 tumors, stageⅠ~Ⅱhad longer survival compared with those had T3-4 and stage Ⅲ~Ⅳafter RT (P=0.001,0.013). The survival time was not significantly difference between N0 and N1. (5) The effect of Survivin, Caspase-3 and DFF45 expression plus clinical stage of ESCC for prognosis: the patiants who had Survivin negative expression and Caspase –3 positive expression plus earlier stage had longer survival time. The expression of DFF45 plus clinical stage did not increase the prognosis efficiency. (6) Multivariate analysis showed that Survivin expression, tumor stage and N stage were probably independent prognostic factors of ESCC. The patients who had Survivin positive expression and advanced clinical stage had shorter survival (P=0.035,0.018,0.044).Conclusion: Survivin positive expression, advanced advanced tumor stage and N stage had a poor prognosis after RT. Survivin expression may be as a biology index of evaluating prognosis.