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BackgroundP53 mutations are an adverse prognostic factor in esophageal cancer. P53 and KRas mutations are involved in chemo-radioresistance. Circulating anti-p53 or anti-KRas antibodies are associated with gene mutations. We studied whether anti-p53 or anti-KRas auto-antibodies were prognostic factors for response to chemoradiotherapy (CRT) or survival in esophageal carcinoma.MethodsSerum p53 and KRas antibodies (abs) were measured using an ELISA method in 97 consecutive patients treated at Saint Louis University Hospital between 1999 and 2002 with CRT for esophageal carcinoma (squamous cell carcinoma (SCCE) 57 patients, adenocarcinoma (ACE) 27 patients). Patient and tumor characteristics, response to treatment and the follow-up status of 84 patients were retrospectively collected. The association between antibodies and patient characteristics was studied. Univariate and multivariate survival analyses were conducted.ResultsTwenty-four patients (28%) had anti-p53 abs. Abs were found predominantly in SCCE (p = 0.003). Anti-p53 abs were associated with a shorter overall survival in the univariate analysis (HR 1.8 [1.03-2.9], p = 0.04). In the multivariate analysis, independent prognostic factors for overall and progression-free survival were an objective response to CRT, the CRT strategy (alone or combined with surgery [preoperative]) and anti-p53 abs. None of the long-term survivors had p53 abs. KRas abs were found in 19 patients (23%, no difference according to the histological type). There was no significant association between anti-KRas abs and survival neither in the univariate nor in the multivariate analysis. Neither anti-p53 nor anti-KRas abs were associated with response to CRT.ConclusionsAnti-p53 abs are an independent prognostic factor for esophageal cancer patients treated with CRT. Individualized therapeutic approaches should be evaluated in this population.

difference for the patient! PET will always be more practical in interpretation as compared with CT-a spot is a spot, and it has been interpreted as a positive node by us, irrespective of the standard uptake value. CT evaluation has many more uncertainties.Finally, we doubt that triple endoscopy, CT scanning, and physical exam are less straining and less costly for both the patients and the society. A large portion of distant metastases and synchronous second primaries are detected by PET, which cannot be detected by the mentioned tools. In fact, skeletal scintigraphy and abdominothoracic CT have to be added to the mentioned tools resulting in even higher costs. These findings by PET completely change the regimen necessary for the respective patients. However, our main goal pursued in our article was to demonstrate the possibility of reducing the rate of elective neck dissections in oral and oropharyngeal cancer patients with a combination of imaging techniques and sentinel node biopsy. The emphasis lies on the usage of sentinel node biopsy. If other groups are able to demonstrate this using CT and sentinel node biopsy, we will be content. The future, however, belongs to a combination of morphologic and functional diagnostics.