Using a microarray technique, we found decorin to be underexpressed, but osteopontin (OPN) to be overexpressed, in esophageal squamous cell carcinoma (ESCC). This study aims to examine whether plasma decorin and OPN plus personal substances use (tobacco, alcohol and areca) can serve as suitable clinical markers to predict the presence of ESCC. In total, 570 archived plasma specimens (275 patients and 295 controls) were collected from 2 medical centers in Taiwan between 2000 and 2008. Decorin and OPN protein levels were measured by ELISA. Means and standard deviation of plasma decorin were 5.6 6 3.6 ng/ml in case patients, which were significantly lower than those in controls (7.8 6 3.1, p < 0.0001). Plasma OPN levels in case patients were not significantly different from controls (p 5 0.33). When compared to subjects with the lowest quartile of plasma decorin, those with the highest quartile one had a significantly lower risk to have ESCC (Adjusted OR 5 0.03, p < 0.001). Receiver operator characteristic (ROC) analysis was performed for the combination of plasma decorin and 3 substances use (smoke, alcohol and areca) for the patients compared with the controls. The area under the curve was 88.6% and the optimal cut-point of ROC curve (any 3 factors) had 73.5% sensitivity and 90.2% specificity with~82% of corrected classification. Plasma decorin, but not OPN, is a potential clinical marker for the detection of ESCC. When plasma decorin plus the use of the 3 substances are combined, this factor cluster could be used to detect the presence of ESCC.Esophageal cancer is the 8th most common malignancy worldwide.1 In Taiwanese males, esophageal cancer, predominantly esophageal squamous cell carcinoma (ESCC), is the 6th leading cause of cancer deaths.2,3 Once diagnosed with ESCC, the prognosis is very poor with a 5-year survival rate below 10%. [4][5][6] Thus, identification of the novel markers with the use of a simple, easy and relatively noninvasive technique to measure them and apply the findings to clinical settings for detecting the presence of ESCC becomes crucial.Decorin is a small leucine-rich proteoglycan. Decorin has been shown to phosphorylate and degrade epidermal growth factor receptor, to activate mitogen-activated protein kinase, and to upregulate p21 WAF , the cell-cycle inhibitor, of tumor cells that leads to growth suppression. [7][8][9] Although many studies have found that the low expression of decorin is associated with advanced grades of malignancies such as myeloma, breast cancer and oral cancer, 9-11 few have examined the effect of its expression in esophageal cancer. Only 1 recent study has shown decorin expression decreases, but not significantly, in esophageal cancer patients.
12Osteopontin (OPN) is a secreted adhesive glycoprotein that may play a role in the process of carcinogenesis. [13][14][15][16] Several studies, including ours, have shown increased OPN mRNA or protein expression in the tumor tissues of ESCC,