Ann Thorac Surg 2012;93:1688-1689. doi:10.1016/j.athoracsur.2012.02.058
© 2012 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited Commentary
Kenneth A. Kesler, MD
Indiana University Department of Surgery, Cardiothoracic Division, Barnhill Drive EH #215, Indianapolis, IN 46202
(Email: kkesler{at}iupui.edu).
In a series of 407 patients with esophageal squamous cell carcinoma treated with operation alone, Dr Luo and coworkers [1] report significant staging and prognostic implications of a tumor biomarker Id-1 (inhibitor of differentiation 1). Id-1 is 1 of 4 Id proteins [1], the primary role of which is antagonizing cellular differentiation; it has been shown to play an important role in cell proliferation, tumor angiogenesis, and development of metastatic disease. High levels of tumor Id-1 have been reported, eg, in metastatic lung cancer tissue microarrays. Elevated levels of Id-1 have a negative impact on prognoses in other epithelial neoplasms such as cervical and breast cancer. In this current study, Id-1 was highly predictive of pathologic evidence of lymph node metastases in patients with esophageal squamous cell carcinoma. From a prognostic standpoint, high Id-1 levels stratified patients with poorly differentiated and advanced T stage tumors to poorer prognoses. In addition, Id-1 biomarker expression was independently predictive of a poor prognosis, even superseding pathologic evidence of lymph node metastasis in a multivariate risk model.
Id-1 now joins a list of other markers that have been reported to potentially have prognostic value in patients with esophageal squamous cell carcinoma, including stanniocalcin 2, FOXC2, VEGF, NBS1, and T-cell lymphoma invasion and metastasis (TIAM1) to name a few. To date however, none of these biomarkers, including Id-1, has been validated. As it has been well established that risk factors for esophageal squamous cell cancers are very heterogeneous across geographic regions, validation in esophageal cancer patient subsets will be needed. Future study to determine if this specific biomarker plays a primary or secondary role in the complex process of carcinogenesis will also be important.
The authors are to be congratulated on a large, well-conducted, and well-analyzed biomarker study. Although this current study adds to the growing evidence that Id-1 may play an important role in carcinogenesis, well-designed validation studies for Id-1 as well as other biomarkers are needed before applicability can be determined. Continued biomarker discovery and validation is important, having a wide range of implications from incorporation into future esophageal cancer staging systems to guiding neoadjuvant or adjuvant treatment strategies. More significantly, discovery of biomarkers critical to carcinogenesis will hopefully lead to the "holy grail" of effective targeted cancer therapy, which continues to be a dire need in esophageal cancer. Along these same lines, identification of biomarkers, which predict response to neoadjuvant or adjuvant treatment, would be of great value.
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- Luo KJ, Wen J, Xie X, et al. Prognostic relevance of Id-1 expression in patients with resectable esophageal squamous cell carcinoma Ann Thorac Surg 2012;93:1682-1689.[Abstract/Free Full Text]
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Prognostic Relevance of Id-1 Expression in Patients With Resectable Esophageal Squamous Cell Carcinoma
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