Cytotoxic T lymphocyte antigen-4 expression in esophageal carcinoma: Implications for prognosis

// Xiao-Fei Zhang 1, 2 , Ke Pan 1, 2 , De-Sheng Weng 1, 2 , Chang-Long Chen 1, 2 , Qi-Jing Wang 2 , Jing-Jing Zhao 1, 2 , Qiu-Zhong Pan 1, 2 , Qing Liu 2 , Shan-Shan Jiang 1, 2 , Yong-Qiang Li 2 , Hong-Xia Zhang 1, 2 , Jian-Chuan Xia 1, 2 1 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People’s Republic of China 2 Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, People’s Republic of China Correspondence to: Jian-Chuan Xia, e-mail: xiajch@mail.sysu.edu.cn Keywords: esophageal carcinoma, overall survival, cytotoxic T lymphocyte antigen-4 Received: November 23, 2015     Accepted: March 02, 2016     Published: March 30, 2016 ABSTRACT To examine the relationship between cytotoxic T lymphocyte antigen-4 (CTLA-4) expression and esophageal carcinoma prognosis, CTLA-4 expression was immunohistochemically detected in paraffin-embedded primary tumor specimens from 158 patients with esophageal cancer. CTLA-4 was detected in the cytoplasm and cell membranes of esophageal cancer cells and in interstitial lymphocytes. In univariate analyses (log-rank), higher interstitial CTLA-4 + lymphocyte density and higher tumor CTLA-4 expression were associated with shorter overall survival (OS). After controlling for age and clinical stage, multivariate analysis (Cox) found that tumor CTLA-4 expression was an independent predictor of shorter OS (HR 2.016, P = 0.004). These results indicate that CTLA-4 expression in the tumor environment (both lymphocytes and tumor cells) is associated with poorer prognosis. In addition, CTLA-4 profiles may be useful for predicting the benefits and toxicity of CTLA-4 blockade in patients with esophageal carcinoma.