© 2007 The Authors 214 Journal compilation © 2007 The International Society for Diseases of the Esophagus Diseases of the Esophagus (2008) 21, 214–219 DOI: 10.1111/j.1442-2050.2007.00754.x Blackwell Publishing Asia Original article Prognostic role of immunosuppressive acidic protein in patients with esophageal cancer M. Kogure, S. Kashimura, S. Matsuyama, S. Ohtani, Z. Saze, Y. Odashima, T. Saitoh, N. Soeta, F. Osuka, Y. Hoshino, T. Saito, S. Terashima, M. Terashima, M. Gotoh Department of Surgery 1, Fukushima Medical University, Fukushima, Japan SUMMARY. Immunosuppressive acidic protein (IAP) suppresses several immune responses in vivo and in vitro, and high preoperative IAP levels could predict the impairment of the host’s immunity. In this study prognostic significance of preoperative IAP levels was investigated in 68 esophageal cancer patients with curative resection and eight with non-curative resection. The curative group had significantly lower levels than the non-curative group (432 ± 183 μg/mL vs. 739 ± 235 μg/mL, P < 0.0001). The IAP levels were associated with T-status (P < 0.0001), lymphatic invasion (P < 0.05), and p-stages (P < 0.0001). When 5-year survival rate of patients with curative resection was compared by setting various cutoff values of IAP between high and low IAP groups, several cutoff points (400–580 μg/mL) were revealed to be significantly associated with survival. Set- ting cutoff value of IAP to 560 μg/mL resulted in a most significant difference of 5-year survival rate of patients between the high and low IAP groups (13.9% and 61.5%, P < 0.0001). These data indicate that pre- operative IAP level is a useful parameter to predict the prognosis of esophageal cancer patients after curative resection. KEY WORDS : immunosuppressive acidic protein, esophageal cancer, prognosis. INTRODUCTION Immunosuppressive acidic protein (IAP) was first isolated from ascitic fluid and serum of cancer patients as a non-specific and soluble immunosuppressive factor with a molecular weight of 50 000. 1 It has been shown that IAP suppresses several immune responses in vivo and in vitro including both phyto- hemagglutinin (PHA)-induced lymphocyte blast formation and mixed lymphocyte reaction, and belongs to the alpha-1 acid glycoproteins. 2,3 Two mechanisms are known to be involved in IAP production. In cancer patients, IAP is produced in the lymphocytes and macrophages and is associated with tumor progression. 4 In the inflammatory response, IAP is produced by hepatocytes with IL-6 stimulation. 5 It is well known that IAP has strong immunosuppressive activity. In our previous study, it was revealed that the preoperative serum IAP level has good association with the status of progression in gastric cancer, and may be useful as a prognostic factor. 6 However, few reports have been seen in association with IAP and esophageal cancer patients. Here we show that preoperative IAP levels can be a prognostic factor for patients with esophageal cancer after radical operation. MATERIALS AND METHODS Subjects This study included 76 patients, 41–79 years of age (mean age, 63.2 years) with previously untreated esophageal cancer, whose serum IAP levels were measured between April 1990 and March 2000 in the Department of Surgery 1, Fukushima Medical University, Japan. After serum IAP levels were measured, curative resection was performed in 68 patients. In the curative group, preoperative or postoperative treatment including chemotherapy and/or radiation was administered to 58 patients Address to correspondence to: Michihiko Kogure, MD, Department of Surgery I, Fukushima Medical University, Fukushima, 1 Hikarigaoka Fukushima, 960-1295, Japan. Email: kogure@fmu.ac.jp Downloaded from https://academic.oup.com/dote/article/21/3/214/2374252 by guest on 09 July 2022