Clinicopathological and prognostic significance of FOXM1 expression in esophageal squamous cell carcinoma

Background: Esophageal squamous cell carcinoma (ESCC) has a poor prognosis because invasion and metastasis are prevalent. To improve diagnosis, it is important to identify and characterize tumor-specific molecular markers in ESCC. FOXM1 is overexpressed and correlates with pathogenesis in a variety of human malignancies. We aimed to investigate the clinical significance of FOXM1 overexpression in ESCC. Patients and Methods: FOXM1 expression was assessed in ESCC specimens from 174 curatively-resected cases. The relationships between FOXM1 expression, clinicopathological parameters, and prognoses were examined. Results: Immunohistochemical analysis showed that 94 (54.0%) tumors were positive for FOXM1 expression. FOXM1 positivity did not correlate with any clinicopathological parameter. However, FOXM1-positive cases had poorer prognoses than FOXM1-negative ones (p=0.0037, log-rank test). In multivariate analysis, the following were independent prognostic factors: pT, pN, neoadjuvant chemotherapy, and FOXM1 expression (hazard ratio=1.69, 95% confidence interval=1.06-2.75, p=0.027). Conclusion: FOXM1 may be a novel prognostic factor in patients with ESCC who undergo curative resection.