Oxford University Press (OUP), Carcinogenesis: Integrative Cancer Research, 9(36), p. 956-962
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Polymorphisms in the VEGF/angiogenesis pathway have been previously implicated in cancer risk, prognosis, and response to therapy including in esophageal adenocarcinoma. Prior esophageal adenocarcinoma studies focused on using candidate polymorphisms, limiting the discovery of novel polymorphisms. Here, we applied the tagSNP approach to identify new VEGF-pathway polymorphisms associated with esophageal adenocarcinoma prognosis and validated them in an independent cohort of esophageal adenocarcinoma patients. In 231 esophageal adenocarcinoma patients of all stages/treatment plans, 58 genetic polymorphisms (18 KDR, 7 VEGFA, 33 FLT1), selected through tagging and assessment of predicted function were genotyped. Cox-proportional hazard models adjusted for important socio-demographic and clinico-pathological factors were applied to assess the association of genetic polymorphisms with overall survival (OS) and progression-free survival (PFS). Significantly associated polymorphisms were then validated in an independent cohort of 137 esophageal adenocarcinoma patients. Among the 231 discovery cohort patients, 86% were male, median diagnosis age was 64 years, 34% were metastatic at diagnosis, and median OS and PFS were 20 and 12 months respectively. KDR rs17709898 was found significantly associated with PFS (adjusted hazard ratio,aHR=0.69, 95%CI:0.53-0.90;P=5.2E-3). FLT1 rs3794405 and rs678714 were significantly associated with OS (aHR=1.44, 95%CI:1.04-1.99;P=0.03 and aHR=1.50, 95%CI:1.01- 2.24;P=0.04, respectively). No VEGFA polymorphisms were found significantly associated with either outcome. Upon validation, FLT1 rs3794405 remained strongly associated with OS (aHR=1.59, 95%CI:1.04-2.44;P=0.03). FLT1 rs3794405 is significantly associated with OS in esophageal adenocarcinoma; whereby each variant allele confers a 45-60% increased risk in mortality. Validation and evaluation of this association in other cancer sites is warranted.