Vasculogenic mimicry and aberrant expression of HIF-lα/E-cad are associated with worse prognosis of esophageal squamous cell carcinoma

This study aims to find good markers for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Vasculogenic mimicry (VM) and the expression of hypoxia inducible factor-l alpha (HIF-l alpha)/E-cad protein in ESCC were investigated by immunostaining. The association between VM, HIF-l alpha/E-cad and clinicopathologic characteristics and 5-year-survival rate of patients with ESCC was analyzed. A total of 160 ESCC specimens were involved in this study and 28 specimens of normal esophageal mucosa served as controls. VM channels were identified in 78 (48.75%) of the 160 ESCC specimens and none of the normal esophageal mucosa was found to have VM. The rates of high-expression of HIF-l alpha and E-cad in ESCC were 43.75% and 38.75%, while the rates in control were 17.86% and 71.43%, respectively (P < 0.05 for all). VM and the expression levels of HIF-l alpha and E-cad were significantly related to lymph node metastasis, serosa infiltration, PTNM staging and 5-year-survival rates of patients with ESCC (P < 0.05 for all). VM was positively correlated with HIF-l alpha but negatively with E-cad, and HIF-l alpha was negatively correlated with E-cad (P < 0.001 for all). The 5-year-survival rate of patients with ESCC was 6.41% (5/78) in VM group and 65% (52/82) in non-VM group, 7.14% (5/70) in high HIF-l alpha expression group and 57.78% (52/90) in low HIF-l alpha expression group. Oppositely, the 5-year-survival rate in high E-cad expression group was 80.65% (50/62) and that in low E-cad expression group was 7.37% (7/98) (P < 0.05 for all). Cox multifactor regression analysis indicated that lymph node metastasis, PTNM stage, VM and expression levels of HIF-l alpha and E-cad were independent risk factors of patients with ESCC (P < 0.05 for all). Combined detection of VM, HIF-l alpha and E-cad plays an important role in predicting the invasion, metastasis and prognosis of patients with ESCC.