Facteurs pronostiques et prédictifs des cancers de l'oesophage

Oesophageal carcinoma is a frequent disease, which incidence is high and stable (6,000 new cases per year in France). Its epidemiology has changed over the last three decades, adenocarcinoma becoming the most frequent histologic subtype. It is an aggressive disease with an early lymphatic spread. The prognosis of oesophageal carcinoma remains poor despite improved diagnosis and therapeutic strategies. The aim of this review is to describe the major prognostic and predictive factors of oesophageal carcinoma. These factors are mostly based on patient characteristics (performance status, weight loss, hemoglobin level), tumor spread (TNM stage, lymph node micrometastases, ratio of involved lymph nodes, extracapsular involvement), radicality of surgical resection (R0) or radiological and endoscopic response to chemoradiation therapy. Many molecular prognostic factors have also been described, among which the presence p53 mutations or high-levels of NF-κB are worth naming. An early decrease of tumoral glucose uptake measured by PET-CT appears to be a predictive factor of response to antitumor treatment. Genetic profiles of drug action pathways in oesophageal carcinoma have been described. They may provide additional information to predict tumor response to medical treatment.