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Background  Esophageal squamous cell carcinoma (ESCC) is a highly malignant neoplasm.  The glucocorticoid (GC)-glucocorticoid receptor (GR) pathway plays pivotal roles in cellular response to various stresses of tumor cells, including chemotherapy. However, the status of the GC-GR pathway in ESCC, including its correlation with chemotherapeutic responses, is largely unknown.    Methods  GR, serum-and glucocorticoid-regulated kinase 1 (Sgk1), and N-myc down regulation gene 1 (NDRG1) were immunolocalized in 98 patients with ESCC who had undergone esophagectomy following neoadjuvant chemotherapy (NAC) with 2 courses of 5-fluorouracil + cisplatin. We also examined biopsy specimens before NAC in 42 cases and compared the results between those before and after NAC.    Results  Overall survival (OS) of the patients treated with surgery following NAC was significantly shorter in the group with high GR than that with low GR status ( P  = 0.0473). Both OS and disease-free survival (DFS) were significantly shorter in both Sgk1- and NDRG1-high groups than in the low groups (OS: Sgk1,  P  = 0.0055; NDRG1,  P  = 0.0021; DFS: Sgk1,  P  = 0.0240; NDRG1,  P  = 0.0086). Biopsy specimens before NAC showed significantly shorter DFS in the high Sgk1 group ( P  = 0.0095), while both OS and DFS were shorter in the high NDRG1 group (OS,  P  = 0.0233; DFS,  P  = 0.0006) than in the respective low groups. In the high NDRG1 group of biopsy specimens before NAC, the tumor reduction rate by NAC was significantly attenuated ( P  = 0.021).    Conclusions  High GR, Sgk1, and NDRG1 statuses in ESCC after NAC was significantly associated with an overall worse prognosis, with no significant changes in their expression levels before and after NAC. Therefore, increased activity of the GC-GR pathway with enhanced induction of Sgk1 and NDRG1 in carcinoma cells play pivotal roles in tumor progression and development of chemo-resistance in patients with ESCC undergoing NAC.

GR, Sgk1, and NDRG1 in esophageal squamous cell carcinoma: their correlation with therapeutic outcome of neoadjuvant chemotherapy