Network and pathway-based analysis of candidate genes associated with esophageal adenocarcinoma
Original Article

Network and pathway-based analysis of candidate genes associated with esophageal adenocarcinoma

Junfeng Li1, Ling Peng2, Hanbing Li3, Yan Cai1, Peng Yao1, Qin Chen1, Xiaolei Li1, Qiuxi Zhou2

1Department of Thoracic Surgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China; 2Department of General Internal Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, China; 3Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China

Contributions: (I) Conception and design: J Li, Q Zhou; (II) Administrative support: L Peng, Q Zhou; (III) Provision of study materials: H Li, Y Cai; (IV) Collection and assembly of data: P Yao; (V) Data analysis and interpretation: Q Chen, X Li; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Qiuxi Zhou. Department of General Internal Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, China. Email:

Background: Previous studies have made some headway in analyzing esophageal adenocarcinoma (EA) with respect to pathogenic factors, treatment methods, and prognosis. However, far less is known about the molecular mechanisms. Thus, a comprehensive analysis focusing on the biological function and interaction of EA genes would provide valuable information for understanding the pathogenesis of EA, which may provide new insights into gene function as well as potential therapy targets.

Methods: We selected 109 genes related to EA by reviewing 458 publications from the PubMed database. In addition, performing gene enrichment assays, pathway enrichment assays, pathway crosstalk analysis, and extraction of EA-specific subnetwork were used to describe the relevant biochemical processes.

Results: Function analysis revealed that biological processes and biochemical pathways associated with apoptotic and metabolic processes, a variety of cancers, and drug reaction pathways. Further, 12 novel genes (PTHLH, SUMO2, TYMS, APP, PTGIR, SP1, UBC, COL1A1, GSTO1, TRAF6, BMP7, and RAB40B) were identified in the EA-specific network, which might provide helpful information for clinical application.

Conclusions: Overall, by integrating pathways and networks to explore the pathogenetic mechanisms underlying EA, our results could significantly improve our understanding of the molecular mechanisms of EA and form a basis for selection of potential molecular targets for further exploration.

Keywords: Esophageal adenocarcinoma; oncogene; function enrichment analysis; pathway crosstalk; protein-protein interaction network

Submitted Dec 07, 2022. Accepted for publication Feb 02, 2023. Published online Feb 15, 2023.

doi: 10.21037/jgo-22-1286

Highlight box

Key findings

• We found that biochemical processes and pathways associated with the metabolic process, biological regulation process, and the signal transduction process played key roles in the molecular mechanism of esophageal adenocarcinoma (EA). In addition, a number of new genes were identified in the EA-specific network.

What is known and what is new?

• We know which genes and their pathways have been studied in EA.

• We found that biochemical processes and pathways associated with the metabolic process, biological regulation process, and the signal transduction process played key roles in the molecular mechanism of EA. In addition, there were 2 interconnected pathway modules: metabolic regulation and drug reactions, and transcriptional regulation. Finally, we extracted an EA-specific subnetwork and identified some novel genes potentially bound up with EA.

What is the implication, and what should change now?

• Our results suggested that in future studies in EA, we should focus on the pathways and new genes involved.


Esophageal cancer, the ninth most common cancer and the sixth most fatal cancer worldwide, is classified into 2 major histologic types, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EA), the latter of which has increased rapidly in Western countries over the past several decades (1). Risk factors for EA include Barrett’s esophagus, gastroesophageal reflux disease, Caucasian race, male gender, obesity, smoking, and some genetic factors (2). EA has shown a poor prognosis, with an overall survival rate of approximately 20% at 5 years (3). Recently, with the development of neoadjuvant chemoradiotherapy and radiotherapy, survival rates have improved in patients with locally advanced EA compared to surgery alone, but there is wide interindividual variation in response to neoadjuvant therapy (4). In recent years, analysis of the genome of patients with EA has become increasingly relevant for guiding treatment planning.

The genomic complexity of EA is characterized by a high burden of point mutations and genome structural alterations, including TP53, CDKN2A, KRAS, MYC, and CDK6 (3). Rapid advances in high throughput technologies over the past decade have helped researchers generate numerous genetic and genomic datasets in order to reveal causal genes and their actions in complex diseases (5). Pathway analysis examines series of actions or interactions among genes or genes products that lead to the generation of a certain product or a change in the cell and protein-protein interaction (PPI) network, and it has been recognized as a powerful tool for understanding how genes perform their biological function (6).

In this study, we conducted a comprehensive analysis of genes which have been published potentially involved in EA. We then performed biological enrichment analyses and the interaction among the enriched biochemical pathways was analyzed, in addition to examining the crosstalk among the significantly enriched pathways. Finally, a molecular network of EA was constructed. We present the following article in accordance with the STREGA reporting checklist (available at


Identification of EA-related genes

The genes genetically associated with EA (the standardized term found though MeSH) were gathered by retrieving human genetic association studies published in PubMed ( We retrieved 458 articles published to June 30, 2022 using the search terms (adenocarcinoma of esophageal and polymorphism [MeSH]) or (adenocarcinoma of esophageal and genotype [MeSH]) or (adenocarcinoma of esophageal and alleles [MeSH]), with ‘humans’ as the limiting condition. After browsing the abstracts of all of the articles, we excluded those which were not gene-related or were not focused primarily on EA, which left 125 articles remaining. We then focused on studies reporting a significant association between 1 or more genes with EA. For the purpose of reducing the number of potential false-positive genes, the studies reporting negative or insignificant associations were excluded even though some of them might influence EA in further research based on a large number of studies. Finally, we read the full text of each selected article to ensure the conclusion was in accord with its contents, and we also added some genes that were synergistic to the investigated genes. Eventually, we found 109 genes related to EA. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

Function enrichment analysis

We used software from the Database for Annotation, Visualization and Integrated Discovery (DAVID) v6.8 ( to convert the names of 109 EA genes from the literature into Entrez Gene GeneIDs. To examine the functional features of EA genes, Gene Ontology (GO, and Kyoto Encyclopedia of Genes and Genomes (KEGG, were applied for functional enrichment analysis. In brief, GO enrichment analysis was used to annotate and classify the candidate genes of EA according to molecular function (MF), biological process (BP), and cellular component (CC). In addition, directed acyclic graph (DAG) was used to depict the results of GO enrichment analysis. In DAG, the top 10 terms with the lowest P value in the rectangle and their parent nodes in the circle were shown, with the branches indicating annotation moving from more general to more specific as one moved from parent nodes to child nodes, and the defined function range became smaller from top to bottom. The terms with pane marks indicated significant enrichment, with more red indicating more significance. We then applied KOBAS 2.1.1 software for comparison with the genes included in each pathway in the KEGG database, which is a knowledge base for systematic analysis of gene functions in order to link genomic information with higher order functional information. Next, we extracted the significantly enriched pathways and assigned a P value for each of them using Fisher’s exact test. In our study, both the GO and KEGG biological process terms with a multiple testing correction P value [false discovery rate (FDR)] <0.05 calculated using the Benjamini-Hochberg procedure were considered to be significantly enriched. In addition, we evaluated the degree of gene enrichment in a single function by enrichment score with the formula:


Pathway crosstalk analysis

We further performed pathway crosstalk analysis to investigate interactions of the enriched pathways. In this study, we used 2 measures to describe the overlap between any 2 pathways, the overlap coefficient (OC) and the Jaccard coefficient (JC).


where A and B are the lists of genes included in the 2 pathways under examination. The following procedure was carried out to construct the pathway crosstalk:

  • We first selected a set of pathways for crosstalk analysis. Only the pathways with FDR <0.05 were kept. At the same time, more than 5 candidate genes were required in each pathway as pathways with too few genes might not have had sufficient biological information.
  • Next, we counted the shared candidate genes of each pathway pair and removed pathways with fewer than 3 overlapping genes.
  • We then calculated the JC and OC of the qualified pathway pairs and ranked them according to their score values.


Lastly, we visualized the final pathway crosstalk with Cytoscape software (7). The node size represented the degree of the pathways, with a larger node corresponding to a deeper degree, and the thickness of the line represented the score value of pathways, with a thicker line corresponding to a higher score.

Construction of the EA-specific protein subnetwork

Human PPI data was downloaded from the Protein Interaction Network Analysis (PINA) platform (8), which pools and curates unique physical interaction information from 6 main public PPI databases (IntAct, BioGRID, MINT, DIP, HPRD , and MIPS/MPact). We then used the Klein-Ravi algorithm in GenRev software to extract the subnetwork using the 109 EA genes as seeds (9). To examine the nonrandomness of the constructed network, 1000 random networks with the same number of nodes and edges as the EA-specific network were generated using the Erdos-Renyi model in the igraph package in R. Afterwards, we compared the seed genes with the 1000 random networks to generate subnetworks and calculated the average values of the shortest-path distance and clustering coefficient in random subnetworks. We estimated the significance of nonrandomness by counting the number of random networks with average shortest-path distance (nL) less than that of the EA-specific network and the number of random networks with average clustering coefficient (nc) more than that of the EA-specific network. Finally, we calculated the P-value = nL/1000 and nc/1000.


Identification of genes related to EA

By searching PubMed, we collected literature on genetic associations related to EA. We selected 125 publications which reported gene(s) significantly associated with EA and collected 109 genes related to EA (Table 1). Some of the genes were involved in transcriptional regulation, such as hypoxia-inducible factor-1 (HIF-1) signaling (FLT1, BCL2, IGF1R, VEGFA, and PIK3CA), tumor necrosis factor (TNF) signaling (IL1B, MMP14, and PTGS2), vascular endothelial growth factor (VEGF) signaling (CASP9, KRAS), and others may be involved in drug metabolism, such as glutathione S-transferase mu 1 (GSTM1), glutathione S-transferase mu 3 (GSTM3), and cytochrome P450 family 2 subfamily E member 1 (CYP2E1).

Table 1

List of the 109 EA-related genes

Gene abbreviations Gene ID Species Gene name
CTHRC1 115908 Homo sapiens Collagen triple helix repeat containing 1 (CTHRC1)
FHIT 2272 Homo sapiens Fragile histidine triad (FHIT)
PTGS2 5743 Homo sapiens Prostaglandin-endoperoxide synthase 2 (PTGS2)
GDF7 151449 Homo sapiens Growth differentiation factor 7 (GDF7)
ASCC1 51008 Homo sapiens Activating signal cointegrator 1 complex subunit 1 (ASCC1)
SELENBP1 8991 Homo sapiens Selenium binding protein 1 (SELENBP1)
MMP3 4314 Homo sapiens Matrix metallopeptidase 3 (MMP3)
XRCC1 7515 Homo sapiens X-ray repair cross complementing 1 (XRCC1)
MMP2 4313 Homo sapiens Matrix metallopeptidase 2 (MMP2)
IL10 3586 Homo sapiens Interleukin 10 (IL10)
MMP1 4312 Homo sapiens Matrix metallopeptidase 1 (MMP1)
PGR 5241 Homo sapiens Progesterone receptor (PGR)
GSTM1 2944 Homo sapiens Glutathione S-transferase mu 1 (GSTM1)
GSTM3 2947 Homo sapiens Glutathione S-transferase mu 3 (GSTM3)
MUTYH 4595 Homo sapiens mutY DNA glycosylase (MUTYH)
CDKN2A 1029 Homo sapiens cyclin dependent kinase inhibitor 2A (CDKN2A)
GATA6 2627 Homo sapiens GATA binding protein 6 (GATA6)
FOXF1 2294 Homo sapiens Forkhead box F1 (FOXF1)
GATA4 2626 Homo sapiens GATA binding protein 4 (GATA4)
IL1B 3553 Homo sapiens Interleukin 1 beta (IL1B)
PIK3CA 5290 Homo sapiens Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)
NQO1 1728 Homo sapiens NAD (P)H quinone dehydrogenase 1 (NQO1)
WWOX 51741 Homo sapiens WW domain containing oxidoreductase (WWOX)
EGFR 1956 Homo sapiens Epidermal growth factor receptor (EGFR)
NEIL2 252969 Homo sapiens nei like DNA glycosylase 2 (NEIL2)
GSTT1 2952 Homo sapiens Glutathione S-transferase theta 1 (GSTT1)
ARID1A 8289 Homo sapiens AT-rich interaction domain 1A (ARID1A)
CYP2E1 1571 Homo sapiens Cytochrome P450 family 2 subfamily E member 1 (CYP2E1)
CDO1 1036 Homo sapiens Cysteine dioxygenase type 1 (CDO1)
RFC3 5983 Homo sapiens Replication factor C subunit 3 (RFC3)
VEGFA 7422 Homo sapiens Vascular endothelial growth factor A (VEGFA)
HPP1 780897 Homo sapiens Hyperpigmentation, progressive, 1 (HPP1)
FGFR2 2263 Homo sapiens Fibroblast growth factor receptor 2 (FGFR2)
WNT5A 7474 Homo sapiens Wnt family member 5A (WNT5A)
MCL1 4170 Homo sapiens BCL2 family apoptosis regulator (MCL1)
CRTC1 23373 Homo sapiens CREB regulated transcription coactivator 1 (CRTC1)
ERBB2 2064 Homo sapiens erb-b2 receptor tyrosine kinase 2 (ERBB2)
TIMP3 7078 Homo sapiens TIMP metallopeptidase inhibitor 3 (TIMP3)
EPHB4 2050 Homo sapiens EPH receptor B4 (EPHB4)
WT1 7490 Homo sapiens Wilms tumor 1 (WT1)
VDR 7421 Homo sapiens vitamin D (1,25- dihydroxyvitamin D3) receptor (VDR)
KRAS 3845 Homo sapiens KRAS proto-oncogene, GTPase (KRAS)
DMD 1756 Homo sapiens Dystrophin (DMD)
EGF 1950 Homo sapiens Epidermal growth factor (EGF)
RUNX1 861 Homo sapiens Runt related transcription factor 1 (RUNX1)
RUNX3 864 Homo sapiens Runt related transcription factor 3 (RUNX3)
CYP19A1 1588 Homo sapiens Cytochrome P450 family 19 subfamily A member 1 (CYP19A1)
TP53BP1 7158 Homo sapiens Tumor protein p53 binding protein 1 (TP53BP1)
MET 4233 Homo sapiens MET proto-oncogene, receptor tyrosine kinase (MET)
SMAD4 4089 Homo sapiens SMAD family member 4 (SMAD4)
FOXP1 27086 Homo sapiens Forkhead box P1 (FOXP1)
NR1I2 8856 Homo sapiens Nuclear receptor subfamily 1 group I member 2 (NR1I2)
FBXO32 114907 Homo sapiens F-box protein 32 (FBXO32)
PTPN1 5770 Homo sapiens Protein tyrosine phosphatase, non-receptor type 1 (PTPN1)
ABL1 25 Homo sapiens ABL proto-oncogene 1, non-receptor tyrosine kinase (ABL1)
IER3 8870 Homo sapiens Immediate early response 3 (IER3)
MSR1 4481 Homo sapiens Macrophage scavenger receptor 1 (MSR1)
CCNE1 898 Homo sapiens Cyclin E1 (CCNE1)
BARX1 56033 Homo sapiens BARX homeobox 1 (BARX1)
CASP9 842 Homo sapiens Caspase 9 (CASP9)
CASP7 840 Homo sapiens Caspase 7 (CASP7)
HMOX1 3162 Homo sapiens Heme oxygenase 1 (HMOX1)
CASP8 841 Homo sapiens Caspase 8 (CASP8)
NOS3 4846 Homo sapiens Nitric oxide synthase 3 (NOS3)
MYB 4602 Homo sapiens MYB proto-oncogene, transcription factor (MYB)
MYC 4609 Homo sapiens v-myc avian myelocytomatosis viral oncogene homolog (MYC)
TERT 7015 Homo sapiens Telomerase reverse transcriptase (TERT)
TP53 7157 Homo sapiens Tumor protein p53 (TP53)
PRKCI 5584 Homo sapiens Protein kinase C iota (PRKCI)
CDK6 1021 Homo sapiens Cyclin dependent kinase 6 (CDK6)
PADI4 23569 Homo sapiens Peptidyl arginine deiminase 4 (PADI4)
MBNL1 4154 Homo sapiens Muscleblind like splicing regulator 1 (MBNL1)
CDK4 1019 Homo sapiens Cyclin dependent kinase 4 (CDK4)
MMP14 4323 Homo sapiens Matrix metallopeptidase 14 (MMP14)
MMP12 4321 Homo sapiens Matrix metallopeptidase 12 (MMP12)
TNFRSF10A 8797 Homo sapiens TNF receptor superfamily member 10a (TNFRSF10A)
VSIG10L 147645 Homo sapiens V-set and immunoglobulin domain containing 10 like (VSIG10L)
Myo9B 4650 Homo sapiens Myosin IXB (MYO9B)
NCOA3 8202 Homo sapiens Nuclear receptor coactivator 3 (NCOA3)
TARP 445347 Homo sapiens TCR gamma alternate reading frame protein (TARP)
MDM2 4193 Homo sapiens MDM2 proto-oncogene (MDM2)
GHRL 51738 Homo sapiens Ghrelin and obestatin prepropeptide (GHRL)
JMJD1C 221037 Homo sapiens Jumonji domain containing 1C (JMJD1C)
CHFR 55743 Homo sapiens Checkpoint with forkhead and ring finger domains (CHFR)
GSTP1 2950 Homo sapiens Glutathione S-transferase pi 1 (GSTP1)
DCC 1630 Homo sapiens DCC netrin 1 receptor (DCC)
FKBP5 2289 Homo sapiens FK506 binding protein 5 (FKBP5)
MGMT 4255 Homo sapiens O-6-methylguanine-DNA methyltransferase (MGMT)
CDH1 999 Homo sapiens Cadherin 1 (CDH1)
CDH3 1001 Homo sapiens Cadherin 3 (CDH3)
IGF1R 3480 Homo sapiens Insulin like growth factor 1 receptor (IGF1R)
TNFRSF1A 7132 Homo sapiens TNF receptor superfamily member 1A (TNFRSF1A)
MTHFR 4524 Homo sapiens Methylenetetrahydrofolate reductase (MTHFR)
MDC1 9656 Homo sapiens Mediator of DNA damage checkpoint 1 (MDC1)
BCL2 596 Homo sapiens BCL2, apoptosis regulator (BCL2)
TGM2 7052 Homo sapiens Transglutaminase 2 (TGM2)
MTMR9 66036 Homo sapiens Myotubularin related protein 9 (MTMR9)
ERCC1 2067 Homo sapiens ERCC excision repair 1, endonuclease non-catalytic subunit (ERCC1)
APC 324 Homo sapiens APC, WNT signaling pathway regulator (APC)
ERCC2 2068 Homo sapiens ERCC excision repair 2, TFIIH core complex helicase subunit (ERCC2)
FLT1 2321 Homo sapiens fms related tyrosine kinase 1 (FLT1)
GMDS 2762 Homo sapiens GDP-mannose 4,6-dehydratase (GMDS)
VHL 7428 Homo sapiens Von Hippel-Lindau tumor suppressor (VHL)
KLK3 354 Homo sapiens Kallikrein related peptidase 3 (KLK3)
TBX5 6910 Homo sapiens T-box 5 (TBX5)
IGF1 3479 Homo sapiens Insulin like growth factor 1 (IGF1)
IGF2 3481 Homo sapiens Insulin like growth factor 2 (IGF2)
BNC2 54796 Homo sapiens Basonuclin 2 (BNC2)
PERP 64065 Homo sapiens PERP, TP53 apoptosis effector (PERP)

GO enrichment analysis of EA

Functional enrichment analysis revealed a more specific function spectrum of these genes. Among the GO terms overrepresented in candidate genes were those associated with regulation and metabolic processes. In the BP category, terms directly associated with regulation and metabolic processes were identified, including organic substance metabolic process [Benjamini-Hochberg-corrected P (PBH) =1E-30], metabolic process (PBH =1E-30), cellular metabolic process (PBH =1E-30), and biological regulation (PBH =1E-30). Similarly, in the MF category, terms such as transcription factor binding (PBH =2.278E-08), receptor binding (PBH =9.10E-08), and protein binding (PBH =3.08E-13) were significantly enriched. In the CC category, the terms organelle lumen (PBH =8.73E-11), membrane-enclosed lumen (PBH =8.73E-11), and intracellular organelle lumen (PBH =8.73E-11) were extracted.

Enrichment of certain GO terms could be due to the contribution of other GO terms enriched at a lower hierarchy. Therefore, DAG was used to depict the results of GO enrichment analysis and how these affected other GO terms through upper hierarchies. For example, a part of the DAG representing BP (Figure 1A) was related with the GO term “biological regulation” in the rectangle. Surprisingly, this GO term was enriched at a very low FDR (<1e-20), and some other GO terms at lower hierarchies such as “regulation of biological process” and “regulation of cellular process” in the circle were enriched as a result. At the same, CC (Figure 1B) was associated with “intracellular”, and the lower terms such as “intracellular organelle” and “intracellular organelle part” were enriched. Moreover, in MF (Figure 1C), the GO term “regulatory region nucleic acid binding” was enriched and so were its upper terms “nucleic acid binding” and “organic cyclic compound binding”.

Figure 1 DAG of BP, CC, and MF. The branches represent the inclusion of GO terms. Top 10 GO enrichment terms in the rectangle and other related GO terms in the circle are shown by inclusion relationship, and more red indicates more significance. The defined function range becomes smaller from top to bottom. DAG, directed acyclic graph; BP, biological process; CC, cellular component; MF, molecular function; GO, Gene Ontology.

We used the ggplot2 package in Goseq software to depict the top 10 terms of BP, CC, and MF in graphs (Figure 2A-2C). For example, at the far left of the BP table, there were 4 biggest points representing “organic substance metabolic process”, “metabolic process”, “cellular metabolic process”, and “biological regulation” with the P value less than 1e-20 and count of EA genes more than 90. Interestingly, the most significant dot here was also the most red in DAG. The same results could be observed in CC and MF.

Figure 2 Dot plot graph of BP, CC, MF, and KEGG. The graph shows the richness factor and P value for the top 10 GO terms. The size of the solid dot indicates the count of EA-related genes in this term. BP, biological process; CC, cellular component; MF, molecular function; KEGG, Kyoto Encyclopedia of Genes and Genomes; GO, Gene Ontology; EA, esophageal adenocarcinoma.

Pathway enrichment analysis of EA

Detection of the biological pathways enriched in the candidate genes may provide important information about the pathogenic molecular mechanism underlying EA. Through KEGG analysis, we found 177 significant enrichment pathways and extracted 19 most significant enrichment pathways (FDR ≤0.05) (Table 2). Among them, several pathways related to cancer, including bladder cancer (PBH =1.702E-6), prostate cancer (PBH =8.588E-5), pancreatic cancer (PBH =1.741E-4), chronic myeloid leukemia (PBH =1.079E-3), and small cell lung cancer (PBH =1.017E-2). In addition, drug reaction and metabolism-related processes were identified, such as platinum drug resistance (PBH =1.371E-4) and microRNAs in cancer (PBH =0.030). Further, pathways associated with cell growth and survival, including the p53 signaling pathway (PBH =0.003) and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor resistance (PBH =0.002), were also detected. The KEGG results in table 2 showed that “pathways in cancer” had an EA gene count of more than 30.

Table 2

Pathways enriched in the EA-related genes (top 19 pathways)

Pathway name Database ID Input number Background number P value Corrected P value Gene ID Gene name
Bladder cancer KEGG PATHWAY hsa05219 13 41 9.62E-09 1.70E-06 4312|4313|7157|999|1029|4193|1956|3845|1019|7422|4609|2064|1950 MMP1|MMP2|TP53|CDH1|CDKN2A|MDM2|EGFR|KRAS|CDK4|VEGFA|MYC|ERBB2|EGF
Prostate cancer KEGG PATHWAY hsa05215 15 89 9.70E-07 8.59E-05 842|596|7157|3480|2064|3479|5290|4193|898|354|1956|3845|1950|2263|2950 CASP9|BCL2|TP53|IGF1R|ERBB2|IGF1|PIK3CA|MDM2|CCNE1|KLK3|EGFR|KRAS|EGF|FGFR2|GSTP1
Melanoma KEGG PATHWAY hsa05218 13 71 2.27E-06 0.000134 1021|7157|3480|1029|3479|5290|4193|999|1956|3845|1019|4233|1950 CDK6|TP53|IGF1R|CDKN2A|IGF1|PIK3CA|MDM2|CDH1|EGFR|KRAS|CDK4|MET|EGF
Pathways in cancer KEGG PATHWAY hsa05200 33 397 3.02E-06 0.000134 596|4089|5290|5743|1630|25|7157|4233|3479|1019|324|2263|7474|4312|4313|898|3480|999|4193|1956|1950|4609|2950|1021|842|841|861|1029|354|3845|7422|2064|7428 BCL2|SMAD4|PIK3CA|PTGS2|DCC|ABL1|TP53|MET|IGF1|CDK4|APC|FGFR2|WNT5A|MMP1|MMP2|CCNE1|IGF1R|CDH1|MDM2|EGFR|EGF|MYC|GSTP1|CDK6|CASP9|CASP8|RUNX1|CDKN2A|KLK3|KRAS|VEGFA|ERBB2|VHL
Platinum drug resistance KEGG PATHWAY hsa01524 13 75 3.87E-06 0.000137 842|841|596|7157|2064|1029|4193|5290|2947|2944|2950|2952|2067 CASP9|CASP8|BCL2|TP53|ERBB2|CDKN2A|MDM2|PIK3CA|GSTM3|GSTM1|GSTP1|GSTT1|ERCC1
Pancreatic cancer KEGG PATHWAY hsa05212 12 66 5.90E-06 0.000174 1021|842|7157|4089|1029|7422|5290|1956|3845|1019|2064|1950 CDK6|CASP9|TP53|SMAD4|CDKN2A|VEGFA|PIK3CA|EGFR|KRAS|CDK4|ERBB2|EGF
Non-small cell lung cancer KEGG PATHWAY hsa05223 11 56 7.55E-06 0.000191 1021|842|2272|7157|1029|5290|1956|3845|1019|2064|1950 CDK6|CASP9|FHIT|TP53|CDKN2A|PIK3CA|EGFR|KRAS|CDK4|ERBB2|EGF
Endometrial cancer KEGG PATHWAY hsa05213 10 52 2.30E-05 0.000508 842|7157|999|5290|1956|3845|1950|324|4609|2064 CASP9|TP53|CDH1|PIK3CA|EGFR|KRAS|EGF|APC|MYC|ERBB2
Glioma KEGG PATHWAY hsa05214 11 65 2.60E-05 0.000511 1021|7157|3480|1029|3479|5290|4193|1956|3845|1019|1950 CDK6|TP53|IGF1R|CDKN2A|IGF1|PIK3CA|MDM2|EGFR|KRAS|CDK4|EGF
Endocrine resistance KEGG PATHWAY hsa01522 13 97 4.52E-05 0.000801 4313|8202|596|7157|3480|1029|3479|5290|4193|1956|3845|1019|2064 MMP2|NCOA3|BCL2|TP53|IGF1R|CDKN2A|IGF1|PIK3CA|MDM2|EGFR|KRAS|CDK4|ERBB2
Chronic myeloid leukemia KEGG PATHWAY hsa05220 11 73 6.71E-05 0.001079 25|1021|7157|4089|1029|4193|5290|861|3845|1019|4609 ABL1|CDK6|TP53|SMAD4|CDKN2A|MDM2|PIK3CA|RUNX1|KRAS|CDK4|MYC
EGFR tyrosine kinase inhibitor resistance KEGG PATHWAY hsa01521 11 81 0.000154 0.002278 596|3480|3479|5290|2064|1956|3845|1950|2263|4233|7422 BCL2|IGF1R|IGF1|PIK3CA|ERBB2|EGFR|KRAS|EGF|FGFR2|MET|VEGFA
p53 signaling pathway KEGG PATHWAY hsa04115 10 69 0.00019 0.002585 1021|842|841|7157|1029|3479|4193|64065|898|1019 CDK6|CASP9|CASP8|TP53|CDKN2A|IGF1|MDM2|PERP|CCNE1|CDK4
HIF-1 signaling pathway KEGG PATHWAY hsa04066 12 103 0.000289 0.003654 2321|596|3480|7422|3479|5290|2064|1956|1950|4846|3162|7428 FLT1|BCL2|IGF1R|VEGFA|IGF1|PIK3CA|ERBB2|EGFR|EGF|NOS3|HMOX1|VHL
Colorectal cancer KEGG PATHWAY hsa05210 9 62 0.00039 0.004601 1630|842|596|7157|4089|5290|3845|324|4609 DCC|CASP9|BCL2|TP53|SMAD4|PIK3CA|KRAS|APC|MYC
Small cell lung cancer KEGG PATHWAY hsa05222 10 86 0.00092 0.010174 1021|842|2272|7157|596|5290|898|5743|1019|4609 CDK6|CASP9|FHIT|TP53|BCL2|PIK3CA|CCNE1|PTGS2|CDK4|MYC
Central carbon metabolism in cancer KEGG PATHWAY hsa05230 8 67 0.002516 0.0262 7157|2064|5290|1956|3845|4609|2263|4233 TP53|ERBB2|PIK3CA|EGFR|KRAS|MYC|FGFR2|MET
MicroRNAs in cancer KEGG PATHWAY hsa05206 20 299 0.003053 0.030023 25|4170|596|7157|3162|2064|7078|1029|4193|5290|5743|898|1956|3845|7422|324|4609|1021|4233|27086 ABL1|MCL1|BCL2|TP53|HMOX1|ERBB2|TIMP3|CDKN2A|MDM2|PIK3CA|PTGS2|CCNE1|EGFR|KRAS|VEGFA|APC|MYC|CDK6|MET|FOXP1
Proteoglycans in cancer KEGG PATHWAY hsa05205 15 205 0.004502 0.041943 4313|7078|7157|3480|2064|4193|5290|3479|3481|1956|3845|7422|4609|7474|4233 MMP2|TIMP3|TP53|IGF1R|ERBB2|MDM2|PIK3CA|IGF1|IGF2|EGFR|KRAS|VEGFA|MYC|WNT5A|MET

Crosstalk among significantly enriched pathways

To perform further analysis of the pathways and how they interact with each other, we implemented a pathway crosstalk analysis for the 19 enriched pathways. The screening conditions included more than 5 candidate genes per pathway and at least 3 genes for each pathway shared with 1 or more other pathways. Coincidentally, the 19 pathways met our screening criteria for crosstalk analysis. All of the 161 pathway pairs (edges) among the 19 pathways, which were ranked according to the average JC and OC scores, were used to construct the pathway crosstalk network. Based on the crosstalk, these pathways could be probably divided into 2 major modules, each of which contained pathways that had more crosstalk with each other compared with other pathways and were likely related to the similar biological processes or etiology (Figure 3). The first module included a variety of cancers, metabolism-related processes, and drug reaction pathways, such as bladder cancer, prostate cancer, pancreatic cancer, non-small cell lung cancer, endocrine resistance, microRNAs in cancer, proteoglycans in cancer, and platinum drug resistance. In the other module, cell transcriptional regulation predominated, including endometrial cancer, chronic myeloid leukemia, p53 signaling, HIF-1 signaling, and central carbon metabolism in cancer. As the above results indicated, pathway crosstalk analysis could provide important insight into the understanding of oncogenic mechanisms.

Figure 3 Pathway crosstalk among EA genes-enriched pathways. Crosstalk network indicating EA-overrepresented pathways. Nodes represent biological pathways and lines represent crosstalk among pathways. The width of the line is proportional to the crosstalk level of the given pathway pair, and the size of the node represents the degree of the pathways. EA, esophageal adenocarcinoma.

EA-specific protein network

To distill insight into the potential pathological protein network of EA, we constructed a subnetwork for EA from the human PPI network with the Klein-Ravi algorithm. Typically, this algorithm will connect as many input nodes as possible (genes included in EA genes) with the minimum number of interlinking nodes. As shown in Figure 4, the protein network of EA contained 116 nodes and 284 edges. Of the 109 EA genes, 104 were included in the EA-specific network, which accounted for about 95.4% of the EA genes and 89.7% of the genes in the EA-specific network, indicating a high coverage of EA genes in the subnetwork. In addition to EA genes, a further 12 genes were contained in the EA-specific network (Table 3). In view of the close interaction of these genes with reported EA-related genes, they may also participate in the pathological process of EA. Notably, many of the EA-related genes, including TYMS, GSTO1, and BMP7, have been reported in previous studies (10-12). While some of these genes have not been shown to directly participate in the pathophysiology of EA, some of the genes linked to them or other member genotypes of the same protein family have been found to be involved in these reactions.

Figure 4 EA-specific network. The orange circular nodes represent EA genes and the blue triangle nodes are non-EA genes. Bigger size indicates higher degree. EA, esophageal adenocarcinoma.

Table 3

Twelve new genes associated with EA discovered by EA-specific network

Gene abbreviations Gene ID Species Gene name
PTHLH 5744 Homo sapiens parathyroid hormone like hormone (PTHLH)
SUMO2 6613 Homo sapiens small ubiquitin-like modifier 2 (SUMO2)
TYMS 7298 Homo sapiens thymidylate synthetase (TYMS)
APP 351 Homo sapiens amyloid beta precursor protein (APP)
PTGIR 5739 Homo sapiens prostaglandin I2 (prostacyclin) receptor (IP) (PTGIR)
SP1 6667 Homo sapiens Sp1 transcription factor (SP1)
UBC 7316 Homo sapiens ubiquitin C (UBC)
COL1A1 1277 Homo sapiens collagen type I alpha 1 chain (COL1A1)
GSTO1 9446 Homo sapiens glutathione S-transferase omega 1 (GSTO1)
TRAF6 7189 Homo sapiens TNF receptor associated factor 6 (TRAF6)
BMP7 655 Homo sapiens bone morphogenetic protein 7 (BMP7)
RAB40B 10966 Homo sapiens RAB40B, member RAS oncogene family (RAB40B)


Recently, considerable progress has been made in the study of the molecular mechanisms of EA. Advances in technology have allowed us to identify more and more genes and proteins associated with this disease on a larger scale. While a large number of studies have reported on the pathogenesis genes of EA, especially in the progression of Barrett’s esophagus to EA, in-depth analysis of the biochemical processes related to the pathogenesis of EA at the molecular level is still limited. Besides, there is no literature to summarize and analyze the relationship between these genes and EA. As a result, a systematic analysis of EA-related genes based on pathways and networks would provide a valuable resource for analyzing gene function, biochemical pathways, and subnetworks of EA (13). In this study, we pooled and managed data from a number of studies on human genes associated with EA to provide a comprehensive analysis of EA-related biochemical processes and their interrelations.

Functional enrichment analysis has brought the specific biological processes involved in EA genes to light. Our results showed that genes involved in EA might play an important role in metabolic processes, cell growth and survival, and drug reactions. The terms cellular metabolic process, organic substance metabolic process, biological regulation, regulation of cell death, regulation of apoptotic process, and response to stimulus were significantly enriched in EA genes, suggesting they play an important role in the pathogenesis of EA.

Pathway analysis showed that various cancer pathways were enriched in EA genes, such as bladder cancer, prostate cancer, pancreatic cancer, and so forth. This might be due to the regulation of the same genes among various cancers and also confirmed that the occurrence of cancer is not a single molecular event but a multistep process. Meanwhile, it was noteworthy that almost all of these cancer pathways contained TP53 and PIK3CA. As a well-known tumor suppressor gene, TP53, also called p53, can induce cell cycle arrest to repair DNA damage or lead to apoptosis when growth arrest is not realized. However, after p53 deletion or when mutated cells undergo DNA damage, the cells continue to increase, and hence the abnormality of DNA is transmitted to the progeny cells. More than 50% of human tumors carry mutations in the p53 gene (14). PIK3CA encodes the p110α catalytic subunit of the class IA phosphatidylinositol 3-kinases (PI3Ks) and then initiates a complex signaling cascade reaction that can result in cell proliferation, survival, and regulation of motility, among others (15). At the same time, some pathways were associated with cell growth and survival. For example, as a transcription factor, HIF-1 plays an important role in the formation of blood vessels and the proliferation of tumor cells (16). The generation of tumor blood vessels brings oxygen and nutrients to tumor cells, promotes the growth and proliferation of tumor cells, and is the basis for tumor cell invasion and metastasis. In addition, EGFR tyrosine kinase inhibitors block the abnormal signal transduction of EGFR and tyrosine kinase and induce apoptosis, thereby inhibiting the growth of tumor cells. EGFR tyrosine kinase inhibitors produce resistance via mechanisms such as EGFR mutations (17). Further, proteoglycans, as a sort of extracellular matrix in the tumor microenvironment, regulate the biological behavior of tumor cells via metabolic processes (18). These results suggested that the molecular mechanism of EA was rather intricate, involving many genes, pathways, and their interactions.

Importantly, in pathway crosstalk analysis, we established 2 major modules, of which 1 was mainly related to metabolic regulation and drug reactions. Among the pathways, we noted that many were tumor-associated pathways involved in metabolism. For example, the MMP1 and MMP2 genes in bladder cancer are members of the matrix metalloproteinase (MMP) gene family, which are involved in the breakdown of the extracellular matrix and play an important role in physiological processes, and thus their dysfunction is related to many diseases (including tumors) (19). In addition, the protein encoded by insulin like growth factor 1 (IGF1), which is found in prostate cancer, melanoma, and glioma, is similar to insulin in function and structure but has much higher growth promoting activity and is related to tumors (20). Similarly, platinum drug resistance, microRNAs, and endocrine resistance involved in metabolic regulation and drug reactions have been well studied (21). MicroRNAs directly or indirectly regulate several key enzymes and/or signaling hubs that result in the altering of metabolic pathways, leading to tumor progression and/or metastasis (22). Further, we noted that the 2 pathway modules were related to each other, and the genes in the pathways also interacted, suggesting that there was a transcription-metabolic regulatory network in the molecular mechanism of EA.

In addition, we extracted EA-specific protein networks based on the human PPI network. It was worth noting that some genes did not belong to EA genes but were contained in the human PPI network which may be related to EA. For instance, RAB40B may be involved in tissue-supporting basement membrane or extracellular matrix destruction, and its encoded protein may regulate secretory vesicles, which may participate in tumor metastasis (23). NFB is activated in cells that become malignant tumors and cells that are recruited to and constitute the tumor microenvironment. TRAF6 can serve as its activation molecule, leading to the expression of abnormal genes and malignancy (24). TYMS has recently been spotlighted as a target of cancer chemotherapeutics, particularly 5-FU, considering that it plays a role in DNA replication and repair (25). SUMO2 plays a crucial role in nuclear transport, DNA replication and repair, mitosis, and signal transduction (26). As the results showed, network-based analysis could provide subnetworks for EA genes and also have the potential to detect promising related genes.

However, our study had some limitations. First, our analysis was based on reported EA-related genes from existing literature and as a result, the potential biases and deficiencies in the available reports inevitably affected our result. At the same time, there were few studies on the molecular mechanism of EA, and consequently, we might have omitted a number of important processes related to EA. Although the overall quality of PPI databases has been greatly improved, current technical limitations remain, and PPI data may also contain some false-positive results (27). With PPI data becoming more comprehensive and accurate, an EA-specific subnetwork will become more valuable.


We performed a comprehensive investigation into the pathways and molecular network of EA based on the EA genes. Integrating information from biological functions, biochemical pathways, and pathway crosstalk analyses, we found that biochemical processes and pathways associated with metabolic processes, biological regulation processes, and the signal transduction process played key roles in the molecular mechanism of EA. In addition, there were 2 interconnected pathway modules: 1 which included metabolic regulation and drug reactions, and the other transcriptional regulation. Furthermore, we extracted an EA-specific subnetwork and predicted some novel genes potentially bound up with EA. Our results provided critical information for further analysis and indicated that system level analysis was promising for exploring the molecular mechanisms of EA.


Funding: None.


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Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:


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(English Language Editor: A. Muylwyk)

Cite this article as: Li J, Peng L, Li H, Cai Y, Yao P, Chen Q, Li X, Zhou Q. Network and pathway-based analysis of candidate genes associated with esophageal adenocarcinoma. J Gastrointest Oncol 2023;14(1):40-53. doi: 10.21037/jgo-22-1286

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