Proliferating cell nuclear antigen (PCNA) has been shown to be of prognostic significance in some gastrointestinal tumors. Immunohistochemical analysis was performed to determine whether PCNA is useful for predicting the outcome of patients with squamous cell carcinoma of the esophagus. Using a mouse monoclonal antibody, PC 10, the expression of PCNA was studied in resected squamous cell carcinomas of the esophagus from 59 patients who had undergone curative esophagectomy. None had received any preceding therapy. The proliferation rate was assessed in terms of the percentage of the PCNA-positive nuclear area relative to the total area of cancer nuclei using a cell analysis system (CAS). Clinicopathological variables including PCNA staining were assessed in relation to prognosis. Survival rate was obtained by the Kaplan-Meier method. The PCNA indices (percentage of the positive nuclear area) of the tumors varied from 4.4% to 96.2%. Among the clinicopathological variables, only tumor size (5 cm) and depth of invasion were correlated significantly with PCNA index (P<0.05). Microscopically, PCNA was stained in non-keratinized cells but not in keratinized cells. However the histological grade was not correlated with PCNA index. The survival rate was significantly worse in patients with high PCNA indices (> or = 40%) than in those with low indices (<40%) (P<0.05). However, multivariate analysis revealed that PCNA index was not an independent prognostic factor.