High levels of CTSE have been shown to be associated with improved survival in various cancers, but in EAC we found only a non-significant trend in which expression of CTSE above the 25th percentile resulted in a 41 % risk reduction for death.31–33A larger study including patients with worse disease stage could be undertaken, as limited power and small survival differences due to the inclusion of only early stage, chemoradiotherapy-naive patients may have reduced our ability to detect a statistically significant association. Here, CTSE is linked to cancer.