title: Expression of carbohydrate antigen sialyl Le(a): a new functional prognostic factor in gastric cancer.
abstract: OBJECTIVE
  The prognostic value of the altered expression of carbohydrate antigens sialyl Le(a) (sLe(a)) and sialyl Le(x) (sLe(x)), which have been implicated as functional ligands in heterotypic-cell-adhesion systems in the multistep process of tumor metastasis, were evaluated.
  
  
  METHODS
  The level of expression of sLe(a) and sLe(x) antigens was examined immunohistochemically in paraffin-embedded tumor samples from 137 patients who underwent resection for gastric cancer. Correlation between the antigens' expression, various established clinicopathologic factors, and prognosis were studied by univariate and multivariate analysis.
  
  
  RESULTS
  Tumors that were positive for the sLe(a) antigen were significantly more likely to be large (P = .035), to be localized at the proximal third of the stomach (P = .018), to have an infiltrate appearance (P = .013), to have an invasive mode both in depth of invasion (P = .028) and in lymphatic invasion (P = .002), and to be classified as late stage (P = .011) than those that were negative for sLe(a), whereas the sLe(x) antigen status was not correlated with any clinicopathologic factors. The overall survival of patients with an sLe(a)-antigen-positive tumor was significantly poorer than that of those with an sLe(a)-antigen-negative tumor (P = .0001). Survival within each pathologic stage differed also (stage I, P = .030; stage II, P = .046; stage III, P = .026, respectively). A Cox regression analysis with multiple covariates showed that positive sLe(a) antigen status was an independent prognostic factor for a worse outcome in patients with gastric cancer. According to the mode of recurrence, increased sLe(a) antigen expression significantly affected both peritoneal dissemination and liver metastasis.
  
  
  CONCLUSIONS
  Increased expression of the sLe(a) antigen may serve as a potent prognostic indicator for recurrence in patients with gastric cancer. Careful follow-up and intensive therapy are required for patients with an sLe(a)-antigen-positive gastric cancer.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakamori
authors.forename: H
authors.initials: H
authors.lastname: Furukawa
authors.forename: M
authors.initials: M
authors.lastname: Hiratsuka
authors.forename: T
authors.initials: T
authors.lastname: Iwanaga
authors.forename: S
authors.initials: S
authors.lastname: Imaoka
authors.forename: O
authors.initials: O
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Kabuto
authors.forename: Y
authors.initials: Y
authors.lastname: Sasaki
authors.forename: M
authors.initials: M
authors.lastname: Kameyama
authors.forename: S
authors.initials: S
authors.lastname: Ishiguro
authors.forename: T
authors.initials: T
authors.lastname: Irimura
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology* / Q000473:pathology / Q000556:secondary; D000704:Analysis of Variance; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D018395:CA-19-9 Antigen; D005260:Female; D005732:Gangliosides / Q000032:analysis*; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000276:immunology* / Q000473:pathology; D016019:Survival Analysis
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D005732:Gangliosides; C064564:sialyl Le(a) ganglioside