E-cadherin expression as predictive marker of proximal resection line involvement for advanced carcinoma of the gastric cardia.
OBJECTIVE
Total gastrectomy for gastric cardia tumours harbours a high risk of proximal resection line (PRL) involvement. The adhesion markers CD44v6 and E-cadherin were evaluated as predictive factors for PRL involvement independent of tumour stage.


METHODS
Forty-nine gastrectomy specimens for gastric cardia carcinoma (type II) were evaluated for stage, resection margins, and CD44v6 and E-cadherin immunohistochemistry.


RESULTS
PRL involvement was microscopically recognized in 49% of specimens. CD44v6 expression was found in 84% of intestinal tumours, and in 56% of diffuse/mixed tumours (p=0.045). In the group of resections performed with curative intent, the proximal extension of the resection (margin) was significantly shorter in E-cadherin negative tumours than in E-cadherin positive tumours (p=0.029). Histological type and stage of the tumour, lymph node metastases, and absence of E-cadherin expression, but not the presence of CD44v6 correlated with PRL involvement. Only the absence of E-cadherin expression appeared to be a significant predictor of PRL involvement, independent of tumour stage. Survival for patients with PRL involvement was shorter than that for patients after R0 resection (p=0.07). Stage was the only independent prognostic factor emerging from multivariate survival analysis (p=0.002).


CONCLUSIONS
When curative resection is intended in type II cardiac cancer patients, an oesophageal resection and gastric tube reconstruction should be considered, especially for a tumour without E-cadherin expression.
Polkowski
Wojciech P
WP
Second Department of General Surgery, Medical University of Lublin, Lublin, Poland. wojpolk@panaceum.am.lublin.pl
Skomra
Danuta G
DG
Mielko
Jerzy
J
Wallner
Grzegorz T
GT
Szumiło
Justyna
J
Zinkiewicz
Krzysztof
K
Korobowicz
Elzbieta M
EM
van Lanschot
J Jan B
JJ
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D015820:Cadherins / Q000032:analysis*; D002299:Cardia / Q000473:pathology* / Q000601:surgery; D002448:Cell Adhesion; D005260:Female; D005544:Forecasting; D005743:Gastrectomy; D006023:Glycoproteins / Q000032:analysis; D006801:Humans; D018960:Hyaluronan Receptors / Q000032:analysis; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate
D014408:Biomarkers, Tumor; C112697:CD44v6 antigen; D015820:Cadherins; D006023:Glycoproteins; D018960:Hyaluronan Receptors