title: Prognostic significance of E-cadherin expression and peripheral blood micrometastasis in gastric carcinoma patients.
abstract: BACKGROUND
  The primary objective is to evaluate the prognostic value of E-cadherin (E-cad) expression and peripheral blood micrometastasis (PBMM) in gastric carcinoma. Secondary objective is to study the association between these 2 markers and the clinicopathological features of the patients.
  
  
  METHODS
  This study took place at Ain Shams University Hospitals. A total of 30 patients with histologically proven gastric adenocarcinoma after curative surgical resection were enrolled in this study. E-cad expression was assessed in tumor tissue samples. Before the start of adjuvant chemoradiotherapy, fresh blood samples were collected to detect PBMM as indicated by cytokeratin18 mRNA expression using real-time quantitative polymerase chain reaction (RQ-PCR).
  
  
  RESULTS
  Both abnormal E-cad expression and PBMM were significantly associated with lymph node metastasis, TNM stage, and lymphatic invasion. Moreover, PBMM was significantly associated with poor tissue differentiation and vascular invasion (P < .05). We found strong agreement between E-cad expression and presence of PBMM (P = .001). Both cases with altered E-cad expression and cases with positive PPMM showed shorter relapse-free survival (RFS) (P = .003 and <.001, respectively). Cox regression analysis showed that positive PBMM was independent predictor factor for relapse (hazard ratio [HR] = 6.14; 95% confidence interval [95% CI] = 1.06-35.63; P = .04). Cases with positive PBMM showed shorter overall survival (OS) (P = .001).
  
  
  CONCLUSIONS
  In conclusion, loss of normal E-cad expression in gastric cancer showed a close correlation with the presence of PBMM. PBMM was associated with poor RFS independent of other clinicopathological features. Additionally, detection of PBMM was a significant indicator of OS, and intensive chemotherapy seems to be indicated for these patients.
authors.affiliation: Department of Clinical Pathology, Ain Shams University, Cairo, Egypt. salmazead@yahoo.com
authors.forename: Abeer A
authors.initials: AA
authors.lastname: Saad
authors.forename: Nahla M
authors.initials: NM
authors.lastname: Awed
authors.forename: Nashwa N A
authors.initials: NN
authors.lastname: Abd Elkerim
authors.forename: Dina
authors.initials: D
authors.lastname: El-Shennawy
authors.forename: Marian A
authors.initials: MA
authors.lastname: Alfons
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Elserafy
authors.forename: Yaser W
authors.initials: YW
authors.lastname: Darwish
authors.forename: Eman M F
authors.initials: EM
authors.lastname: Barakat
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Ezz-Elarab
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism* / Q000473:pathology*; D015820:Cadherins / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D013274:Stomach Neoplasms / Q000378:metabolism* / Q000473:pathology*; D016019:Survival Analysis
chemical_list: D015820:Cadherins