title: Expression of cell adhesion molecules and prognosis in breast cancer.
abstract: BACKGROUND
  Cell adhesion molecules (CAMs) play an important role in the process of metastasis. The prognostic value of tumour expression of N-cadherin, E-cadherin, carcinoembryonic antigen (CEA) and epithelial CAM (Ep-CAM) was evaluated in patients with breast cancer.
  
  
  METHODS
  A tissue microarray of the patient cohort was stained immunohistochemically for all markers and analysed by microscopy. Expression was classified into two categories, with the median score as cut-off level. For CEA, the above-median category was further subdivided in two subgroups based on staining intensity (low or high intensity).
  
  
  RESULTS
  The cohort consisted of 574 patients with breast cancer with a median follow-up of 19 years. Below-median expression of E-cadherin (P = 0·015), and above-median expression of N-cadherin (P = 0·004), Ep-CAM (P = 0·046) and CEA (P = 0·001) all resulted in a shorter relapse-free period. Multivariable analysis revealed E-cadherin and CEA to be independent prognostic variables. Combined analysis of CEA and E-cadherin expression showed a 3·6 times higher risk of relapse for patients with high-intensity expression of CEA, regardless of E-cadherin expression, compared with patients with below-median CEA and above-median E-cadherin tumour expression (hazard ratio 3·60, 95 per cent confidence interval 2·12 to 6·11; P < 0·001). An interaction was found between expression of these two CAMs (P < 0·001), suggesting a biological association.
  
  
  CONCLUSIONS
  Combining E-cadherin and CEA tumour expression provides a prognostic parameter with high discriminative power that is a candidate tool for prediction of prognosis in breast cancer.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Saadatmand
authors.forename: E M
authors.initials: EM
authors.lastname: de Kruijf
authors.forename: A
authors.initials: A
authors.lastname: Sajet
authors.forename: N G
authors.initials: NG
authors.lastname: Dekker-Ensink
authors.forename: J G H
authors.initials: JG
authors.lastname: van Nes
authors.forename: H
authors.initials: H
authors.lastname: Putter
authors.forename: V T H B M
authors.initials: VT
authors.lastname: Smit
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: G J
authors.initials: GJ
authors.lastname: Liefers
authors.forename: P J K
authors.initials: PJ
authors.lastname: Kuppen
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality*; D015820:Cadherins / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000401:mortality*; D015815:Cell Adhesion Molecules / Q000378:metabolism*; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism*; D011379:Prognosis
chemical_list: D000951:Antigens, Neoplasm; D015820:Cadherins; D002272:Carcinoembryonic Antigen; D015815:Cell Adhesion Molecules; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule; D009363:Neoplasm Proteins