EXPRESSION OF ONCOPROTEINS AND THE AMOUNT OF EOSINOPHILIC AND LYMPHOCYTIC INFILTRATES CAN BE USED AS PROGNOSTIC FACTORS IN GASTRIC-CANCER

Preoperative staging of gastric cancer is difficult. Several molecular markers associated with initiation and progression of cancer seem pro mising for obtaining preoperative prognostic information. To investiga te whether these markers are indicative especially for the presence of lymph node metastases in patients with gastric cancer, we have examin ed primary tumour specimens from 105 patients with primary adenocarcin oma of the stomach entered in a surgical trial. In this trial, lymph n ode status was determined by strictly quality-controlled lymph node di ssection and examination. The selected markers were growth regulators (p53, Rb and myc), metastasis-suppressor gene product (nm23), adhesion molecules (Ep-CAM, E-cadherin, CD44v5 and CD44v6) and urokinase-type plasminogen activator (u-PA). Also, the amount of eosinophilic and lym phocytic infiltrates available post-operatively was analysed with resp ect to its prognostic value for lymph node status. Moreover, the assoc iation of these parameters with survival and disease-free period (DFP) was evaluated. Of all molecular markers investigated, only Rb express ion had a significant association with the presence of lymph node meta stasis in both univariate and multivariate analysis. For curative rese ctability, a significant association was found with Rb and E-cadherin expression, while in multivariate analysis Rb and myc were selected as the combination with additional independent prognostic value, and E-c adherin had no additional independent value. For overall survival in u nivariate analysis, the amount of both eosinophilic and lymphocytic in filtrates and Rb and myc expression were of significant prognostic val ue. Only the amount of lymphocytic infiltrate had a prognostic signifi cance for DFP. In stepwise multivariate analysis, TNM stage (I+II) and marked lymphocytic infiltrate were associated with better overall sur vival and longer DFP. We conclude that, if these results are confirmed in a larger series of patients, molecular markers can provide useful prognostic information.