Apoptotic and proliferative activity in the neoplastic progression of Barrett's oesophagus: A comparative study

The balance between proliferation and apoptosis within a tissue is importan t in controlling its overall growth, When either or both are altered, uncon trolled cell proliferation can contribute to cancer. The aim of this study was to investigate apoptosis and proliferation in the progression from Barr ett's oesophagus to adenocarcinoma. Fifty-one paraffin sections of Barrett' s mucosa with both intestinal and gastric-type Barrett's mucosa, dysplasia, and adenocarcinoma, from 28 patients, mere examined for apoptosis using ha ematoxylin and eosin (H & E)-stained sections counterstained immunohistoche mically with CD45 to distinguish leucocytes from apoptotic bodies. Prolifer ation was detected by immunohistochemistry using the MLB-1 (Ki-67) antibody . There was an increase in proliferation in dysplastic and carcinomatous ti ssue compared with metaplastic tissue (p=0.0001). In dysplasia, proliferati on was distributed throughout the basal-luminal axis, whereas in metaplasia , cell division was compartmentalized to the lower crypt (p<0.001). Convers ely, there was a decrease in apoptosis in the upper crypt and luminal surfa ce in dysplasia and adenocarcinoma compared with metaplasia (p<0.0008). The re was a significant increase in apoptotic activity in intestinal-type Barr ett's mucosa compared with gastric-type. There was a highly significant inc rease in the glandular proliferation to apoptosis ratio (GPAR) in the progr ession of metaplasia to dysplasia to adenocarcinoma (p=0.001). The shift in the GPAR in the progression of neoplastic change suggests that it may be a useful and sensitive marker of neoplastic change in Barrett's oesophagus, especially if the assessment of both apoptotic and proliferative activity i n the mucosa can be made easier by more sophisticated technical methods, Co pyright (C) 1999 John Wiley & Sons, Ltd.