Preoperative chemoradiotherapy alters the expression and prognostic significance of adhesion molecules in Barrett's-associated adenocarcinoma

A variety of prognostic markers have been related to decreased patient surv ival in patients: with epithelial malignancies. These include expression of the homotypic adhesion molecule E-cadherin (ECAD) and the hyaluronic acid receptor CD44. Expression of ECAD and CD44 was evaluated in Barrett's-assoc iated adenocarcinoma (BAd) from 67 patients. Expression was determined by i mmunoperoxidase staining and graded semiquantitatively based on the proport ion of positively stained cells. These data were then correlated with clini cal and pathological parameters, including the presence or absence of chemo radiotherapy (chemrad) and patient survival. There were 56 men and 11 women (mean age, 62 years). Thirty-nine (58%) patients received preoperative che mrad. ECAD expression was detected in all (100%) tumors. The ECAD staining grade did not correlate with other pathological features of the tumors. How ever, ECAD staining was significantly increased in BAd of patients who rece ived chemrad (P = .003), in comparison with those who did not, and in indiv idual patients when prechemrad biopsies and postchemrad resection specimens were compared (P = .04). In terms of prognosis, increased ECAD expression was associated with shortened patient survival only in BAd patients who had received chemrad (univariate analysis of chemrad patients with stage I and II BAd, P = .02). ECAD expression was not significantly associated with su rvival in BAd patients who did not receive chemrad. CD44 expression was det ected in 88% of cases, CD44 expression did not correlate with any of the pa thological features of the tumors or with chemrad status. Increased express ion of CD44 was significantly associated with shortened patient survival in chemrad patients only (univariate analysis P = .03, multivariate analysis P = .04), although a strong trend was observed when all patients were analy zed regardless of chemrad status (P = .07). The results of this study indic ate that chemrad alters the expression of ECAD in BAd. Thus, the prognostic utility of ECAD expression must be evaluated in the context of chemrad sta tus. CD44 also may be a valuable prognostic marker in BAd. Copyright (C) 20 00 by W.B. Saunders Company.