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Prognostic value of DNA ploidy and c erb B‐2 oncoprotein overexpression in adenocarcinoma of Barrett's esophagus
Author(s) -
Nakamura Tsutomu,
Nekarda Hjalmar,
Hoelscher Arnulf H.,
Bollschweiler Elfriede,
Harbec Nadia,
Becker Karen,
Siewert J. Ruediger
Publication year - 1994
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19940401)73:7<1785::aid-cncr2820730703>3.0.co;2-0
Subject(s) - adenocarcinoma , lymph node , esophagus , medicine , pathology , immunohistochemistry , aneuploidy , primary tumor , clinical significance , cancer , cancer research , oncology , biology , metastasis , gene , biochemistry , chromosome
Abstract Background . During the last two decades, a rising incidence of adenocarcinoma of the esophagus has been observed in the Western world. The prognostic relevance of tumor‐biological factors, such as DNA ploidy or c‐ erb B‐2 overexpression, for overall survival following complete resection is still unknown. Methods . In a retrospective study of 80 patients with adenocarcinoma of Barrett's esophagus, the prognostic significance of flow cytometric DNA ploidy determination was investigated. Overexpression of c‐ erb B‐2 oncoprotein was studied by immunohistochemical alkaline phosphatase‐antialkaline phosphatase staining of formalin fixed, paraffin embedded tissue sections of the primary tumor. Results . The rate of aneuploidy was 86%. Aneuploidy was significantly correlated with lymph node metastases only. c‐ erb B‐2 oncoprotein overexpression of the primary tumor was detected in 15 patients (19%). A significant correlation was seen between c‐ erb B‐2 overexpression and depth of tumor invasion, lymph node involvement, distant metastases, and status of residual tumor after resection (R category, International Union Against Cancer [UICC], 1987). All primary tumors with c‐ erb B‐2 oncoprotein overexpression were aneuploid. In a multivariate Cox regression analysis for overall survival of those 62 patients (78%) whose tumor resection was macroscopically and microscopically complete (RO‐UICC), depth of invasion, distant metastases, and c‐ erb B‐2 over‐expression were independent prognostic factors. The relative risk of death due to recurrence was nearly identical for patients with either c‐ erb B‐2 oncoprotein overexpression or distant metastases: 4.06 (1.4–11.8) and 3.94 (1.6–9.5). In a multivariate Cox regression analysis of the subgroup of lymph node‐negative patients (n = 26), the ploidy status of the primary tumor (defined as neardiploid plus tetraploid versus aneuploid plus multiploid) was the only independent prognostic factor for overall survival. Conclusions . These findings demonstrate that DNA ploidy as well as c‐ erb B‐2 oncoprotein overexpression are valuable prognostic factors in patients with adenocarcinoma of Barrett's esophagus after complete tumor resection.