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Annals of Surgical Oncology, Vol 6, Issue 3 290-297, Copyright © 1999 by Society of Surgical Oncology
ARTICLES |
W. Polkowski, J. W. van Sandick, G. J. Offerhaus, F. J. ten Kate, J. Mulder, H. Obertop and J. J. van Lanschot
Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
BACKGROUND: The prognostic value of the Lauren classification and of c-erbB-2 oncogene overexpression has been described for gastric cancer. The aim of this study was to investigate the clinical significance of these factors in adenocarcinoma of the esophagus and/or gastroesophageal junction (GEJ). METHODS: Forty-one adenocarcinomas of the esophagus and/or GEJ were reviewed for tumor stage, lymph node status, Lauren classification, and c-erbB-2 overexpression, as assessed by immunohistochemical analysis. RESULTS: According to the Lauren classification, tumors were classified as intestinal-, mixed-, or diffuse-type (54%, 32%, and 15%, respectively). Diffuse-type tumors were associated with a significantly worse prognosis than were intestinal-type tumors (P = .018; log-rank test). The prognostic value of the Lauren classification was independent of stage (P = .048; Cox regression model). Overexpression of c-erbB-2 was detected in 24% of the tumors and was present exclusively in intestinal-type tumors and in intestinal-type areas of mixed-type tumors. Ten of the 30 stage III/IV tumors (33%) were c-erbB-2-positive, whereas none of the 11 stage I/II tumors (0%) overexpressed the oncogene product (P = .04; Fisher exact test). The prognostic value of c-erbB-2 overexpression was not independent of stage (P = .7; Cox regression model). CONCLUSIONS: (1) The Lauren classification is an independent prognostic factor in adenocarcinoma of the esophagus and GEJ. (2) c-erbB-2 overexpression is limited to (areas of) intestinal-type tumors, indicating that intestinal- and diffuse-type tumors differ oncogenetically. (3) c-erbB-2 overexpression is associated with the stage of disease, indicating that it is a late event during tumor progression.
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