Immune expression of E-cadherin and α, β and γ-Catenin adhesion molecules and prognosis for upper urinary tract urothelial carcinomas

INTRODUCTION: Cell adhesion molecules (CAM) are required for maintaining a normal epithelial phenotype, and abnormalities in CAM expression have been related to cancer progression, including bladder urothelial carcinomas. There is only one study that correlates E-cadherin and α-, β- and γ-catenin expression with prognosis of upper tract urothelial carcinomas. Our aim is to study the pattern of immune expression of these CAMs in urothelial carcinomas from the renal pelvis and ureter in patients who have been treated surgically. Our goal is to correlate these expression levels and characteristics with well-known prognostic parameters for disease-free survival. MATERIALS AND METHODS: We evaluated specimens from 20 patients with urothelial carcinomas of the renal pelvis and ureter who were treated with nephroureterectomy or ureterectomy between June 1997 and January 2007. CAM expression was evaluated by immunohistochemistry in a tissue microarray and correlated with histopathological characteristics and patient outcomes after a mean follow-up of 55 months. RESULTS: We observed a relationship between E-cadherin expression and disease recurrence. Disease recurrence occurred in 87.5% of patients with strong E-cadherin expression. Only 50.0% of patients with moderate expression and 0% of patients with weak or no expression of E-cadherin had disease recurrence (p = 0.014). There was also a difference in disease-free survival. Patients with strong E-cadherin expression had a mean disease-free survival rate of 49.1 months, compared to 83.9 months for patients with moderate expression (p = 0.011). Additionally, an absence of α-catenin expression was associated with tumors that were larger than 3 cm (p = 0.003). CONCLUSIONS: We demonstrated for the first time that immune expression of E-cadherin is related to tumor recurrence and disease-free survival rates, and the absence of α-catenin expression is related to tumor size in upper tract urothelial carcinomas.

Análise da expressão de moléculas de adesão no carcinoma urotelial do trato urinário superior: implicações prognósticas / Analysis of adhesion molecules expression in the urothelial carcinoma of the upper urinary tract: prognostic implications

Introdução: As moléculas de adesão celular (MAC) participam da interação entre o epitélio e a matriz extracelular (MEC) que são importantes para o desenvolvimento normal da célula. Alguns estudos têm revelado que alterações na expressão das MAC têm implicações no processo de carcinogênese. Nosso objetivo foi estudar a influencia da expressão da E-caderina e cateninas por imuno-histoquímica (IH) na previsão prognóstica de pacientes com carcinoma urotelial do trato urinário superior submetidos à cirurgia. Material e métodos: Avaliamos os espécimes de 20 pacientes com carcinoma urotelial da pelve renal e ureter tratados com nefroureterectomia ou ureterectomia com intenção curativa entre junho de 1997 e janeiro de 2007, todas realizadas pelo mesmo cirurgião (MS). A expressão das MAC foi avaliada através de IH pela técnica de microarranjo tecidual ou tissue microarray (TMA), e correlacionada com as características anatomopatológicas do tumor e sobrevida dos pacientes Resultados: Observamos uma relação entre a expressão de E-caderina com a recidiva da doença. Dos tumores com expressão forte de E-caderina, 85,7% sofreram recidiva contra 50,0% daqueles com moderada expressão (p=0,014). Também houve diferença na sobrevida livre de doença, sendo que aqueles com expressão forte evidenciaram media de sobrevida livre de doença de 49,1 meses, enquanto aqueles com expressão moderada ou ausente sofreram média de 83,9 meses (p=0,011). A ausência de expressão de -catenina se relacionou com maior frequência de tumores com mais de 3cm (p=0,003). Conclusões: Demonstramos que a imuno-expressão da E-caderina e - catenina estão relacionadas com recidiva e tamanho tumoral no carcinoma urotelial do trato urinário alto, podendo constituir novos marcadores prognósticos nessa neoplasia.

Introduction: The cell adhesion molecules (CAM) participating in the interaction between epithelium and extracellular matrix (ECM) that are important for normal development of the cell. Some studies have shown that changes in the expression of CAM have implications in the process of carcinogenesis. We studied the E-cadherin and catenins expression profile by immunohistochemistry in patients with urothelial carcinoma of upper urinary tract underwent surgery. Materials and Methods: We evaluated specimens from 20 patients with urothelial carcinoma of renal pelvis and ureter treated with nephroureterectomy or ureterectomy between June 1997 and January 2007, all performed by one surgeon (MS). The expression of CAM was evaluated by tissue microarray technique (TMA). Results: We observed a relation between E-cadherin expression with disease recurrence. Tumors with strong expression of E-cadherin, 85.7% recurrence compared to 50.0% of those with moderate expression and 0.0% with weak expression (p = 0.014). There was also a difference in disease-free survival, and those with strong expression recurrence a median time of 49.1 months while those with moderate expression recurrence a median time of 83.9 months (p = 0.011). The absence of -catenin expression was associated with tumors larger than 3 cm (p = 0.003). Conclusions: We demonstrate that the immuno-expression of E-cadherin and -catenin are related to recurrence and tumor size in urothelial carcinoma of upper urinary tract, may be new prognostic markers in these disease.