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Down regulation of E-Cadherin (ECAD) - a predictor for occult metastatic disease in sentinel node biopsy of early squamous cell carcinomas of the oral cavity and oropharynx

Gerhard F Huber1*, Lena Züllig1, Alex Soltermann2, Matthias Roessle2, Nicole Graf3, Stephan K Haerle1, Gabriela Studer4, Wolfram Jochum5, Holger Moch2 and Sandro J Stoeckli6

Author Affiliations

1 Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland

2 Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland

3 Clinical Trials Center, Center for Clinical Research, University Hospital Zurich, Switzerland

4 Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland

5 Department of Pathology, Kantonsspital St.Gallen, Switzerland

6 Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St.Gallen, Switzerland

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BMC Cancer 2011, 11:217  doi:10.1186/1471-2407-11-217

Published: 3 June 2011



Prognostic factors in predicting occult lymph node metastasis in patients with head and neck squamous-cell carcinoma (HNSCC) are necessary to improve the results of the sentinel lymph node procedure in this tumour type. The E-Cadherin glycoprotein is an intercellular adhesion molecule in epithelial cells, which plays an important role in establishing and maintaining intercellular connections.


To determine the value of the molecular marker E-Cadherin in predicting regional metastatic disease.


E-Cadherin expression in tumour tissue of 120 patients with HNSCC of the oral cavity and oropharynx were evaluated using the tissue microarray technique. 110 tumours were located in the oral cavity (91.7%; mostly tongue), 10 tumours in the oropharynx (8.3%). Intensity of E-Cadherin expression was quantified by the Intensity Reactivity Score (IRS). These results were correlated with the lymph node status of biopsied sentinel lymph nodes. Univariate and multivariate analysis was used to determine statistical significance.


pT-stage, gender, tumour side and location did not correlate with lymph node metastasis. Differentiation grade (p = 0.018) and down regulation of E-Cadherin expression significantly correlate with positive lymph node status (p = 0.005) in univariate and multivariate analysis.


These data suggest that loss of E-cadherin expression is associated with increased lymhogeneous metastasis of HNSCC. E-cadherin immunohistochemistry may be used as a predictor for lymph node metastasis in squamous cell carcinoma of the oral cavity and oropharynx.

Level of evidence: 2b

Head and Neck squamous cell carcinoma (HNSCC); oral cavity; oropharynx; E-Cadherin (ECAD); Immunohistochemistry; Sentinel node biopsy