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Open Access Research article

High EpCAM expression is linked to proliferation and lauren classification in gastric cancer

Feride Kroepil1, Agnieszka Dulian1, Daniel Vallböhmer1, Helene Geddert4, Andreas Krieg1, Christian Vay1, Stefan A Topp1, Jan Schulte am Esch1, Stephan E Baldus2, Olivier Gires3, Wolfram T Knoefel1 and Nikolas H Stoecklein1*

Author Affiliations

1 Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

2 Department of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

3 Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Munich, Germany

4 Institute of Pathology St. Vincent’s Hospital, Karlsruhe, Germany

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BMC Research Notes 2013, 6:253  doi:10.1186/1756-0500-6-253

Published: 5 July 2013

Abstract

Background

The association of EpCAM expression with the progression of gastric cancer remains unclear. Here, we investigated the expression of EpCAM in gastric cancer subtypes and correlated the data to tumor cell proliferation and clinicopathologic factors.

Methods

The intratumoral expression of EpCAM was assessed in 163 primary gastric cancers (61 diffuse-, 62 intestinal-, 32 mixed-type and 8 unclassified tumors) by immunohistochemistry, using the monoclonal antibody Ber-EP4. Intensity of staining was classified according the HercepTest-score using a standardized scoring system. Ki-67 was used to examine the proliferation in tumor tissue.

Results

Strong EpCAM expression was observed in 77% of the tumors and in 85% of the corresponding lymph nodes. Of the primary tumors, 58% (n=74) presented a homogeneous intratumoral EpCAM expression while 42% were characterised by a heterogenous expression pattern. Tumors with high EpCAM expression at the invasive front were associated with significantly (p=0.03) higher proportion of lymph node metastases and lower median overall survival (p=0.001). Diffuse type tumors presented a significantly higher EpCAM expression at the invasion front compared with the tumor centre (p=0.036). Multivariate survival analysis identified high EpCAM expression at the invasive front as an independent prognostic factor.

We observed a significant (p=0.001) correlation between high EpCAM expression and higher tumor cell proliferation.

Conclusion

High EpCAM expression associates with proliferation and progression of gastric cancer, especially in the diffuse type. Considering the discontenting results of the current adjuvant concepts for gastric cancer patients, EpCAM might be target in the adjuvant therapy of this malignant disease.

Keywords:
Gastric cancer; EpCAM expression; Laurén-classification; Overall survival; Ki 67