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Prognostic Effect of Epithelial Cell Adhesion Molecule Overexpression in Untreated Node-Negative Breast Cancer

Authors' Affiliations: ¹ Department of Obstetrics and Gynecology, Johannes Gutenberg University, and ² Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; ³ Department of Pathology, Johannes Gutenberg University, Mainz, Germany; ⁴ Department of Obstetrics and Gynecology, Ruesselsheim, Germany; ⁵ Department of Obstetrics and Gynecology, Ludwigshafen, Germany; ⁶ Department of Obstetrics and Gynecology, Frankenthal, Germany; ⁷ Siemens Medical Solutions, Diagnostics GmbH, Leverkusen, Germany; ⁸ Insitute of Pathology, Centre Hospitalier Universite Vaudois, University of Lausanne, Lausanne, Switzerland; ⁹ IfADo- Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany; and ¹⁰ Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, Essen Germany

Requests for reprints: Marcus Schmidt, Department of Obstetrics and Gynecology, Johannes Gutenberg University, Medical School, Langenbeckstr. 1, 55131 Mainz, Germany. Phone: 0049-6131-172683; Fax: 0049-6131-175673; E-mail: marcus.schmidt{at}frauen.klinik.uni-mainz.de.

Purpose: Epithelial cell adhesion molecule (Ep-CAM) recently received increased attention not only as a prognostic factor in breast cancer but also as a potential target for immunotherapy. We examined Ep-CAM expression in 402 consecutive node-negative breast cancer patients with long-term follow-up not treated in the adjuvant setting.

Experimental Design: Ep-CAM expression was evaluated by immunostaining. Its prognostic effect was estimated relative to overexpression/amplification of HER-2, histologic grade, tumor size, age, and hormone receptor expression.

Results: Ep-CAM status was positive in 106 (26.4%) patients. In multivariate analysis, Ep-CAM status was associated with disease-free survival independent of age, pT stage, histologic grade, estrogen receptor (ER), progesterone receptor (PR), as well as HER2 status (P = 0.028; hazard ratio, 1.60; 95% confidence interval, 1.05-2.44). Recently, so-called triple-negative (HER-2, ER, and PR) breast cancer has received increased attention. We noticed a similar association of Ep-CAM with disease-free survival in the triple-negative group as for the entire cohort.

Conclusion: In this study of untreated breast cancer patients, Ep-CAM overexpression was associated with poor survival in the entire cohort and in the subgroup of triple-negative breast cancer. This suggests that Ep-CAM may be a well-suited target for specific therapies particularly in HER-2–, ER-, and PR-negative tumors.