Esophageal Cancer
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2005; 11(37): 5751-5756
Published online Oct 7, 2005. doi: 10.3748/wjg.v11.i37.5751
Significance and prognostic value of lysosomal enzyme activities measured in surgically operated adenocarcinomas of the gastroesophageal junction and squamous cell carcinomas of the lower third of esophagus
Aron Altorjay, Balazs Paal, Nicolette Sohar, Janos Kiss, Imre Szanto, Istvan Sohar
Aron Altorjay, Balazs Paal, Department of Surgery, Saint George University Teaching Hospital, Szekesfehervar, Seregelyesi u. 3., H-8000, Hungary
Nicolette Sohar, Istvan Sohar, Center for Advanced Biotechnology and Medicine, UMDNJ, Piscataway , NJ , USA
Janos Kiss, Imre Szanto, National Medical Center, Department of Surgery, Budapest, Szabolcs u. 33-35., H-1135, Hungary
Author contributions: All authors contributed equally to the work.
Correspondence to: Aron Altorjay, MD, PhD, Professor of Surgery, Department of Surgery, Saint George University Teaching Hospital, Seregelyesi u. 3., Szekesfehervar, H-8000, Hungary . altorjay@mail.fmkorhaz.hu
Telephone: +36-22-504-100 Fax: +36-22-504-100
Received: December 23, 2004
Revised: February 15, 2005
Accepted: February 18, 2005
Published online: October 7, 2005
Abstract

AIM: To establish whether there are fundamental differences in the biochemistries of adenocarcinomas of the gastroesophageal junction (GEJ) and the squamous cell carcinomas of the lower third of the esophagus (LTE).

METHODS: Between February 1, 1997 and February 1, 2000, we obtained tissue samples at the moment of resection from 54 patients for biochemical analysis. The full set of data could be comprehensively analyzed in 47 of 54 patients samples (81%). Of these, 29 were adenocarcinomas of the GEJ Siewert type I (n = 8), type II (n = 12), type III (n = 9), and 18 presented as squamous cell carcinomas of the LTE. We evaluated the mean values of 11-lysosomal enzyme and 1-cytosol protease activities of the tumorous and surrounding mucosae as well as their relative activities, measured as the ratio of activity in tumor and normal tissues from the same patient. These data were further analyzed to establish the correlation with tumor localization, TNM stage (lymph-node involvement), histological type (papillary, signet-ring cell, tubular), state of differentiation (good, moderate, poor), and survival (≤ 24 or ≥ 24 mo).

RESULTS: In adenocarcinomas, the activity of α-mannosidase (AMAN), cathepsin B (CB) and dipeptidyl-peptidase I (DPP I) increased significantly as compared to the normal gastric mucosa. In squamous cell carcinomas of the esophagus, we also found a significant difference in the activity of cathepsin L and tripeptidyl-peptidase I in addition to these three. There was a statistical correlation of AMAN, CB, and DPP I activity between the level of differentiation of adenocarcinomas of the GEJ and lymph node involvement, because tumors with no lymph node metastases histologically confirmed as well-differentiated, showed a significantly lower activity. The differences in CB and DPP I activity correlated well with the differences in survival rates, since the CB and DPP I values of those who died within 24 mo following surgical intervention were significantly higher than of those who survived for 2 years or more.

CONCLUSION: Adenocarcinomas of the GEJ form a homogenous group from a tumor-biochemical aspect, and differ from the biochemical characteristics of squamous cell carcinomas of the LTE on many points. When adenocarcinomas of the GEJs are examined at the preoperative phase, the ratio of the performed AMAN, CB, and DPP I enzymatic activity of the tissue sample from the tumor and adjacent intact mucosa within2 cm of the tumor may have a prognostic value even in the preoperative examination period, and may indicate that ranking of these patients into the neo-adjuvant treatment group should be considered.

Keywords: Prognostic value; Lysosomal enzymes; Cardiac adenocarcinomas; Siewert classification; Esophageal squamous cell carcinoma