Downregulation and abnormal expression of e-cadherin and β-catenin in nasopharyngeal carcinoma: Close association with advanced disease stage and lymph node metastasis

Abstract

Nasopharyngeal carcinoma (NPC) is predominantly of the undifferentiated histological subtype. Histological differentiation is of limited prognostic significance in NPC. Recent studies have suggested that downregulation of the cadherin-catenin cell adhesion complex may play a crucial role in the initial stage of cancer invasion and metastasis and is associated with poor prognosis in human cancers. Expression of E-cadherin has not been reported previously in NPC, and its prognostic value in NPC is unknown. The purpose of this study was to examine the expression pattern of E-cadherin and its associated partner, β-catenin, in NPC and their possible applications as prognostic markers to predict the clinical outcome of NPC. Expression of the E-cadherin and β-catenin was examined by immunohistochemical methods in 74 cases of primary NPC and 17 of their corresponding lymph node metastases. Normal nasopharyngeal epithelium showed strong and homogeneous immunocytochemical staining of E-cadherin and β-catenin at the cell membranes and intercellular junctions. In contrast, primary NPC showed variable and heterogeneous staining patterns of E-cadherin and β-catenin. Loss of membranous E-cadherin expression was significantly associated with advanced stages of diseases (P < .001). Eighty percent to ninety percent of NPC in stages IV and V (Ho's staging), respectively, showed a reduced (<35%) membranous staining of E- cadherin compared with normal nasopharyngeal epithelium. Expression of β- catenin also was downregulated in advanced NPC. Ninety percent to one hundred percent of NPC in stages IV and V (Ho's staging) expressed a reduction (<35%) of immunocytochemical staining of β-catenin. The expression pattern of β- catenin staining was strongly associated with the expression of E-cadherin (P < .001). Unlike E-cadherin, nuclear staining of β-catenin expression was observed in some of the primary NPC and lymph node metastasis. Reduced expression of E-cadherin and β-catenin expression was associated with a shorter survival of NPC patients (P < .001). In advanced NPC patients (stages IV and V), a significant difference in survival was observed in tumors with higher or lower levels of E-cadherin expression (P = .0224, log-rank test). These observations suggests that expression of E-cadherin and β-catenin may have prognostic values in NPC patients.