Prognostic factors in Barrett's esophagus: an immunohistochemical and morphometric study of 120 cases

Barrett's esophagus is a condition in which the squamous mucosa that normally lines the distal esophagus is replaced by a columnar type of epithelium. Although it carries a clear risk of adenocarcinoma, the estimation of this risk and therefore the value of endoscopic screening remain highly controversial.

To investigate more sensitive techniques to identify those patients who are at high risk of developing cancer and who need intensive endoscopic surveillance for early detection.

A morphologic, histochemical and morphometric study was performed on paraffin-embedded material from 120 patients with Barrett's esophagus and 18 with adenocarcinoma. In addition, each sample was analyzed immunohistochemically with proliferating cell nuclear antigen (PCNA), p53, c-erbB-2, CEA and EMA antibodies.

In all zones of the glandular mucosa we found a higher percentage of PCNA-positive nuclei when the specialized epithelium was present. We saw PCNA expression in 75% of the patients with adenocarcinoma, and p53 expression in 15% of the patients without dysplasia, 37% of the patients with dysplasia and 44% of the patients with adenocarcinoma. Positivity for c-erbB-2 was found in 38% of the patients without dysplasia, 53% of those with dysplasia and 37% of those with adenocarcinoma. Aneuploidy was found in 70% of the patients with metaplasia or dysplasia and in all patients with adenocarcinoma.

We conclude that p53, PCNA overexpression and aneuploidy are markers of risk for malignancy in Barrett's esophagus.