Clinical Implications of E-cadherin and N-cadherin as Epithelial to Mesenchymal Transition (EMT) Markers in Breast Cancer

Abstract

Epithelial to mesenchymal transition (EMT) is a widely accepted hypothesis for the progression and metastasis of carcinoma. The purpose of this study was to evaluate the expression of a mesenchymal marker, the loss of an epithelial marker, and to investigate the clinical implications of these markers as prognostic factors in breast cancer.. Clinicopathologic data of 282 patients who underwent surgery for invasive ductal carcinoma (IDC) from February 2001 to December 2008 was used for analysis. Epithelial (E)-cadherin (EC) was considered an epithelial marker and neural (N)-cadherin (NC) was considered a mesenchymal marker. Cases where expression of the mesenchymal marker was present or there was a loss of the epithelial marker were interpreted as the EMT-positive group. Expression of the NC and loss of the EC were observed in 22 (7.8%) and 57 (20.2%) patients. A total of 75 patients (26.6%) were interpreted as EMT-positive. Expression of NC was associated with positive HER2 status (P =0.0456) and HER2 and TN (P =0.0067) subtype. The EMT-positive group correlated with negative ER status (P = 0.0199). There was a trend in 5-year overall survival rate according to EC, NC, and EMT status; however, the differences were not found to be statistically significant. Expression of NC status and the EMT-positive group were found to be a specific immunohistochemical feature and molecular subtype with unfavorable clinical outcomes and prognosis. Further studies with a larger sample size and a greater variety of epithelial and mesenchymal markers are necessary to confirm our findings.