Gastric mucin and beta-catenin are useful markers to predict submucosal invasion and lymph node metastasis in intestinal type early gastric cancer

Background and aim: With the increasing therapeutic use of endoscopic resection for intestinal early gastric cancer (EGC), it is very important to predict biological behaviors of intestinal type EGC prior to endoscopic resection. On this background, we tried to elucidate the presumptive clinicopathologic factors and biologic markers to predict submucosal invasion and lymph node metastasis based on mucin expression in EGCs. Methods: One hundred and thirty cases of intestinal EGCs were divided as EGCs with intestinal mucin phenotypes (EGC-IPs) and EGCs with gastric mucin phenotypes (EGC-GPs) based on mucin expression. The expressions of mucins (Muc2, Muc5Ac, Muc6, CD10), other protein markers (p53, CDX2, beta-catenin, E-cadherin, Smad4) by immunohistochemistry were studied. Results: EGC-IPs showed significantly increased p53 expression, CDX2 expression and beta-catenin delocalization than EGC-GPs. Using binary logistic regression analysis, expression of both gastric mucin and nuclear beta-catenin expression could be independent predictive factors of lymph node metastasis and submucosal invasion in intestinal EGCs. Lymphovascular emboli, and size of lesion could be clinicopathological independent predictive factors of lymph node metastasis and submucosal invasion in intestinal EGCs, respectively. Conclusions: Taken together, we suggest that beta-catenin expression based on mucin phenotype might be used to predict biologic behavior prior to endoscopic mucosal resection in intestinal EGC.