Notch3 signaling is associated with MUC5AC expression and favorable prognosis in patients with small intestinal adenocarcinomas

BackgroundNotch signaling plays diverse roles not only in physiologic processes, including development and differentiation but also in tumorigenesis, either as a tumor promoter or suppressor depending on the cellular context, level of expression and cross-talk with other signaling pathways. In this study we investigated the expression of Notch3 and MUC proteins and their clinicopathological significance in small intestinal adenocarcinoma (SIAC).MethodsSurgically resected 191 SIACs and their clinical data were collected. Immunohistochemistry for Notch3, MUC2, MUC5AC, and MUC6 using tissue microarrays from formalin-fixed paraffin-embedded normal and matched tumor tissues was performed.ResultsNotch3 expression was found in 52 (29.9%) cases of the tumors. MUC2, MUC5AC, and MUC6 were expressed in 52 (27.5%), 51 (31.9%), and 42 (22.0%) cases of the tumor, respectively. Notch3 expression was correlated with the absence of lymphovascular invasion (p = 0.009), lower T stage (p = 0.038), and histological subtype of tubular adenocarcinoma (p = 0.01), respectively. MUC2 was correlated with large tumor size (p = 0.013) and mucinous and signet ring cell adenocarcinomas (p = 0.01). MUC5A was correlated with proximal tumor location (p < 0.0001) and tumor differentiation (p = 0.027). MUC6 was correlated with proximal tumor location (p < 0.0001) and lower pT stage (p = 0.009), and absence of lymphovascular invasion, respectively. A significant correlation was noted between Notch3 and MUC5AC expression (p = 0.019). Notch3 expression was a relatively favorable prognostic factor in SIACs by univariate (p = 0.05) and multivariate analysis (p = 0.08, Cox Hazard ratio 0.841).ConclusionOur findings indicate that Notch3 signaling, associated with MUC5AC expression, could be a more favorable prognostic factor in SIACs.