Cell surface carbohydrates as prognostic markers in human carcinomas.

Tumour development is usually associated with changes in cell surface carbohydrates. These are often divided into changes related to terminal carbohydrate structures, which include incomplete synthesis and modification of normally existing carbohydrates, and changes in the carbohydrate core structure. The latter includes chain elongation of both glycolipids and proteins, increased branching of carbohydrates in N-linked glycoproteins, and blocked synthesis of carbohydrates in O-linked mucin-like glycoproteins. In mature organisms, expression of distinct carbohydrates is restricted to specific cell types; within a given tissue, variation in expression may be related to cell maturation. Tumour-associated carbohydrate structures often reflect a certain stage of cellular development; most of these moieties are structures normally found in other adult or embryonic tissues. There is no unique tumour carbohydrate structure, since certain structures which are tumour-related in one organ may be normal constituents of other tissues. Tumour-associated carbohydrate changes have been used in the diagnosis of human cancers. Recently, however, it has been demonstrated that the expression of some carbohydrate structures is associated with prognosis. Tn, sialyl-Tn, and T are cell membrane-bound mucin-like carbohydrate structures that may be expressed in tumours due to blocked synthesis of the core carbohydrate chain of mucin-like structures. Their expression is strongly associated with prognosis in certain tumours, but the biological relationship between their expression and tumour progression is at present unknown. The blood group-related carbohydrate structures Le(x), sialyl-Le(x), ABH, and Le(y) are examples of terminal carbohydrate structures which are related to tumour prognosis. These structures are of increasing interest since they may function as adhesion molecules; adhesion of tumour cells to endothelial cells of blood vessels may be mediated by an interaction between sialosyl-Le(x) and E-selectin and studies indicate that Le(y) is related to cell motility. These findings are now the basis for tumour therapeutic experiments.