Promotor hypermethylation is a common event in human cancer. O 6 -Methylguanine-DNA Methyltransferase (MGMT) is a gene involved in DNA repair, which is methylated in a variety of cancer types. In colorectal cancer and lung cancer, hypermethylation of MGMT has been correlated with p53 mutation. In the present study, 132 samples of esophageal adenocarcinoma and 58 samples of normal esophageal tissue were investigated for MGMT hypermethylation status by methylation-specific real-time PCR and results were correlated to clinicopathological parameters, patient's survival, p53 mutation and expression of p53 protein and MGMT protein. In the carcinomas, hypermethylation of MGMT was found in 63.6% of cases and loss of MGMT protein expression in 48.5% of cases. Furthermore, MGMT hypermethylation was found in 5.7% of normal esophageal smooth muscle tissue, in 20.0% of esophageal squamous epithelium and in 61.5% of nonneoplastic Barrett's mucosa. In the carcinomas, hypermethylation of the MGMT gene was correlated with loss MGMT protein expression (p < 0.0001) and with high tumor differentiation (p 5 0.0079). In contrast, no correlation between MGMT hypermethylation, Lauren's classification, WHO classification, tumor size, gender, age, pT category and pN category, and p53 status was found. Neither MGMT hypermethylation nor loss of MGMT protein expression was correlated with patient's survival. In conclusion, MGMT hypermethylation in esophageal adenocarcinoma is a frequent event that is associated with loss of MGMT protein expression but not with patient's outcome. ' 2006 Wiley-Liss, Inc.Key words: esophageal adenocarcinoma; MGMT; hypermethylation; prognosis; p53During the last few years, cancer researchers have focused on methylation of cytosine residues within a CpG island. Methylation of cytosine per se is not only found in cancer cells but also in all normal cells in which 3-4% of cytosines are methylated. However, methylation of CpG islands in normal cells occurs only in a limited number of conditions, e.g. in the case of gene imprinting. 1 Since CpG islands are mostly located in promotor regions, i.e. the 5 0 untranslated region or the exon 1 of a gene, CpG island methylation often has an influence on gene expression. 2 Promotor methylation of tumor supressor genes or DNA repair genes has been found within various types of cancer. Additionally it has been shown that promotor methylation of certain genes may be tumor specific and tissue specific. [3][4][5][6] One gene whose promotor has been found methylated in 20-30% of human tumor cell lines is that of the enzyme O 6 -methylguanine-DNA methyltransferase (MGMT; E.C. 2.1.1.63). 7 MGMT, a DNA repair enzyme, removes methyl-or alkyl-groups from guanine after chemical modification and therefore protects cells from G to A mutations. 8 For that reason, hypermethylation of the MGMT promotor can promote the accumulation of mutations within the cell. Previous investigations indicated that MGMT hypermethylation can facilitate G:C to A:T mutations in the tumor suppressor gene p53 i...