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MUC4 expression is a novel prognostic factor in patients with invasive ductal carcinoma of the pancreas

¹ Department of Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
² Department of Pathology, Kagoshima Medical Association Hospital, 890-0064, Japan
³ Department of Surgery, Kagoshima Medical Association Hospital
⁴ Research Centre for Life Science Resources, Kagoshima University, Kagoshima 890-8544, Japan
⁵ Departments of Biochemistry and Molecular Biology, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-4525, USA
⁶ Surgical Oncology and Digestive Surgery, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences
⁷ Department of Internal Medicine, Sapporo Medical College, Sapporo 060-8556, Japan

Correspondence to:
Dr S Yonezawa
Department of Human Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan; syoneza{at}m2.kufm.kagoshima-u.ac.jp Background: Many patients with invasive ductal carcinoma of the pancreas (IDC) have a poor outcome. MUC4 expression has been implicated as a marker for diagnosis and progression of IDC, but there are no studies of the relation between MUC4 expression and patient prognosis in IDC.

Aims: To investigate the prognostic significance of MUC4 expression in IDC.

Methods: The expression profiles of MUC4, ErbB2, p27, and MUC1 were investigated in IDC tissues from 135 patients by means of immunohistochemistry.

Results: MUC4 was expressed in 43 of the 135 patients with IDC (31.9%). The survival of 21 patients with high MUC4 expression (>20% of neoplastic cells stained) was significantly worse than that of the 114 patients with low MUC4 expression (<20% of neoplastic cells stained) (p = 0.0043). Univariate analysis showed that high MUC4 expression (p = 0.0061), large primary tumour status (>T2) (p = 0.0436), distant metastasis (p = 0.0383), lymphatic invasion (p = 0.0243), and surgical margins (p = 0.0333) were significant risk factors affecting the outcome of patients with IDC. Backward stepwise multivariate analysis showed that MUC4 expression (p = 0.0121), lymph node metastasis (p = 0.0245), and lymphatic invasion (p = 0.0239) were significant independent risk factors. ErbB2, p27, and MUC1 were not independent risk factors.

Conclusions: This study shows that MUC4 expression in IDC is a new independent factor for poor prognosis and predicts the outcome of patients with IDC.

Abbreviations: ABC, avidin–biotinylated horseradish peroxidase complex; CI, confidence interval; HR, hazard ratio; ICC-MF, intrahepatic cholangiocarcinoma mass forming type; IDC, invasive ductal carcinoma of the pancreas; PanIN, pancreatic intraepithelial neoplasia; PBS, phosphate buffered saline; SMC, sialomucin complex

Keywords: pancreatic cancer; mucin; immunohistochemistry; cumulative survival rate; multivariate analysis

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