Tumor Expression of CXCR4 and Survival after Resection for Pancreatic Cancer: a Retrospective Cohort Study

ABSTRACTurpose: Liver recurrence develops in 60% of patients who undergo resection for pancreatic cancer (PC) and predicts a dismal prognosis. Experimental evidences suggested chemokine receptor CXCR4 as the key mediator of liver metastasis in PC, but its significance has not been investigated with patient outcome. This study aimed to investigate the potential associations between CXCR4 expression and liver recurrence or overall survival after resection for PC.ethods: Ninety-seven patients undergoing R0 resection were evaluated. CXCR4 expression was analyzed by immunohistochemistry, and its association with liver recurrence-free or overall survival was analyzed by Kaplan-Meier estimates and multivariable proportional hazards models.esults: Patients with CXCR4-positive tumors had worse prognosis than those with CXCR4-negative tumors, with a shorter liver recurrence-free survival (median: 8.7 vs. 39.7 months; p=0.004) and overall survival (median: 10.2 vs. 22.3 months; p<0.001). Overall survival for CXCR4-positive stage IIa patients was similar to stage IIb patients and significantly shorter than CXCR4-negative stage IIa patients (p=0.002). The adjusted hazard ratio of positive CXCR4 immunostaining was 2.22 for liver recurrence (p=0.018), and 1.78 for death due to PC (p=0.041), respectively.onclusion: CXCR4 expression is an independent predictor of early liver recurrence and death after resection for PC. CXCR4 immunohistochemistry provides exclusive prognostic information that can not be replaced by known prognostic factors and supplements TNM stage in predicting survival.