title: Expression of hypoxia-inducible factors is correlated with the presence of a fibrotic focus and angiogenesis in pancreatic ductal adenocarcinomas.
abstract: OBJECTIVE
  To study the expression of hypoxia-regulated markers in pancreatic ductal adenocarcinomas (PA) in relationship to the presence of a fibrotic focus, angiogenesis quantification and clinical outcome.
  
  
  RESULTS
  The expression of hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, carbonic anhydrase 9 (CA9) and vascular endothelial growth factor (VEGF) was immunohistochemically detected in 50 PA and correlated with tumour characteristics, microvascular density (MVD) and survival. HIF-1alpha was expressed within tumour cells in 68%, HIF-2alpha in 46%, CA9 in 78% and VEGF in 52% of the cases. Stromal expression was also noted for HIF-2alpha and CA9 in, respectively, 42% and 48% of the cases. Tumour CA9 expression was associated with that of VEGF (P=0.004) and that of stromal HIF-2alpha (P=0.013), with the presence of a fibrotic focus (P=0.046) and with an increased MVD (P=0.034). Tumour VEGF expression correlated with the presence of a fibrotic focus (P=0.039) and a greater MVD (P=0.047). Both the presence of a fibrotic focus (P=0.0002) and high tumour CA9 expression (P=0.029) were associated with reduced overall survival.
  
  
  CONCLUSIONS
  The strong association of the presence of a fibrotic focus with CA9 expression and lower survival demonstrates that hypoxia-driven angiogenesis plays an important role in the progression of PA.
authors.affiliation: Department of Pathology, Hopital Beaujon, Assistance Publique - Hopitaux de Paris, Clichy, France. anne.couvelard@bjn.ap-hop-paris.fr
authors.forename: A
authors.initials: A
authors.lastname: Couvelard
authors.forename: D
authors.initials: D
authors.lastname: O'Toole
authors.forename: R
authors.initials: R
authors.lastname: Leek
authors.forename: H
authors.initials: H
authors.lastname: Turley
authors.forename: A
authors.initials: A
authors.lastname: Sauvanet
authors.forename: C
authors.initials: C
authors.lastname: Degott
authors.forename: P
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
authors.forename: A L
authors.initials: AL
authors.lastname: Harris
authors.forename: K
authors.initials: K
authors.lastname: Gatter
authors.forename: F
authors.initials: F
authors.lastname: Pezzella
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis; D051792:Basic Helix-Loop-Helix Proteins; D014408:Biomarkers, Tumor / Q000032:analysis*; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000378:metabolism / Q000473:pathology*; D010179:Pancreas / Q000098:blood supply / Q000737:chemistry / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D016019:Survival Analysis; D014157:Transcription Factors / Q000032:analysis; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D000099162:Endothelial PAS Domain-Containing Protein 1
chemical_list: D000951:Antigens, Neoplasm; D051792:Basic Helix-Loop-Helix Proteins; D014408:Biomarkers, Tumor; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D014157:Transcription Factors; D042461:Vascular Endothelial Growth Factor A; D000099162:Endothelial PAS Domain-Containing Protein 1; C497442:HIF1A protein, human; C089226:CA9 protein, human