title: CD24 expression predicts distant metastasis in extrahepatic bile duct cancer.
abstract: OBJECTIVE
  To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer.
  
  
  METHODS
  Eighty-four patients with EHBD cancer who underwent curative resection followed by adjuvant chemoradiotherapy were enrolled in this study. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to a median of 40 Gy (range: 40-56 Gy). All patients also received fluoropyrimidine chemotherapy for radiosensitization during radiotherapy. CD24 expression was assessed with immunohistochemical staining on tissue microarray. Clinicopathologic factors as well as CD24 expression were evaluated in multivariate analysis for clinical outcomes including loco-regional recurrence, distant metastasis-free and overall survival.
  
  
  RESULTS
  CD24 was expressed in 36 patients (42.9%). CD24 expression was associated with distant metastasis, but not with loco-regional recurrence nor with overall survival. The 5-year distant metastasis-free survival rates were 55.1% and 29.0% in patients with negative and positive expression, respectively (P = 0.0100). On multivariate analysis incorporating N stage, histologic differentiation and CD24 expression, N stage was the only significant factor predicting distant metastasis-free survival (P = 0.0089), while CD24 expression had borderline significance (P = 0.0733). In subgroup analysis, CD24 expression was significantly associated with 5-year distant metastasis-free survival in node-positive patients (38.4% with negative expression vs 0% with positive expression, P = 0.0110), but not in node-negative patients (62.0% with negative expression vs 64.0% with positive expression, P = 0.8599).
  
  
  CONCLUSIONS
  CD24 expression was a significant predictor of distant metastasis for patients undergoing curative resection followed by adjuvant chemoradiotherapy especially for node-positive EHBD cancer.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 110-744, South Korea.
authors.forename: Kyubo
authors.initials: K
authors.lastname: Kim
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Min
authors.forename: Eui Kyu
authors.initials: EK
authors.lastname: Chie
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Sun Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Sae-Won
authors.initials: SW
authors.lastname: Han
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.forename: Seock-Ah
authors.initials: SA
authors.lastname: Im
authors.forename: Tae-You
authors.initials: TY
authors.lastname: Kim
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
authors.forename: Ja-June
authors.initials: JJ
authors.lastname: Jang
authors.forename: Sung W
authors.initials: SW
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017734:Bile Ducts, Extrahepatic / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D014408:Biomarkers, Tumor / Q000032:analysis*; D051927:CD24 Antigen / Q000032:analysis*; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D051927:CD24 Antigen; C497889:CD24 protein, human; D005472:Fluorouracil
keywords: Adjuvant chemoradiotherapy; CD24; Distant metastasis; Extrahepatic bile duct cancer; Tissue microarray
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