title: Prognostic value of neutrophil distribution in cholangiocarcinoma.
abstract: OBJECTIVE
  To explore the relationship of clinicopathological features and the distribution of neutrophils in the tumor microenvironment with the prognosis of cholangiocarcinoma.
  
  
  METHODS
  Two hundred and fifty-four formalin-fixed and paraffin embedded tissue blocks were analyzed, including tissues from cholangiocarcinoma (n = 254), and tumor adjacent tissues (n = 238). Tissue sections were stained for CD15 using immunohistochemical staining. CD15 expression was detected to identify the distribution of neutrophils in the local tumor microenvironment. The neutrophil density of the tumor tissues and the adjacent tumor tissues was detected to reflect their inflammatory status. Clinical data and follow-up information of cholangiocarcinoma patients who underwent surgery from January 2004 to December 2010 were analyzed retrospectively. The relationship between clinicopathological features and the distribution of neutrophils with prognosis of the patients were analyzed.
  
  
  RESULTS
  The positive expression level of CD15 was only significantly related to the TNM stage. CD15 expression was higher in tumor tissues than in adjacent tissues (73.6% vs 54.6%), with significant differences. Patients with high expression of CD15 had significantly shorter overall survival (OS) than those with low expression of CD15 (median overall survival time 39.77 mo vs 16.87 mo, P = 0.008). Patients with high CD15 expression had significantly shorter disease free survival time (DFS) than those with low expression of CD15 (median DFS 38.27 mo vs 16.83 mo, P = 0.029). COX multivariate analysis indicated that high CD15 expression in tumor tissues was an independent risk factor for predicting OS for patients with cholangiocarcinoma [P = 0.012, relative risk (RR) = 1.601], but it was not an independent risk factor for predicting DFS (P = 0.073, RR = 1.462).
  
  
  CONCLUSIONS
  Patients with high CD15 expression in cancer tissues had shorter DFS and OS. High expression of CD15 is an independent risk factor for OS.
authors.affiliation: Zhi-Yuan Mao, Guang-Qing Zhu, Department of Oncology, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Zhi-Yuan
authors.initials: ZY
authors.lastname: Mao
authors.affiliation: Zhi-Yuan Mao, Guang-Qing Zhu, Department of Oncology, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Guang-Qing
authors.initials: GQ
authors.lastname: Zhu
authors.affiliation: Zhi-Yuan Mao, Guang-Qing Zhu, Department of Oncology, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Xiong
authors.affiliation: Zhi-Yuan Mao, Guang-Qing Zhu, Department of Oncology, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ren
authors.affiliation: Zhi-Yuan Mao, Guang-Qing Zhu, Department of Oncology, Air Force General Hospital of PLA, Beijing 100142, China.
authors.forename: Li
authors.initials: L
authors.lastname: Bai
mesh_terms: D001650:Bile Duct Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D014408:Biomarkers, Tumor / Q000032:analysis; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005647:Fucosyltransferases / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D016256:Lewis X Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000276:immunology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D059016:Tumor Microenvironment; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; D016256:Lewis X Antigen; C066693:FUT4 protein, human; D005647:Fucosyltransferases
keywords: CD15; Cholangiocarcinoma; Neutrophils; Prognosis; Surgery; Tumor microenvironment