SSAT - RELATIONSHIP BETWEEN SECRETED PROTEIN ACIDIC AND RICH IN CYSTEINE EXPRESSION AND CLINICAL OUTCOMES IN PATIENTS WITH RESECTED PANCREATIC DUCTAL ADENOCARCINOMA TREATED WITH ADJUVANT GEMCITABINE-BASED CHEMOTHERAPY

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RELATIONSHIP BETWEEN SECRETED PROTEIN ACIDIC AND RICH IN CYSTEINE EXPRESSION AND CLINICAL OUTCOMES IN PATIENTS WITH RESECTED PANCREATIC DUCTAL ADENOCARCINOMA TREATED WITH ADJUVANT GEMCITABINE-BASED CHEMOTHERAPY
Ryuta Shintakuya^*, Naru Kondo, Yoshiaki Murakami, Kenichiro Uemura, Naoya Nakagawa, Keisuke Okano, Hiroki Ohge, Taijiro Sueda
Hiroshima University, Hiroshima, Japan

Background: Although postoperative adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC) improves survival in some patients, its efficacy varies among individuals. It is useful to identify the biomarkers which can predict the prognosis of patients with PDAC treated with adjuvant chemotherapy.
Objective: The aim of this study was to investigate whether SPARC expression can predict the survival of patients with PDAC who received adjuvant gemcitabine-based chemotherapy (AGC).
Methods: Stromal SPARC and cytoplasmic SPARC were examined immunohistochemically in 241 patients who underwent surgical resection for PDAC between 2000 and 2014. The association of SPARC expression with clinicopathological factors and overall survival (OS) was analyzed.
Results: Of the 241 patients, stromal SPARC expression and cytoplasmic SPARC expression were high in 140 (58%) and in 65 (27%) patients, respectively. Pathological differentiation (P=0.046) and lymph node metastasis (P<0.001) were significantly associated with stromal SPARC expression, whereas no clinicopathological factor was significantly associated with cytoplasmic SPARC expression. In univariate analysis, high stromal SPARC was significantly associated with poor OS (P<0.001). In multivariate analysis, R1 factor (P=0.007), moderately or poorly differentiated adenocarcinoma (P=0.019), lymph node metastasis (P<0.001) and high stromal SPARC expression (P<0.001) was independently associated with poor OS. In addition, the prognostic significance of SPARC expression was also evaluated in the subgroups of patients who did and did not receive AGC. Within a subset of 211 patients treated with AGC, high stromal SPARC expression was significantly associated with poor OS (P<0.001). Moreover, multivariate OS analysis revealed that only high stromal SPARC expression was independently associated with poor OS (P<0.001). In contrast, both stromal and cytoplasmic SPARC expression did not affect OS in 30 patients who did not receive AGC.
Conclusions: High stromal SPARC expression was an independent predictor of poor OS, particularly in patients treated with AGC. Stromal SPARC expression could be a relevant biomarker for prediction of prognosis and AGC efficacy in patients with PDAC after resection.

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