Open Access Research article

Comparison of thymidine phosphorylase expression and prognostic factors in gallbladder and bile duct cancer

Hye Sung Won1, Myung Ah Lee2*, Eun-Seon Chung3, Dong-Goo Kim4, Young Kyoung You4, Tae Ho Hong4 and In-Seok Lee5

Author Affiliations

1 Division of Medical Oncology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, Kyonggi-do, Korea

2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea

3 Department of Hospital Pathology, Seoul St. Mary's Hospital, Seoul, Korea

4 Department of Surgery, Seoul St. Mary's Hospital, Seoul, Korea

5 Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea

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BMC Cancer 2010, 10:564  doi:10.1186/1471-2407-10-564

Published: 19 October 2010

Abstract

Background

Biliary tract cancers have limitations in information about different location-related pathogenesis and clinico-pathological characteristics. The goal of this study was to investigate anatomical site-related similarities and differences in biliary tract cancers and to assess the expression and clinical significance of functional proteins such as p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1.

Methods

One hundred and sixty-one patients with biliary tract adenocarcinomas, who underwent curative or palliative surgery in a single institution between October 1994 and December 2003 were evaluated, retrospectively. The level of protein expression of p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1 was assessed by immunohistochemistry.

Results

With respect to clinico-pathological characteristics, gallbladder cancer was more frequent in women, and bile duct cancer was more common in men. Perineural invasion was more common in bile duct cancer. Recurrence as a distant metastasis was more common in gallbladder cancer. Immunohistochemical analysis revealed that thymidine phosphorylase expression was significantly higher in gallbladder cancer than in bile duct cancer. Positive thymidine phosphorylase and p53 staining were associated with an advanced stage. Differentiation, vascular invasion, perineural invasion, lymphatic invasion, lymph node metastasis, and TNM stage independently predicted poor prognosis in biliary tract cancer. These correlations were seen more clearly in gallbladder cancer. The immunohistochemical staining patterns of p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1 showed no prognostic significance in biliary tract cancers.

Conclusions

We concluded that gallbladder and bile duct cancers are considered to be separate diseases with different clinico-pathological characteristics and prognostic factors. In addition, we hypothesize that high expression of thymidine phosphorylase by gallbladder cancer results in a higher response rate to capecitabine by gallbladder cancer than bile duct cancer.