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Int J Clin Exp Pathol 2012;5(8):754-761

Original Article
Expression of the stem cell markers CD133 and nestin in pancreatic ductal
adenocarcinoma and clinical relevance

Hyung-Seok Kim, Seon-Young Yoo, Kyung-Tae Kim, Jong-Tae Park, Hyun-Jong Kim, Jung-Chul Kim

Department of Forensic Medicine and Pathology, and Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Chonnam National
University Medical School, Gwangju, South Korea; Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University,
Goyang, Korea

Received July 12, 2012; Accepted September 3, 2012; Epub October 1, 2012; Published October 15, 2012

Abstract: Background: To evaluate the prognostic implication of cancer stem cell markers in pancreac ductal adenocarcinoma (PDAC), the
expression of CD133 and nestin were investigated in a series of PDAC patients in relation to the survival rate. Methods: This series included 42
cases of PDAC patients and evaluated the stem cell markers CD133 and nestin expression detected by immunohistochemistry. The presence
of immunopositive tumor cells considering intensity and area was evaluated and interpreted in comparison to the patients’ clinicopathological
and survival data. Results: Twenty eight cases (66.7%) showed high CD133 expression. The CD133 expression was mainly identified in the
apical border of the tumor cell, but aberrant expression in the cytoplasmic or perinuclear location was also noted. High nestin expression in
tumor cells were found in only 2 cases, but high nestin expression along perinuerial or stromal region was found in 15 cases (35.7%). There
was no correlation between CD133, nestin expression and gemcitabine resistance. Statistically significant difference was found in patient
survival in N stage (p=0.007), and CD133 expression (p= 0.014) in univariate analysis. Nestin expression wan not statistically significant, but it
was helpful to identify the perineurial invasion. In Cox-regression hazard model stratified by age and sex for multivariable analysis, AJCC stage
and CD133 were independent prognostic factors for overall survival. Conclusions: CD133 expression is upregulated in PDAC that is related to
poor prognosis, and treatment targeted the CD133 positive cancer/cancer stem cells might be a promising therapeutic strategy for this
patients. (IJCEP1207007).

Keywords: Pancreatic ductal adenocarcinoma, cancer stem cell, CD133, nestin, prognosis

Address all correspondence to:
Dr. Jung Chul Kim, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Chonnam National University Medical School, 5 Hak-
dong, Dong-gu, Gwnagju, South Korea. 501-747. Tel: 82-62-220- 6456; Fax: 82-62-220-1635; E-mail: khs7998@naver.com