High expression of MMP-9 is associated with better prognosis in extrahepatic bile duct cancer patients

Abstract Purpose To evaluate the prognostic value of matrix metalloproteinase-9 (MMP-9) in patients with extrahepatic bile duct (EHBD) cancer undergoing surgical resection and adjuvant radiotherapy. Methods Between January 2000 and August 2006, patients who underwent complete resection followed by adjuvant radiotherapy for EHBD cancer were enrolled in this study. The expression of MMP-9 was assessed with immunohistochemical staining. The prognostic values of the MMP-9 expression and other clinicopathologic factors were evaluated in univariate and multivariate analyses. Results Sixty-six patients were included in this study. All received radiotherapy with a median dose of 40 Gy (range, 40–56), and 61 patients received concomitant fluoropyrimidine chemotherapy. MMP-9 was highly expressed in 33 patients (50.0%). MMP-9 expression was significantly associated with locoregional recurrence-free survival (LRRFS) and overall survival (OS) but not with distant metastasis-free survival (DMFS). The 5-year LRRFS and OS rates were 50.8% versus 86.5% ( p  = .0281), and 23.3% versus 68.1% ( p  = .0087) in patients with low and high expression of MMP-9, respectively. Among the clinicopathologic factors, tumor location was associated with DMFS and OS ( p  = .0292 and .0003, respectively). Nodal stage and histologic differentiation showed significant association with DMFS ( p  = .0277 and .0060, respectively). Based on multivariate analysis for OS, tumor location was the only significant prognostic factor ( p  = .0021), while MMP-9 expression showed marginal significance ( p  = .0633). Conclusion MMP-9 expression is a useful prognostic factor for predicting LRRFS and OS in patients with EHBD cancer after surgical resection and adjuvant radiotherapy.