Ann Surg Treat Res.  2025 Feb;108(2):98-107. 10.4174/astr.2025.108.2.98.

Exploring the prognostic role of cluster of differentiation 47 in patients with advanced pancreatic cancer: a comparative cohort study

• Amare ED
• Lee S
• Choi D
• Shin JH
• Lee KG
• Kim KS
• Kim H
• Jung YK

• KMID: 2564249
• DOI: http://doi.org/10.4174/astr.2025.108.2.98

Abstract

Purpose
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a 5-year survival low of 2% in advanced cases. Despite being a fatal disease, there is a lack of a good predictor of prognosis which can aid in the management of patients. The tumor microenvironment of PDAC, including immune cells, plays a vital role in the progression and invasiveness of PDAC. Cluster of differentiation 47 (CD47) which has a “don’t eat me signal” to macrophages through receptor signal regulatory protein alpha, prevents immune cell surveillance of cancer cells. This contributes to the immune escape and invasiveness of cancer.
Methods
We obtained pancreatic cancer tissue microarray samples from 98 patients treated in Hanyang University Hospital. The diagnosis was proven by a tissue biopsy obtained after surgical resection. Immunohistochemical staining was done using CD47 antibody. Data was analyzed using R software ver. 4.3.3.
Results
In a study of 98 patients with PDAC, CD47 expression (54.1%) was significantly correlated with advanced disease stage. Positive CD47 expression was associated with lower overall survival (P = 0.028) and disease-free survival (P = 0.005) in all patients. In advanced-stage patients, CD47 remained a predictor of lower overall survival (P = 0.012) and diseasefree survival (P = 0.023). Multivariate analysis identified positive CD47 expression as an independent factor affecting overall survival (P = 0.048). These results emphasize CD47’s prognostic relevance in PDAC, particularly in advanced stages.
Conclusion
Positive CD47 expression in PDAC indicates an advanced stage of the disease and independently predicts poor outcomes. This highlights CD47’s role as a crucial prognostic marker in advanced PDAC stages.

Keyword

CD47 antigen; Pancreatic neoplasms; Tumor microenvironment; Prognosis; Tissue array analysis

Figure

• 

  Fig. 1 Immunohistochemical staining of CD47 in pancreatic ductal adenocarcinoma tissues (×400). The intensity of CD47 staining was graded as (A) negative, 0; (B) weak, 1+; (C) moderate, 2+; or (D) strong, 3+. CD47, cluster of differentiation 47.

• 

  Fig. 2 Kaplan-Meier survival curves of patients with pancreatic ductal adenocarcinoma stratified based on CD47 expression. (A) Survival curve for the disease stage, (B) survival curve for the lymph node (LN) metastasis, (C) overall survival of patients by CD47 expression, and (D) disease-free survival of patients by CD47 expression. CD47, cluster of differentiation 47.

• 

  Fig. 3 Kaplan-Meier survival curves of patients with advanced-stage pancreatic ductal adenocarcinoma. (A) Advanced-stage disease patient's overall survival and (B) disease-free survival stratified based on cluster of differentiation 47 (CD47) expression.

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