24301456
BACKGROUND	Human equilibrative nucleoside transporter 1 ( hENT1 ) levels in pancreatic adenocarcinoma may predict survival in patients who receive adjuvant gemcitabine after resection .
METHODS	Microarrays from 434 patients randomized to chemotherapy in the ESPAC-3 trial ( plus controls from ESPAC-1 / 3 ) were stained with the 10D7G2 anti-hENT1 antibody .
METHODS	Patients were classified as having high hENT1 expression if the mean H score for their cores was above the overall median H score ( 48 ) .
METHODS	High and low hENT1-expressing groups were compared using Kaplan-Meier curves , log-rank tests , and Cox proportional hazards models .
METHODS	All statistical tests were two-sided .
RESULTS	Three hundred eighty patients ( 87.6 % ) and 1808 cores were suitable and included in the final analysis .
RESULTS	Median overall survival for gemcitabine-treated patients ( n = 176 ) was 23.4 ( 95 % confidence interval [ CI ] = 18.3 to 26.0 ) months vs 23.5 ( 95 % CI = 19.8 to 27.3 ) months for 176 patients treated with 5-fluorouracil/folinic acid ( ( 2 ) 1 = 0.24 ; P = .62 ) .
RESULTS	Median survival for patients treated with gemcitabine was 17.1 ( 95 % CI = 14.3 to 23.8 ) months for those with low hENT1 expression vs 26.2 ( 95 % CI = 21.2 to 31.4 ) months for those with high hENT1 expression ( ( 2 ) = 9.87 ; P = .002 ) .
RESULTS	For the 5-fluorouracil group , median survival was 25.6 ( 95 % CI = 20.1 to 27.9 ) and 21.9 ( 95 % CI = 16.0 to 28.3 ) months for those with low and high hENT1 expression , respectively ( ( 2 ) = 0.83 ; P = .36 ) .
RESULTS	hENT1 levels were not predictive of survival for the 28 patients of the observation group ( ( 2 ) = 0.37 ; P = .54 ) .
RESULTS	Multivariable analysis confirmed hENT1 expression as a predictive marker in gemcitabine-treated ( Wald ( 2 ) = 9.16 ; P = .003 ) but not 5-fluorouracil-treated ( Wald ( 2 ) = 1.22 ; P = .27 ) patients .
CONCLUSIONS	Subject to prospective validation , gemcitabine should not be used for patients with low tumor hENT1 expression .

