Prognostic value of pAMPKa/ADM2/VEGF expression in hilar cholangiocarcinoma

Activation of AMPK by metformin leads toattenuating tumor angiogenesisin various cancers. ADM2 is a novel tumor angiogenic factor. However, its status and its correlation with AMPKand VEGF protein in hilar cholangiocarcinoma (HCC) were rarely investigated. The purpose of the study was sought to detect the expression of pAMPKa, ADM2 and VEGF and to explore their clinical values. Activation of pAMPKa by metformin leaded to inhibition of ADM2 and VEGF. The positive rates of pAMPKa, ADM2 and VEGF proteins expression in HCC were 51.0% (25/49), 61.2% (30/49), and 83.7% (41/49), respectively. Overexpression of ADM2 correlated significantly with highly invasive tumors (P<0.001) and regional LN metastasis (P=0.018). Overexpression of VEGF was significantly associated with regional lymph node metastases (P=0.049). No significance was found between pAMPKa expression and clinical variable. Additionally, increased expression of ADM2 and VEGF proteins and decreased expression of pAMPKa were associated with tumor recurrence and poor outcome for HCC patients. Multivariate Cox regression analysis identified pAMPKa was an independent predictor for tumor recurrence (P=0.047) and there is a trend thatpAMPKa might be a promising prognostic factor (P=0.083). Taken together, loss expression of pAMPKamight act as a valuable independent marker to predict tumor recurrence of HCC.