Weak HIF-1 alpha expression indicates poor prognosis in resectable pancreatic ductal adenocarcinoma

Background: HIF-1 alpha and CAIX proteins are commonly expressed under hypoxic conditions, but other regulatory factors have been described as well. Pancreatic ductal adenocarcinoma (PDAC) is characterized by hypoxia and strong stromal reaction and has a dismal prognosis with the currently available treatment modalities. Methods: We investigated the expression and prognostic role of HIF-1 alpha and CAIX in PDAC series from Northern Finland (n = 69) using immunohistochemistry. Results: In our PDAC cases, 95 and 85% showed HIF-1 alpha and CAIX expression, respectively. Low HIF-1 alpha expression correlated with poor prognosis, and multivariate analysis identified weak HIF-1 alpha intensity as an independent prognostic factor for PDAC-specific deaths (HR 2.176, 95% CI 1.216-3.893; p = 0.009). There was no correlation between HIF-1 alpha and CAIX expression levels, and the latter did not relate with survival. Conclusions: Our findings are in contrast with previous research by finding an association between low HIF-1 alpha and poor prognosis. The biological mechanisms remain speculative, but such an unexpected relation with prognosis and absence of correlation between HIF-1 alpha and CAIX suggests that the prognostic association of HIF-1 alpha may not directly be linked with hypoxia. Accordingly, the role of HIF-1 alpha might be more complex than previously thought and the use of this marker as a hypoxia-related prognostic factor should be addressed with caution.