Carcinoma of the ampulla of Vater: morphological and immunophenotypical classification predicts overall survival.

Abstract

OBJECTIVES:

The objective of the study was to verify if histopathological differentiation of ampullary carcinoma after surgical resection may be related to survival.

METHODS:

The prognostic role of an accurate histological and immunohistochemical classification has been investigated in a multicentric series of carcinoma of the ampulla of Vater. Immunohistochemical expression of cytokeratin 7 (CK7) and CK20 were analyzed in the different morphological histotypes of ampullary cancers, and results were compared with overall survival.

RESULTS:

Of 72 ampullary cancers, 48.6% were classified as pancreaticobiliary-type carcinomas, 43.1% were classified as intestinal-type carcinomas, and 8.3% were classified as "unusual"-type carcinomas. Cytokeratin 20 was expressed in 28 (90.3%) of the 31 intestinal-type carcinomas, whereas it was always negative in the pancreaticobiliary histotype; CK7 was expressed in 32 (91.4%) of the 35 pancreaticobiliary-type carcinomas and in 18 (58.1%) of the 31 intestinal-type carcinomas. By univariate analysis, overall survival was influenced significantly by pathological T factor, lymph node involvement, and histological/immunohistochemical subtyping. Furthermore, using a multivariate Cox regression model, lymph node metastasis and CK20 were identified as significant independent factors related to prognosis.

CONCLUSION:

Our results prove the clinical use of ampullary cancer subclassification based on different histotypes and indicate the useful role of the CK7/CK20 expression profile for consistent histopathological classification and prognostic relevance.

• Authors: Sergio Morini, Giuseppe Perrone, Domenico Borzomati, Bruno Vincenzi, Carla Rabitti, Daniela Righi, Federica Castri, Andrea D Manazza, Daniele Santini, Giuseppe Tonini, Roberto Coppola, Andrea Onetti Muda
• Journal: Pancreas (Pancreas) Vol. 42 Issue 1 Pg. 60-6 (Jan 2013) ISSN: 1536-4828 [Electronic] United States
• PMID: 22889982 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers, Tumor
• KRT20 protein, human
• KRT7 protein, human
• Keratin-20
• Keratin-7

Topics

• Adult
• Aged
• Ampulla of Vater (immunology, pathology, surgery)
• Biomarkers, Tumor (analysis)
• Carcinoma (diagnosis, immunology, mortality, pathology, surgery)
• Common Bile Duct Neoplasms (diagnosis, immunology, mortality, pathology, surgery)
• Female
• Humans
• Immunophenotyping (methods)
• Italy
• Kaplan-Meier Estimate
• Keratin-20 (analysis)
• Keratin-7 (analysis)
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Time Factors
• Treatment Outcome