Vater 壶腹癌：形态学和免疫表型分类预测总生存期。

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

机构信息

Unit of Human Anatomy, CIR, Campus Bio-Medico University of Rome, Rome, Italy.

出版信息

Pancreas. 2013 Jan;42(1):60-6. doi: 10.1097/MPA.0b013e318258fda8.

DOI:10.1097/MPA.0b013e318258fda8

PMID:22889982

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.

摘要

目的

本研究旨在验证手术切除后的壶腹癌组织病理学分化是否与生存相关。

方法

在一项多中心 Vater 壶腹癌研究中，我们研究了准确的组织学和免疫组织化学分类的预后作用。分析了不同壶腹癌形态学组织类型中细胞角蛋白 7（CK7）和 CK20 的免疫组织化学表达，并将结果与总生存率进行比较。

结果

在 72 例壶腹癌中，48.6%被归类为胰胆管型癌，43.1%被归类为肠型癌，8.3%被归类为“非典型”型癌。28 例（90.3%）肠型癌表达 CK20，而胰胆管型癌均为阴性；32 例（91.4%）胰胆管型癌和 18 例（58.1%）肠型癌表达 CK7。单因素分析显示，总生存率受病理 T 因子、淋巴结受累和组织学/免疫组织化学亚型的显著影响。此外，使用多因素 Cox 回归模型，淋巴结转移和 CK20 被确定为与预后相关的显著独立因素。