title: Expression of the caudal-type homeodomain transcription factors CDX 1/2 and outcome in carcinomas of the ampulla of Vater.
abstract: OBJECTIVE
  Adenocarcinomas of the ampulla of Vater demonstrate a characteristic histology but vary significantly in outcome. As a consequence, prognostic factors for these cancers are poorly defined. The caudal-type homeodomain transcription factors 1 (CDX1) and 2 (CDX2) regulate axial development and intestinal differentiation. We assessed the expression of these putative intestinal epithelial-specific transcription factors and their influence on patient outcome.
  
  
  METHODS
  Fifty-three resected carcinomas of the ampulla of Vater, 31 pancreatic ductal adenocarcinomas, and 15 extrahepatic biliary carcinomas were analyzed for CDX1 and CDX2 expression using immunohistochemistry.
  
  
  RESULTS
  Forty percent of carcinomas of the ampulla of Vater but less than 5% of pancreatic and biliary adenocarcinomas expressed CDX. Expression of CDX was associated with a better prognosis (P = .0009). Individually, both CDX1 (P = .02) and CDX2 (P = .02) expression were associated with a survival advantage on univariate analysis. Advanced T stage (P = .02), lymph node metastases (P = .004), and vascular space invasion (P = .0009) were associated with a poor prognosis. Multivariate analysis revealed vascular space invasion (P = .01) and CDX expression (P = .01) to be independent prognostic factors.
  
  
  CONCLUSIONS
  Expression of CDX was an independent marker of outcome in patients with resected adenocarcinoma of the ampulla of Vater. Expression of CDX may distinguish good prognosis intestinal-like tumors, which potentially arise within intestinal epithelium, from poorer prognosis pancreatobiliary tumors, which arise in adjacent pancreatic and/or biliary ductal epithelium.
authors.affiliation: MBBS, Department of Surgery, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 771, Baltimore, MD 21205, USA. abianki1@jhmi.edu
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hansel
authors.forename: Anirban
authors.initials: A
authors.lastname: Maitra
authors.forename: John W
authors.initials: JW
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Pedram
authors.initials: P
authors.lastname: Argani
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Steven
authors.initials: S
authors.lastname: Piantadosi
authors.forename: Steven D
authors.initials: SD
authors.lastname: Leach
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Biankin
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000378:metabolism / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D014408:Biomarkers, Tumor; D003138:Common Bile Duct Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D005260:Female; D018398:Homeodomain Proteins / Q000378:metabolism / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018398:Homeodomain Proteins