title: Cyclooxygenase-2 overexpression is associated with a poor outcome in resected ampullary cancer patients.
abstract: OBJECTIVE
  To identify potential prognostic molecular factors in ampullary adenocarcinoma that could be of significant importance. To this end, we examined the possible prognostic significance of cyclooxygenase-2 (Cox-2) and Survivin expression and the apoptotic index in a cohort of uniformly treated patients with ampullary cancer treated with radical surgical excision.
  
  
  METHODS
  The entry criteria were that the patients have a pathologic diagnosis of ampullary cancer which had been resected. Expression analysis for Cox-2 and Survivin was done by immunohistochemical staining. Apoptotic cells were identified by the terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method.
  
  
  RESULTS
  Thirty-nine tumor specimens from resected ampullary adenocarcinoma patients were included. By univariate analysis, overall survival was affected by Cox-2 expression and TUNEL staining (respectively, P = 0.0003 and 0.03). Survivin expression did not influence the overall survival in our patient population (P = 0.123). Patients' clinicopathologic features (gender, age, and T and N factors) did not influence outcome. In multivariate Cox regression analysis, Cox-2 expression (relative risk, 4.330; P = 0.005) was the only variable that significantly affected overall survival.
  
  
  CONCLUSIONS
  The results of the present article provide, for the first time, evidence that Cox-2 expression, but not Survivin expression, may represent a significant prognostic factor after surgical resection in patients affected by cancer of the ampulla of Vater. Further studies are required to determine whether Cox-2 inhibitors may be useful for the therapy or prevention of ampullary carcinoma.
authors.affiliation: University Campus Bio-Medico, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.forename: Bruno
authors.initials: B
authors.lastname: Vincenzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
authors.forename: Susanna
authors.initials: S
authors.lastname: Scarpa
authors.forename: Fortunata
authors.initials: F
authors.lastname: Vasaturo
authors.forename: Carolina
authors.initials: C
authors.lastname: Malacrino
authors.forename: Fabio
authors.initials: F
authors.lastname: Vecchio
authors.forename: Domenico
authors.initials: D
authors.lastname: Borzomati
authors.forename: Sergio
authors.initials: S
authors.lastname: Valeri
authors.forename: Roberto
authors.initials: R
authors.lastname: Coppola
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistrelli
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Aurelio
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D017209:Apoptosis; D003138:Common Bile Duct Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D051546:Cyclooxygenase 2; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007150:Immunohistochemistry; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008565:Membrane Proteins; D008869:Microtubule-Associated Proteins / Q000096:biosynthesis / Q000235:genetics; D008875:Middle Aged; D009363:Neoplasm Proteins; D011237:Predictive Value of Tests; D011379:Prognosis; D011451:Prostaglandin-Endoperoxide Synthases / Q000096:biosynthesis* / Q000235:genetics*; D000077022:Survivin
chemical_list: C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D008565:Membrane Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D000077022:Survivin; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases