Cyclooxygenase-2 overexpression is associated with a poor outcome in resected ampullary cancer patients.
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.
Santini
Daniele
D
University Campus Bio-Medico, Rome, Italy.
Vincenzi
Bruno
B
Tonini
Giuseppe
G
Scarpa
Susanna
S
Vasaturo
Fortunata
F
Malacrino
Carolina
C
Vecchio
Fabio
F
Borzomati
Domenico
D
Valeri
Sergio
S
Coppola
Roberto
R
Magistrelli
Paolo
P
Nuzzo
Gennaro
G
Picciocchi
Aurelio
A
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
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