Expression of cytokeratin-20 in pancreatic cancer: an indicator of poor outcome after R0 resection.
BACKGROUND
After complete removal of the neoplasm (R0 resection), approximately 80% of pancreatic cancer patients will die of the disease within 5 years. The expression panel of cytokeratins (CK) is linked closely with cell differentiation. The aim of the study was to investigate the expression of CK-20 in pancreatic cancer tissue and to correlate CK-20 expression with survival in R0-resected pancreatic cancer patients.


METHODS
Tissue samples of 63 patients with pancreatic cancer were subjected to CK-20 reverse-transcription polymerase chain reaction. Thirty-four of 63 patients underwent R0 resection and were followed-up for survival statistics. From these 34 patients, 26 (76%) neoplasms were CK-20 positive and 8 (24%) samples were CK-20 negative. The mean follow-up period for the entire group was 17 months (range, 4-36 mo), the follow-up period in censored patients was 23 months (range, 10-36 mo).


RESULTS
In the R0-resected group, 3 of 8 (38%) patients with CK-20-negative neoplasms, and 16 of 26 (62%) patients with CK-20-positive neoplasms (P = .15) died of recurrent disease. The median survival time of patients with CK-20-positive neoplasms was 13 months (range, 4-36), the median survival in R0-resected patients with CK-20-negative neoplasm was 26 months (range, 13-35; P = .06). The survival difference observed in patients with CK-20-negative neoplasms could not be attributed to intergroup variations in tumor stage or tumor grade.


CONCLUSIONS
A majority of primary ductal pancreatic adenocarcinomas express CK-20. This seems to be associated with poorer survival in R0-resected patients. Our data suggest that ductal pancreatic adenocarcinomas negative for CK-20 constitute a subgroup of patients showing a more favorable disease outcome. The expression of CK-20 in resected pancreatic cancer may be of interest as a prognostic parameter.
Schmitz-Winnenthal
Friedrich Hubertus
FH
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Volk
Christine
C
Helmke
Burckhard
B
Berger
Sara
S
Hinz
Ulf
U
Koch
Moritz
M
Weitz
Jürgen
J
Kleeff
Jörg
J
Friess
Helmut
H
Zöller
Margot
M
Büchler
Markus Wolfgang
MW
Z'graggen
Kaspar
K
D021441:Carcinoma, Pancreatic Ductal / Q000378:metabolism* / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007381:Intermediate Filament Proteins / Q000378:metabolism*; D053554:Keratin-20; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D016019:Survival Analysis; D016896:Treatment Outcome
D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; D053554:Keratin-20