title: Lymph node involvement and not the histophatologic subtype is correlated with outcome after resection of adenocarcinoma of the ampulla of vater.
abstract: BACKGROUND
  Intestinal and pancreaticobiliary types of Vater's ampulla adenocarcinoma have been considered as having different biologic behavior and prognosis. The aim of the present study was to determine the best immunohistochemical panel for tumor classification and to analyze the survival of patients having these histological types of adenocarcinoma.
  
  
  METHODS
  Ninety-seven resected ampullary adenocarcinomas were histologically classified, and the prognosis factors were analyzed. The expression of MUC1, MUC2, MUC5AC, MUC6, CK7, CK17, CK20, CD10, and CDX2 was evaluated by using immunohistochemistry.
  
  
  RESULTS
  Forty-three Vater's ampulla carcinomas were histologically classified as intestinal type, 47 as pancreaticobiliary, and seven as other types. The intestinal type had a significantly higher expression of MUC2 (74.4% vs. 23.4%), CK20 (76.7% vs. 29.8%), CDX2 (86% vs. 21.3%), and CD10 (81.4% vs. 51.1%), while MUC1 (53.5% vs. 82.9%) and CK7 (79.1% vs. 95.7%) were higher in pancreatobiliary adenocarcinomas. The most accurate markers for immunohistochemical classification were CDX2, MUC1, and MUC2. Survival was significantly affected by pancreaticobiliary type (p = 0.021), but only lymph node metastasis, lymphatic invasion, and stage were independent risk factors for survival in a multivariate analysis.
  
  
  CONCLUSIONS
  The immunohistochemical expression of CDX2, MUC1, and MUC2 allows a reproducible classification of ampullary carcinomas. Although carcinomas of the intestinal type showed better survival in the univariate analysis, neither histological classification nor immunohistochemistry were independent predictors of poor prognosis.
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, R Aracaju 42, ap 41, Higienopolis, São Paulo 0501240030, Brazil. lucianabphaddad@uol.com.br
authors.forename: Luciana Bertocco
authors.initials: LB
authors.lastname: de Paiva Haddad
authors.forename: Rosely Antunes
authors.initials: RA
authors.lastname: Patzina
authors.forename: Sônia
authors.initials: S
authors.lastname: Penteado
authors.forename: André Luiz
authors.initials: AL
authors.lastname: Montagnini
authors.forename: José Eduardo Monteiro
authors.initials: JE
authors.lastname: da Cunha
authors.forename: Marcel Cerqueira César
authors.initials: MC
authors.lastname: Machado
authors.forename: José
authors.initials: J
authors.lastname: Jukemura
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D014670:Ampulla of Vater / Q000473:pathology*; D000071616:CDX2 Transcription Factor; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D016014:Linear Models; D008207:Lymphatic Metastasis / Q000473:pathology*; D046228:Microarray Analysis; D018396:Mucin-1 / Q000378:metabolism; D055262:Mucin-2 / Q000378:metabolism; D011379:Prognosis; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; C060192:MUC1 protein, human; C524625:MUC2 protein, human; D018396:Mucin-1; D055262:Mucin-2