Carcinoma of the ampulla of Vater: morphological and immunophenotypical classification predicts overall survival.
OBJECTIVE
The objective of the study was to verify if histopathological differentiation of ampullary carcinoma after surgical resection may be related to survival.


METHODS
The prognostic role of an accurate histological and immunohistochemical classification has been investigated in a multicentric series of carcinoma of the ampulla of Vater. Immunohistochemical expression of cytokeratin 7 (CK7) and CK20 were analyzed in the different morphological histotypes of ampullary cancers, and results were compared with overall survival.


RESULTS
Of 72 ampullary cancers, 48.6% were classified as pancreaticobiliary-type carcinomas, 43.1% were classified as intestinal-type carcinomas, and 8.3% were classified as "unusual"-type carcinomas. Cytokeratin 20 was expressed in 28 (90.3%) of the 31 intestinal-type carcinomas, whereas it was always negative in the pancreaticobiliary histotype; CK7 was expressed in 32 (91.4%) of the 35 pancreaticobiliary-type carcinomas and in 18 (58.1%) of the 31 intestinal-type carcinomas. By univariate analysis, overall survival was influenced significantly by pathological T factor, lymph node involvement, and histological/immunohistochemical subtyping. Furthermore, using a multivariate Cox regression model, lymph node metastasis and CK20 were identified as significant independent factors related to prognosis.


CONCLUSIONS
Our results prove the clinical use of ampullary cancer subclassification based on different histotypes and indicate the useful role of the CK7/CK20 expression profile for consistent histopathological classification and prognostic relevance.
Unit of Human Anatomy, CIR, Campus Bio-Medico University of Rome, Rome, Italy.
Sergio
S
Morini
Giuseppe
G
Perrone
Domenico
D
Borzomati
Bruno
B
Vincenzi
Carla
C
Rabitti
Daniela
D
Righi
Federica
F
Castri
Andrea D
AD
Manazza
Daniele
D
Santini
Giuseppe
G
Tonini
Roberto
R
Coppola
Andrea
A
Onetti Muda
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000276:immunology* / Q000473:pathology* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000032:analysis*; D002277:Carcinoma / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D016130:Immunophenotyping / Q000379:methods; D007558:Italy; D053208:Kaplan-Meier Estimate; D053554:Keratin-20 / Q000032:analysis; D053552:Keratin-7 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; C507499:KRT20 protein, human; C507497:KRT7 protein, human; D053554:Keratin-20; D053552:Keratin-7