title: Prognostic impact of immunohistochemical expression of CK7 and CK20 in curatively resected ampulla of Vater cancer.
abstract: BACKGROUND
  In the consideration of ampullary adenocarcinoma, T stage, lymph node metastases, perineural invasion, tumor differentiation, pancraticobiliary type, and lymph node ratio are considered prognostic factors. The objectives of this study were to investigate surgical outcomes and the clinicopathological predictors affecting survival and recurrence, and to examine the prognostic roles of histopathological subtype and immunohistochemical markers.
  
  
  METHODS
  From April 2006 to September 2012, 37 patients who underwent curative resection of ampullar of Vater adenocarcinoma were enrolled in this study. A retrospective review was performed based on medical records. Immunohistochemical expression, histopathological type and clinicopathologic factors were analyzed.
  
  
  RESULTS
  The 5-year overall survival rates and disease-free survival rates after surgery were 77.4 and 75.7 %, respectively. Multivariate Cox regression analysis showed that advanced T stage (p = 0.019) and positive expression of Cytokeratin 7 (CK7) with negative expression of Cytokeratin 20 (CK20) (p = 0.046) were identified as significant independent factors related to survival, and poor differentiation (p = 0.031) significantly influenced disease-free survival in multivariate analysis.
  
  
  CONCLUSIONS
  Advanced T stage is a significant prognostic factor affecting survival in ampullary adenocarcinoma. Also, positive expression of CK7 with negative expression of CK20 is an independent factor related to overall survival.
authors.affiliation: Department of surgery, Biomedical Research Institute, Pusan National University Hospital, 189 Gudeok-Ro, Seo-Gu, Busan, 602-739, South Korea. soaf000@gmail.com.
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Yun
authors.affiliation: Department of surgery, Biomedical Research Institute, Pusan National University Hospital, 189 Gudeok-Ro, Seo-Gu, Busan, 602-739, South Korea. seohi71@hanmail.net.
authors.forename: Hyung Il
authors.initials: HI
authors.lastname: Seo
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000378:metabolism* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000378:metabolism*; D003138:Common Bile Duct Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053554:Keratin-20 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; C507499:KRT20 protein, human; D053554:Keratin-20; D053552:Keratin-7