title: Differential Expression of β-Catenin, EGFR, CK7, CK20, MUC1, MUC2, and CDX2 in Intestinal and Pancreatobiliary-Type Ampullary Carcinomas.
abstract: BACKGROUND
  The purpose of this study was to associate immunohistochemical expression of β-catenin, EGFR, CK7, CK20, MUC1, MUC2, and CDX2 in ampullary adenocarcinomas with the type of differentiation and prognosis.
  
  
  METHODS
  Forty-seven patients with ampullary adenocarcinoma who underwent pancreatoduodenectomy with curative intent from 1997 to 2014 were included in this study. Nine patients with perioperative death were included in the association analysis but excluded from survival analysis. All tumors were classified as intestinal or pancreatobiliary type, according to histologic criteria, and immunohistochemically stained against the aforementioned markers.
  
  
  RESULTS
  Eighteen carcinomas were classified as intestinal type and 29 carcinomas as pancreatobiliary type. Univariate analysis revealed that CK20 and CDX2 expression correlates with intestinal type, whereas MUC1 positivity indicates pancreatobiliary type. A marginally significant trend was shown for intestinal-type tumors toward larger size and more frequent MUC2 expression. Using multivariate analysis CK20 ( P = .003) and MUC1 ( P = .004) were identified as independent predictors of the intestinal and pancreatobiliary types, respectively. Mean and median survival was 90.3 and 55 months, respectively. Overall 5-year survival rate was 48%. On univariate survival analysis, overall survival was adversely influenced by the number of infiltrated lymph nodes, elevated Ca19-9 serum levels, jaundice, poor differentiation, T4 stage, N1 stage, TNM stage III, and CDX2 immunonegativity. Multivariate analysis identified TNM stage as the only independent prognostic factor in ampullary adenocarcinoma ( P = .048).
  
  
  CONCLUSIONS
  Immunoreactivity against CK20 and MUC1 in ampullary carcinomas is a useful adjunct to histologic examination in determining histotype. None of the immunohistochemical markers studied had prognostic significance.
authors.affiliation: 1 Third Surgical Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: Iraklis
authors.initials: I
authors.lastname: Perysinakis
authors.affiliation: 2 Pathology Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: Emilia
authors.initials: E
authors.lastname: Minaidou
authors.affiliation: 2 Pathology Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: Vasileia
authors.initials: V
authors.lastname: Leontara
authors.affiliation: 3 Second Department of Propaedeutic Surgery, Laiko Hospital, Athens University Medical School, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mantas
authors.affiliation: 3 Second Department of Propaedeutic Surgery, Laiko Hospital, Athens University Medical School, Greece.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.affiliation: 1 Third Surgical Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: Hercules
authors.initials: H
authors.lastname: Tsipras
authors.affiliation: 1 Third Surgical Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: George N
authors.initials: GN
authors.lastname: Zografos
authors.affiliation: 1 Third Surgical Department, "George Gennimatas" General Hospital, Athens, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Margaris
authors.affiliation: 3 Second Department of Propaedeutic Surgery, Laiko Hospital, Athens University Medical School, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology; D014408:Biomarkers, Tumor / Q000032:analysis*; D000071616:CDX2 Transcription Factor / Q000032:analysis / Q000096:biosynthesis; D003138:Common Bile Duct Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D066246:ErbB Receptors / Q000032:analysis / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D053554:Keratin-20 / Q000032:analysis / Q000096:biosynthesis; D053552:Keratin-7 / Q000032:analysis / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000032:analysis / Q000096:biosynthesis; D055262:Mucin-2 / Q000032:analysis / Q000096:biosynthesis; D010446:Peptide Fragments / Q000032:analysis / Q000096:biosynthesis; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult; D051176:beta Catenin / Q000032:analysis / Q000096:biosynthesis
chemical_list: D014408:Biomarkers, Tumor; D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D053554:Keratin-20; D053552:Keratin-7; C520326:MUC-1 protein, human (950-958); C524625:MUC2 protein, human; D018396:Mucin-1; D055262:Mucin-2; D010446:Peptide Fragments; D051176:beta Catenin; C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: EGFR; ampullary adenocarcinoma; intestinal; pancreatobiliary; prognosis; β-catenin