Crucitti A, Masetti R, Breccia C, Coppola R, Magistrelli P, Nuzzo G, Maggiano N, Picciocchi A
Department of General Surgery, Catholic University of the Sacred Heart, Rome, Italy.
Hepatogastroenterology. 1999 Mar-Apr;46(26):1187-91.
BACKGROUND/AIMS: The aim of the present study is to assess the nuclear DNA ploidy patterns, the fraction of cells in the various phases of the cell cycle as determined by flow cytometry and to evaluate Proliferative cell-nuclear antigen (PCNA) expression in order to examine the relationships between phase-two molecular factors, clinicopathological aspects and outcome of patients with cancers of the ampulla of Vater.
Paraffin-embedded specimens from 18 cases of cancers of ampulla of Vater radically resected between 1985 and 1995 were analyzed by flow-cytometry and immunohistochemical staining with monoclonal antibody to the PCNA. The relationships between cell-proliferation kinetics, PCNA-positive cancer cells, clinicopathological findings and the clinical course were evaluated.
Pathologist reports documented 17 papillary adenocarcinomas and one case of mucinous carcinoma. According to the TNM classification, 4 patients were in stage I, 7 in stage II and 7 in stage III. Locally advanced ampullary tumors (T3-T4) had a significantly worse prognosis (p = 0.01); survival at 3 and 5 years for stage I-II patients (11 cases) was 90% and 79% as compared to 42% and 42% for patients with stage III (8 cases), respectively (p = n.s.). Thirteen cancers (72%) were diploid and 5 (28%) aneuploid. Patients with aneuploid tumors were younger (mean age: 59 years) than patients with diploid tumors (mean age: 66 years; p = 0.04). No significant correlation was found between size of the tumor (T), lymphnodal status (N), grading (G) or aneuploidy. Difference in terms of survival between aneuploid and diploid patients was relevant (16 vs. 121 months) but, due to the small number of cases, was not statistically significant (p = n.s). The mean value of S-phase fraction (SPF) was 14.8%. PCNA positive rate significantly correlates with size of the tumor (T1-T2 vs. T3-T4; p = 0.03). Actuarial overall survival resulted in 70%, 63% and 31% at 1, 5 and 10 years, respectively. The high rate of diploidy (72%) supports the relative benign behavior of ampullary cancers.
PCNA positive rate significantly correlates with size of the disease. Aneuploidy, although without significant prognostic value, correlates well with survival. Because of the wide range of all variables, more data are needed to establish the relationships between pathological factors, DNA ploidy and PCNA rate and their significance as molecular predictors of prognosis in ampulla of Vater cancers.
背景/目的：本研究旨在评估核DNA倍体模式、通过流式细胞术测定的细胞周期各阶段细胞比例，并评估增殖细胞核抗原（PCNA）的表达，以探讨二期分子因素、临床病理特征与 Vater 壶腹癌患者预后之间的关系。
对1985年至1995年间根治性切除的18例 Vater 壶腹癌石蜡包埋标本进行流式细胞术分析及PCNA单克隆抗体免疫组化染色。评估细胞增殖动力学、PCNA阳性癌细胞、临床病理表现与临床病程之间的关系。
病理学家报告记录了17例乳头状腺癌和1例黏液癌。根据TNM分类，4例患者为I期，7例为II期，7例为III期。局部进展期壶腹肿瘤（T3 - T4）预后明显较差（p = 0.01）；I - II期患者（11例）1年和5年生存率分别为90%和79%，而III期患者（8例）分别为42%和42%（p = 无统计学意义）。13例癌症（72%）为二倍体，5例（28%）为非整倍体。非整倍体肿瘤患者比二倍体肿瘤患者年轻（平均年龄：59岁 vs. 66岁；p = 0.04）。未发现肿瘤大小（T）、淋巴结状态（N）、分级（G）或非整倍体之间存在显著相关性。非整倍体和二倍体患者的生存差异有相关性（16个月 vs. 121个月），但由于病例数少，无统计学意义（p = 无统计学意义）。S期分数（SPF）的平均值为14.8%。PCNA阳性率与肿瘤大小显著相关（T1 - T2 vs. T3 - T4；p = 0.03）。1年、5年和10年的精算总生存率分别为70%、63%和31%。高比例的二倍体（72%）支持壶腹癌相对良性的行为。
PCNA阳性率与疾病大小显著相关。非整倍体虽然无显著预后价值，但与生存密切相关。由于所有变量范围广泛，需要更多数据来确定病理因素、DNA倍体和PCNA率之间的关系及其作为 Vater 壶腹癌预后分子预测指标的意义。
