壶腹癌的临床、形态学及免疫表型特征，重点关注SMAD4表达情况。
Clinical, morphologic, and immunophenotypic characteristics of ampullary carcinomas with an emphasis on SMAD4 expression.
作者信息
Alkhasawneh Ahmad, Duckworth Lizette Vila, George Thomas J, Desai Neelam V, Sommerfeld Alex J, Lu Xiaomin, Toro Tania Zuluaga
机构信息
Department of Pathology, University of Florida College of Medicine, Jacksonville, FL 32204, USA.
Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
出版信息
J Gastrointest Oncol. 2016 Dec;7(6):974-981. doi: 10.21037/jgo.2016.06.14.
BACKGROUND
The purpose of our study was to examine the relationship between clinicopathologic variables and morphologic subtypes in ampullary carcinoma, with an emphasis on the expression of tumor suppressor gene.
METHODS
Sixty-three cases of ampullary carcinomas resected between 2000-2011 were included in this study. Clinical characteristics and outcome data were recorded. Tumors were classified as pancreatobiliary or intestinal type based on morphology, and immunohistochemical (IHC) studies for cytokeratin 7 (CK7), cytokeratin 20 (CK20), cytokeratin 17 (CK17), and SMAD4 were performed.
RESULTS
Forty-nine percent of the ampullary tumors were pancreatobiliary, 29% were intestinal, and 22% were other variants. Tumors with pancreatobiliary morphology showed worse overall survival than those with intestinal morphology or other variants (P=0.03). A trend for higher stage, recurrence and less survival was seen in cases with negative SMAD4 expression. In multivariate analysis, age group (≤60 . >60 years) and expression of CK17 were the most prognostic of survival.
CONCLUSIONS
Ampullary tumors with pancreatobiliary morphology have a worse overall survival, while negative SMAD4 expression is associated with a trend of less survival.
背景
我们研究的目的是探讨壶腹癌的临床病理变量与形态学亚型之间的关系，重点关注肿瘤抑制基因的表达。
方法
本研究纳入了2000年至2011年间切除的63例壶腹癌病例。记录临床特征和预后数据。根据形态学将肿瘤分为胰胆管型或肠型，并进行细胞角蛋白7（CK7）、细胞角蛋白20（CK20）、细胞角蛋白17（CK17）和SMAD4的免疫组织化学（IHC）研究。
结果
49%的壶腹肿瘤为胰胆管型，29%为肠型，22%为其他变异型。胰胆管形态的肿瘤总体生存率低于肠型或其他变异型肿瘤（P = 0.03）。SMAD4表达阴性的病例显示出更高分期、复发率和更低生存率的趋势。在多变量分析中，年龄组（≤60岁、>60岁）和CK17的表达是生存最具预后价值的因素。
结论
具有胰胆管形态的壶腹肿瘤总体生存率较差，而SMAD4表达阴性与生存率降低的趋势相关。
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