基于免疫组织化学染色的 Vater 壶腹癌亚型分类的临床影响。
Clinical impact of ampulla of Vater cancer subtype classification based on immunohistochemical staining.
机构信息
Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
出版信息
World J Surg Oncol. 2024 Jan 3;22(1):5. doi: 10.1186/s12957-023-03289-y.
BACKGROUND
The histological subtype is an important prognostic factor for ampulla of Vater (AoV) cancer. This study proposes a classification system for the histological subtyping of AoV cancer based on immunohistochemical (IHC) staining and its prognostic significance.
METHODS
Seventy-five AoV cancers were analyzed for cytokeratin 7 (CK7), CK20, and causal-type homeobox transcription factor 2 (CDX2) expression by IHC staining. We differentiated the subtypes (INT, intestinal; PB, pancreatobiliary; MIX, mixed; NOS, not otherwise specified) into classification I: CK7/CK20, classification II: CK7/CK20 or CDX2, classification III: CK7/CDX2 and examined their associations with clinicopathological factors.
RESULTS
Classifications I, II, and III subtypes were INT (7, 10, and 10 cases), PB (43, 37, and 38 cases), MIX (13, 19, and 18 cases), and NOS (12, 9, and 9 cases). Significant differences in disease-free survival among the subtypes were observed in classifications II and III using CDX2; the PB and NOS subtype exhibited shorter survival time compared with INT subtype. In classification III, an association was revealed between advanced T/N stage, poor differentiation, lymphovascular invasion (LVI), the PB and NOS subtypes, and recurrence risk. In classification III, the subtypes differed significantly in T/N stage and LVI. Patients with the PB subtype had advanced T and N stages and a higher incidence of LVI.
CONCLUSIONS
Classification using CDX2 revealed subtypes with distinct prognostic significance. Combining CK7 and CDX2 or adding CDX2 to CK7/CK20 is useful for distinguishing subtypes, predicting disease outcomes, and impacting the clinical management of patients with AoV cancer.
背景
组织学亚型是壶腹（AoV）癌的一个重要预后因素。本研究提出了一种基于免疫组织化学（IHC）染色的 AoV 癌组织学分型系统及其预后意义。
方法
对 75 例 AoV 癌进行细胞角蛋白 7（CK7）、CK20 和因果型同源盒转录因子 2（CDX2）的免疫组织化学染色，我们将亚型（INT，肠型；PB，胰胆管型；MIX，混合型；NOS，非特指型）分为分类 I：CK7/CK20、分类 II：CK7/CK20 或 CDX2、分类 III：CK7/CDX2，并检查它们与临床病理因素的关系。
结果
分类 I、II 和 III 亚型分别为 INT（7、10 和 10 例）、PB（43、37 和 38 例）、MIX（13、19 和 18 例）和 NOS（12、9 和 9 例）。在使用 CDX2 时，在分类 II 和 III 中观察到各亚型无复发生存率存在显著差异，PB 和 NOS 亚型的生存时间短于 INT 亚型。在分类 III 中，与高级 T/N 期、低分化、淋巴血管侵犯（LVI）、PB 和 NOS 亚型以及复发风险相关。在分类 III 中，各亚型在 T/N 期和 LVI 方面存在显著差异。PB 亚型患者的 T 期和 N 期较晚，LVI 的发生率较高。
结论
使用 CDX2 的分类显示了具有不同预后意义的亚型。结合 CK7 和 CDX2 或在 CK7/CK20 中添加 CDX2 有助于区分亚型、预测疾病结局，并影响 AoV 癌患者的临床管理。
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