DNA ploidy and S + G2M fraction (proliferative index) as prognostic determinants in human periampullary cancer.

BACKGROUND/AIMS: The aim of the present study was to investigate the relationship between pathological factors, DNA ploidy patterns, proliferative index and survival in a population of patients undergoing resection for adenocarcinoma of periampullary region.

MATERIALS AND METHODS

DNA ploidy and proliferative index of periampullary cancer tissue was measured by flow cytometry in 73 patients who had undergone pancreatoduodenectomy.

RESULTS

Seventy-four percent (n = 54) of cancers were diploid and 26% (n = 19) were aneuploid. The median survival time of patients with diploid cancers was 30.1 (s.d. 5.1) months and with aneuploid cancers was 16.0 (s.d. 2.9) months (p = 0.02). Kaplan-Meier survival curves showed that the patients with aneuploid cancers succumbed to recurrent disease within 40 months after surgery whereas 20% of patients with diploid cancers survived longer than 40 months. In patients with long survival (3 years) there was a significant difference between aneuploid and diploid cancers (p < 0.001). In the multivariate analysis, tumor location and tumor size are independent prognostic variables for the length of survival after resection of periampullary cancer.

CONCLUSIONS

DNA ploidy pattern appears to be one important prognostic predictor in patients with "long term" survival after successful pancreatoduodenectomy for periampullary cancers.