Adenocarcinoma da ampola de Vater: perfil imuno-histoquímico e fatores prognósticos

Abstract

The two types of ampullary cancer, intestinal and pancreatobiliary were first described by Kimura et al. in 1994. The histopathological classification of ampullary cancer has been described as a prognostic factor and may be important in adjuvant chemotherapy decision. The aim of this study was to define the phenotype of the ampulla of Vater adenocarcinoma by immunohistochemical expression of MUC1,MUC2, MUC5AC, CDX2, CK7, CK20 and EPCAM, and determine prognostics factors. We studied 30 patients with ampullary cancer undergoing to surgical resection (R0) in a single institution. Tumors were classified in intestinal type and pancreatobiliary type and their relationship with clinicopathological variables and survival were analyzed. Data were analyzed using univariate and multivariate methods.The Cluster multivariate method was used to determine the immunohistochemical markers that best discriminated intestinal and pancreatobiliary types. The immunohistochemical markers that best discriminated histological types were CDX2 (intestinal) and CK7 (pancreatobiliary). The mean age of patients was 62 years (range,54-72 years). Nine (30%) tumors were intestinal and 21 (70%) pancreatobiliary. The best markers to discriminate these types were CDX2 and CK7. The variables with significant association with pancreatobiliary type in univariate analysis were lymph nodes involvement (p=0.029), angiolymphatic invasion (p=0.002) and perineuralinvasion (p=0.04). In multivariate model the independent variable associated to the histological type was angiolymphatic invasion (p=0.005, OR = 17). Overall survival at 12, 24, 36 and 60 months was 87.8%, 75.2%, 69.9% and 65.3%. In univariate analysis, the variables with impact on survival were age (p=0.012), lymph node involvement (p=0.002), tumor invasion (p=0.013), stage (p<0,001), angiolymphatic (p=0.010) andperineural invasion (p=0.004). In multivariate model a significant association between poor survival and lymph node involvement was demonstrated (HR=9.03, p=0.009). In conclusion, the immunohistochemical markers that best discriminated histological typeswere CDX2 (intestinal) and CK7 (pancreatobiliary). Lymph node involvement had a major impact on survival and was more frequent in pancreatobiliary type.