Immunohistochemical fhenotype and survival in tumors of the ampulla of Vater

Several histopathologic features of ampullary tumors have been shown to be correlated with prognosis. We classified the tumors in pancreatobiliary and intestinal types and evaluated their relation with staging and survival. 33 Patients with ampullary carcinomas underwent to pancreaticoduodenectomy R0 resections. Clinicopathologic features were assessed. The immunohistochemical markers were MUC1, MUC2, MUC5AC, CDX2, CK7, CK20. The data were analyzed using univariate and multivariate methods. The two step cluster method was used to determine the immunohistochemical markers that best discriminate the intestinal from pancreaticobiliary type. The age of patients was 62.5 years, and the interquartile range from 54 to 62. There were 11 (33.3%) intestinal type and 21 (66.7%) pancreaticobiliary tumors. There was an association between N1 and pancreaticobiliary classification (p = 0.032). In univariate analysis, the variables with impact on survival were N (p = 0.004), T (p = 0.022) and stage (p < 0.001). The final model showed positive nodes (N1) associated with shorter survival (HR = 9.5; p = 0.006) compared to patients with N0. Overall survival at 12, 36 and 60 months was 88.5%, 67.0%, 47.6%, respectively. The variables that best discriminated the two groups were CDX2 (intestinal), CK7 and MUC 1 (pancreaticobiliary). CDX2, CK7 and MUC 1 were the immunohistochemical markers that best discriminated the intestinal from pancreaticobiliary type. Lymph node involvement had high impact on survival, being more frequent in pancreaticobiliary type. [Lymph node involvement on survival]