Determinants Of Long-term Efficacy After Pancreaticoduodenectomy Or Local Resection For Ampullary Carcinoma

Objective:1.To determine the clinicopathologic factors that influence long-term efficacy in patients with resected ampullary carcinoma.2.To study the indication for local resection of ampullary carcinoma.3.To evaluate the feasibility and efficacy of immunohistochemistry (IHC) classification with expression of Cytokeratin 7(CK7)and Cytokeratin 20 (CK20).4.To investigate the correlation between immunohistochemical type,Osteopontin (OPN),matrixmetalloproteinase-2(MMP-2),Artemin and survival of patients after resection.Methods:1.Clinicopathologic data were retrospectively reviewed for patients with ampullary carcinomas resected between January 1993 and December 2008. The correlation between clinicopathologic variables(tumor size, tumor differentiation,depth of tumor infiltration and lymph node status)and survival of patients after resection was examined by the Kaplan-Meier method,the log-rank test, and Cox proportional hazards regression.2.A retrospective comparative study of pancreaticoduodenectomy (PD) or local resection for ampullary carcinoma resection were initiated.3.Immunohistochemical techniquewas used to detect the protein expression of CK7,CK20,OPN,MMP-2 and Artemin in 150 cases.Results:1.Comparing pancreaticoduodenectomy group to local resection group, the duration of hospital stay,blood loss and postoperative complication rate was significantly lower after local resection,whereas median survival did not differ between the two resection groups.2.1n T1-status group, the patients undertake PD had significantly longer median survival than those undertake local resection.3.Factors that significantly influenced survival were lymph node status,depth of tumor infiltration,and tumor differentiation on univariate analysis. Tumor size differences did not reach statistical significance by univariate analysis. 4.0n multivariate analysis, only tumor differentiation was the independent determinants of survival after resection.5.Using cytokeratin IHC,150 carcinomas of Vater's ampulla were classified into pancreaticobiliary, intestinal, and other types. Most carcinomas of the ampulla of Vater were of immunohistochemically other type.6.IHC Classification has not a positive or negative correlation with clinicopathologic variables.7. In intestinal-type group,the patients with OPN(-) had a much better median survival compared to those with OPN(+).In MMP-2(-) group,intestinal-type patients had significantly longer median survival than those pancreaticobiliary-type patients. In the MMP-2(+) group, although differences in survival curves between groups of immunohistochemistry types were observed,these differences did not reach statistical significance by univariate analysis.8.The expression of Artemin carried no significant prognostic relevance.Conclusions:1.Local resection of ampullary carcinoma has the advantages of minimally invasive procedure,lower postoperative complication rate compared to PD group.2. PD is the better treatment for T1-status tumor than local resection. The T grade might not be a convenient marker to evaluate ampullary carcinoma malignancy behavior.3.Tumor differentiation is the independent determinants of survival after resection. The selection of operation pattern for ampullary carcinoma might not be choosed according to the tumor differentiation.4.IHC classification together with OPN detection is helpful to predict the outcome for patients with ampullary carcinoma.5.OPN may be related to the oncogenesis and progression of ampullary carcinoma,but need to be further studied.6.Combined with some other factors MMP-2 may contribute to the oncogenesis and progression of ampullary carcinoma.