背景:组织学亚型是Vater壶腹(AoV)癌的重要预后因素。本研究提出了基于免疫组织化学(IHC)染色的AoV癌组织学分型分类系统及其预后意义。
方法:分析了75种AoV癌症的细胞角蛋白7(CK7),通过IHC染色,CK20和因果型同源异型盒转录因子2(CDX2)表达。我们区分了亚型(INT,肠道;PB,胰胆管;混合,混合;NOS,未另作说明)分为I级:CK7/CK20,II级:CK7/CK20或CDX2,III级:CK7/CDX2,并检查了它们与临床病理因素的关联。
结果:分类I,II,III亚型为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的II和III分类中,观察到这些亚型之间的无病生存率存在显着差异;与INT亚型相比,PB和NOS亚型的生存时间更短。在第三类中,揭示了高级T/N阶段之间的关联,分化差,淋巴管浸润(LVI),PB和NOS亚型,和复发风险。在第三类中,这些亚型在T/N分期和LVI上有显著差异。PB亚型患者的T和N分期较高,LVI的发生率较高。
结论:使用CDX2进行分类显示具有不同预后意义的亚型。结合CK7和CDX2或将CDX2添加到CK7/CK20对于区分亚型有用。预测疾病结果,并影响AoV癌症患者的临床管理。
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.