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Validation of histomolecular classification utilizing histological subtype, MUC1, and CDX2 for prognostication of resected ampullary adenocarcinoma
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Validation of histomolecular classification utilizing histological subtype, MUC1, and CDX2 for prognostication of resected ampullary adenocarcinoma
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Journal Article
Validation of histomolecular classification utilizing histological subtype, MUC1, and CDX2 for prognostication of resected ampullary adenocarcinoma
2015
Overview
Background:
Outcomes for ampullary adenocarcinomas are heterogeneous, and numerous methods of categorisation exist. A histomolecular phenotype based on histology, caudal-type homeodomain transcription factor 2 (CDX2) staining and Mucin 1 (MUC1) staining has recently been tested and validated in two cohorts. We attempt to validate this classification in a large patient population.
Methods:
Tissue samples from 163 patients with resected ampullary adenocarcinoma were classified based on histology and immunohistochemical expression of CDX2 and MUC1. A pancreaticobiliary histomolecular classification (PB) was defined as a sample with pancreaticobiliary histology, positive MUC1 and negative CDX2 expression.
Results:
There were 82 deaths; median follow-up of 32.4 months; and median overall survival of 87.7 (95% CI 42.9–109.5) months. PB comprised 28.2% of the cases. Factors associated with overall survival were histological subtype (
P
=0.0340); T1/2
vs
T3/4 (
P
=0.001); perineural (
P
<0.0001) and lymphovascular (
P
=0.0203) invasion; and histomolecular intestinal histomolecular phenotype (INT)
vs
PB phenotype (106.4
vs
21.2 months,
P
<0.0001). Neither MUC1 nor CDX2 was statistically significant, although MUC1 positivity defined as ⩾10% staining was significant (
P
=0.0023). In multivariate analysis, age (HR 1.03), PB phenotype (HR 2.26) and perineural invasion (PNI; HR 2.26) were associated with poor survival.
Conclusions:
The prognostic ability of histomolecular phenotype has been validated in an independent cohort of ampullary adenocarcinoma patients.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Adult
/ Aged
/ Ampulla of Vater - pathology
/ Biomedical and Life Sciences
/ Cancer
/ Common Bile Duct Neoplasms - metabolism
/ Common Bile Duct Neoplasms - pathology
/ Common Bile Duct Neoplasms - surgery
/ Female
/ Homeodomain Proteins - metabolism
/ Humans
/ Male
/ Medicine
/ Oncology
/ Patients
