Pathological typing and clinical features of Vater ampullary adenocarcinoma

Objective To investigate the features and clinical data of different pathological types of Vater ampullary adenocarcinoma and the influencing factors for prognosis, and to improve the prognostic evaluation and treatment outcome of Vater ampullary adenocarcinoma after surgery.Methods A retrospective analysis was performed for the clinical data of 65 patients with Vater ampullary adenocarcinoma who were admitted to Nanjing First Hospital, namely Nanjing Hospital Affiliated to Nanjing Medical University, from January 2010 to January 2017,and the patients were divided into intestinal-type group, pancreaticobiliary-type group, and mixed-type group according to the results of HE staining. Immunohistochemistry was used to measure the expression of the tumor protein markers MUC1, MUC2, CK7, CK20, and CDX2 in the cancer tissue of various subtypes, and related clinical data and prognosis were compared and analyzed. The chi-square test was used for comparison of categorical data between groups; an analysis of variance was used for comparison of continuous data between groups; the Kaplan-Meier method was used to plot survival curves and calculate survival rates.Results Of all patients, 20 had intestinal type, 34 had pancreaticobiliary type, and 11 had mixed type. The results of immunohistochemistry showed that the intestinal-type group/5500% vs 2.94%/0/14.71%,χ2= 49. 916, 42. 178, and 9. 806, allP< 0. 01), and compared with the intestinal-type group, the pancreaticobiliary-type group had significantly higher positive rates of CK7(97. 06% vs 20. 00%, χ2 =34.665,P< 0. 01) and MUC1(94.12% vs 5.00%,χ2 =42.082,P< 0. 01). The patients in the mixed-type group often had co-expression of various tumor markers,and there were no significant differences in the positive expression of such markers between this group and the other two groups(allP>05). The comparison of clinical data between the three groups showed that there were no significant differences in age, sex, tumor tissue diameter, degree of tumor differentiation, and TNM stage between the patients with different subtypes(allP> 0. 05). The prognostic analysis showed that the median survival time after surgery in the three groups was 64. 00 months, 49. 50 months, and 56. 00 months, respective-ly. The results of comparison between groups showed that the intestinal-type group had significantly higher 5-year survival rate and 5-year disease-free survival rate than the pancreaticobiliary-type group(5-year survival rate: 60. 00% vs 32. 35%,χ2= 5. 206,P=0. 023; 5-year disease-free survival rate: 55. 00% vs 23. 53%,χ2 =6.140,P= 0. 013), and the mixed-type group had lower 5-yearsurvival rate and 5-year disease-free survival rate than the intestinal-type group but higher 5-year survival rate and 5-year disease-free survival rate than the pancreaticobiliary-type group(allP> 0. 05).Conclusion Different pathological subtypes of Vater ampullaryadenocarcinoma have different features of the expression of MUC1, MUC2, CK7, CK20, and CDX2, and combined measurement of thesefive tumor protein markers can better identify the pathological type of Vater ampullary adenocarcinoma and thus assist in prognostic evaluationand postoperative treatment.