Can we improve the classification of ampullary adenocarcinoma? The value of histomolecular classification and clinicopathological features on prognosis - 24/09/21
, Irene Carretero 2 , Raquel Arranz 1 , Esther Moreno 2 , Laura Del Campo Abendea 3 , Ángela Santana 1, Cristian Perna 2 , Alejandra Caminoa 2 , Javier Zamora 3 , José María Fernandez Cebrián 4, Alfonso Sanjuanbenito 1This article has been published in an issue click here to access
HIGHLIGHS |
• | The prognostic implications of the histomolecular classification are yet to be stablished with large and multicentric studies |
• | Our study underline the lack of congruence of the classical histological classification, showing a Kappa agreement index of 0.59, which means that 25% of the cases were re-classified. |
• | The histomolecular classification used in this study modified the AA subtype (PB vs INT) in 32% of the cases |
• | The best histomolecular classification and the combination of molecular markers that better categorize AA is yet to be stablished |
• | Histomolecular classification using IHQ methods could improve CT selection in an heterogenous disease as AA. 37.5% of our patients would have been treated with an inappropriate regimen for their cell line when re-classified with the histomolecular classification. |
ABSTRACT |
BACKGROUND |
Ampullary adenocarcinoma (AA) can originate from three different epitheliums, conditioning its evolution and prognosis. Recently, histomolecular classification has been defined, according to the presence of immunohistochemical (IHQ) markers of intestinal (INT) lineage vs pancreatobiliary (PB).
METHODS |
42 AA patients were retrospectively reviewed and morphologically and molecular classified with IHQ MUC1, MUC2, CDX2, CK20 and CK7 markers, according to the system described by Chang et al. A prognostic study was carried out in relation to histological and histomolecular characterization and other clinicopathological variables.
RESULTS |
24 patients (57%) were pancreatobiliary (Chang-PB) and 16 (43%) intestinal (Chang-INT), 2 patients could not be classified. The histological classification (post-surgical report vs reviewed) showed a congruence of 75% with a kappa concordance index of 0.595. The Chang-PB molecular classification showed lower survival in all comparisons, but it was not statistically significant (long-rank> 0.05). Univariable analysis showed that only lymph node invasion and CK20 staining were associated with overall survival.
CONCLUSION |
An IHC classification could improve the prognostic characterization of AA, however, there is a lack of evidence on the clinical importance of molecular markers in AA with conflicting results, and its applicability has yet to be established.
El texto completo de este artículo está disponible en PDF.KEYWORDS : ampullary adenocarcinoma, MUC1, CDX2, histomolecular phenotype, immunohistochemical typing
Esquema
| Conflicts of Interest and Source of Funding: None declared |
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| Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
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