Can we improve the classification of ampullary adenocarcinoma? The value of histomolecular classification and clinicopathological features on prognosis - 08/10/21
, Irene Carretero b, Raquel Arranz a, Esther Moreno b, Laura Del Campo-Abendea c , Ángela Santana a, Cristian Perna b , Alejandra Caminoa b , Javier Zamora c, José María Fernández-Cebrián d, Alfonso Sanjuanbenito a
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
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.
Le texte complet de cet article est disponible en PDF.Keywords : Ampullary adenocarcinoma, MUC1, CDX2, Histomolecular phenotype, Immunohistochemical typing
Plan
Vol 3
Article 100023- septembre 2021 Retour au numéro
Article précédent
- Should surgical strategies be suspended in case of tumor response to immunotherapy?
- Marc Pocard, Charles Sabbagh
- Designing HIPEC regimens for colon cancer: Is the available evidence being appropriately considered?
- Lana Bijelic, Oriol Crusellas, Isabel Ramos, Kurt Van der Speeten, Pedro Barrios, Domenico Sabia
Bienvenue sur EM-consulte, la référence des professionnels de santé.