Correlation of Ki-67, nm23-H1 and the VEGF Expression with the Clinicopathological Variables for Distant Recurrence after Curative Surgery for Carcinoma of the Ampulla of Vater

PURPOSE: Not a few patients show early distant recurrence after curative resection for carcinoma of the ampulla of Vater, and this recurrence is not just related to the clinicopathological factors. This study was performed to determine the correlation of the clinicopathological and biological characteristics with early distant recurrence after surgery for carcinoma of the ampulla of Vater. METHODS: Of the 158 patients who underwent curative resection for carcinoma of the ampulla of Vater at the Samsung Medical Center between December 1994 and August 2004, 38 patients (the recurrence group) with distant recurrence within a year after surgery and 32 patients (the non-recurrence group) without recurrence for more than 3 years after surgery were retrospectively analyzed. Evaluation of their clinicopathological characteristics and their immunohistochemical staining for Ki-67 antigen, nm23-H1 protein and vascular endothelial growth factor (VEGF) were carried out. RESULTS: Of the recurrence group, 24 patients (63.2%) had multiple recurrence sites and 10 (26.3%) were TNM stage I after surgery. The TNM stage was significantly advanced in the recurrence group. Both the Ki-67 labeling index (LI) (10.2% vs. 5.8%, respectively) and positive rate (50.0% vs.18.8%, respectively) according to the cut-off value of Ki-67 LI (i.e. 9%) were significantly higher in the recurrence group. The immunoreactivity for nm23-H1 protein and VEGF was not different between the two groups. Only lymph node metastasis was statistically significant on the multivariate analysis for early distant recurrence after surgery. CONCLUSION: The recurrence group showed an advanced TNM stage and increased Ki-67 LI. Lymph node metastasis was the single independent poor indicator for early distant recurrence after curative resection for carcinoma of the ampulla of Vater.

Prognostic Factors and Survival Rate of Ampulla of Vater Cancer after Curative Surgery

PURPOSE: Ampulla of Vater cancer has a more favorable prognosis than other malignant tumors of the periampullary region, but prognostic factors have not been identified. The aim of this study was to evaluate the prognostic factors of ampulla of Vater cancer from a single hospital experience. METHODS: The medical records of the 102 patients with ampulla of Vater cancer which underwent curative surgery between 1992 and 2002, were reviewed. All specimens were critically reviewed by an expert pathologist. The relationships between survival and the clinicopathological variables were assessed. RESULTS: In 120 patients that presented with ampulla of Vater cancer, 102 (85%) were resected. The 5 year survival rate was 69.1%. A univariate analysis showed the survival was closely related to gender, the tumor gross morphology, invasion depth and lymph node metastasis. A multivariate analysis identified two significant factors; the depth of invasion and gender. Twenty nine of the 102 patients suffered a recurrence. CONCLUSION: The depth of invasion and gender were independent significant prognostic factors of resectable ampulla of Vater cancer. Careful observation is essential for liver metastasis after surgery, especially in patients that have these factors.