Author/Editor     Tomažič, Aleš; Pleskovič, Alojz; Ferlan-Marolt, Vera; Luzar, Boštjan; Pegan, Vladislav
Title     Napovedni dejavniki preživetja bolnikov po resekciji periampularnega adenokarcinoma
Translated title     Survival predictors after resection of periampullar adenocarcinoma
Type     članek
Source     Gastroenterolog
Vol. and No.     Letnik 8, št. 1-2
Publication year     2004
Volume     str. 96-103
Language     slo
Abstract     Bacground. The outcome of patient undergoing pancreatoduodenectomy depends on various factors, molecular studies have pointed to the important role of oncogenes, tumor suppressor genes, growth factors and factors, which influence apoptosis. The aim of the studywas to define factors predictive of survival in periampullary adenocarcinoma, to find out the prognostic role of expression of cyclin D1, p27Kipl and bax. Methodology. Prospectively, we collected clinicopathological data about patients operated between 1995 and 1998. Expression of cyclin D1, p27Kipl and bax was determined with immunohistochemical methods. Clinicopathological factors and expression ofcyclin D1, p27Kipl and bax were examined with respect to patient survival. Univariate analyses were performed using the Kaplan-Meier method and log-rank test, and multivariate analysis was done with Cox proportional hazards regression. Results. Fifty five patients were included in study. Actuarial 5-year survival was 29%. Diabetes mellitus, blood transfusion, diameter of tumor, histological type of tumor (pancreatic adenocarcinoma), perineural invasion, lymphnode metastasis, overexpression of cyclin D1 and lower expression of bax and p27Kipl significantly decreased survival according to univariate analysis. In the multivariate analysis, histologic type of tumor (p = 0,001), lymphnode metastases (p = 0,03) and overexpression of cyclin D1 (p = 0,02) independently influenced survival. Conclusions. Our present findings confirm that expression of cyclin D1 influences the biological growth behaviour of periampullary adenocarcinomas and contribute to prognosis.
Summary     Izhodišča. Na preživetje bolnikov po cefalični duodenopankreatektomiji zaradi periampularnega adenokarcinoma vplivajo številni dejavniki. Pomemben vpliv imajo tudi onkogeni, tumor zaviralni geni, rastni dejavniki in dejavniki, ki vplivajo na apoptozo. V nalogi smo poleg vpliva kliničnih in histopatoloških dejavnikov proučevali tudi napovedno vrednost izražanja ciklina D1, p27Kipl in baxa. Bolniki in metode. Vsi bolniki so imeli od leta 1995 do leta 1998 na Kliničnem oddelku za abdominalno kirurgijo zaradi periampularnega adenokarcinoma narejeno cefalično duodenopankreatektomijo. Prospektivno smo zbrali klinične in histopatološke podatke. Izraženost ciklina D1, p27Kipl in bax smo določili z imunohistokemijsko metodo. Krivulje preživetja smo izračunali po Kaplan-Meierjevi metodi, razlike v preživetju pa ocenili s testom logrank. Za preživetje statistično pomembne napovedne dejavnike smo vključili v multivariatno analizo, ki smo jo izvedli s Coxovim regresijskim modelom. Rezultati. V analizo je bilo vključenih 55 bolnikov. Ocenjeno 5-letno preživetje je znašalo 29%. V univariatni analizi so se sladkorna bolezen, periope rativna transfuzija, premer tumorja, patohistološka vrsta tumorja, perinevralno vraščanje, zasevki v bezgavkah, čezmerna izraženost ciklina D1 in zmanjšana izraženost p27Kipl in bax izkazali kot negativni napovedni dejavniki. Kot negativni neodvisni napovedni dejavniki so se v multivariatni analizi izkazali histološka vrsta tumorja (p = 0,001), zasevki v bezgavkah (p = 0,03) in čezmerno izražanje ciklina D1 (p = 0,02). Zaključki. Ciklin D1 je pomemben neodvisni napovedni dejavnik. Odpira novo pot, ki bo morda vodila k napredku v zdravljenju periampularnih adenokarcinomov.
Descriptors     ADENOCARCINOMA
VATER'S AMPULLA
COMMON BILE DUCT NEOPLASMS
SURVIVAL ANALYSIS
RISK FACTORS
CYCLINS
ANTIBODIES, MONOCLONAL
IMMUNOHISTOCHEMISTRY
PROTEIN KINASES
GENES, BCL-2