Cyclin D1 and bax influence the prognosis after pancreatoduodenectomy for periampullary adenocarcinoma.

Background/Aims: The outcome of patients undergoing pancreatoduodenectomy for periampullary adenocarcinoma is influenced by various clinicopathological factors, chemo/radiotherapy and expression of various oncogenes, tumor suppressor genes, growth factors and factors controlling apoptosis. The aim of this study was to define clinicopathological predictors of survival in periampullary adenocarcinoma, and to determine the prognostic significance of cyclin D1, p27 kip1 and bax expression in these tumors. Methodology: Prospectively, we collected clinicopathological data for patients operated on between January 1995 and December 1998. Cyclin D1, p27 kip1 and bax expression was assessed immunohistochemically. The potential influence of clinicopathological factors and cyclin D1, p27 kip1 and bax expression on survival was investigated. Univariate analyses were performed using the Kaplan-Meier method and logrank test. For multivariate analysis Cox proportional hazards regression was used. Results: Fifty-five patients were included in the study. The actuarial 5-year survival was 30% 11% for pancreatic adenocarcinoma and 46% for distal bile duct/papillary adenocarcinoma Univariate analysis identified diabetes mellitus, blood transfusion, diameter of the tumor, histological type of the tumor, lymphatic invasion, neural invasion, lymph node metastasis, overexpression of cyclin Dl and lower expression of bax and p27 kip1 as factors that significantly decrease survival rates. In multivariate analysis, the histological type of the tumor (p=0.001), lymph node involvement (p=0-03) and overexpression of cyclin D1 (p=0.02) independently influenced survival, whereas decreased expression of bax nearly reached statistical significance (p=0.054). Conclusions: Our findings confirm the association between cyclin Dl and bax expression and aggressive biological behavior of periampullary adenocarcinomas. Moreover, these parameters were identified as independent prognostic indicators in these tumors.