Abstract
BackgroundExpression of High-Mobility Group Box 1 (HMGB1), a multifunctional protein involved in DNA function as well as cell proliferation, inflammation, and the immune response, has been reported to be prognostic in several types of malignancies. However, the prognostic value of HMGB1 in ampullary cancer has not been studied.MethodsPatients with adenocarcinoma of the ampulla of Vater who underwent R0 resection with pancreaticoduodenectomy between 2001 and 2011 were included in the present multi-institutional study. The degree of HMGB1 expression was examined in each resected specimen by immunohistochemical staining.ResultsA total of 101 patients were enrolled of which, 79 patients were eligible. High expression of HMGB1 was observed in 31 (39%) patients. Blood loss, transfusion, tumor stage, nodal status, and HMGB1 expression were identified as predictors with univariate analysis. Multivariate analysis showed that transfusion, lymph-node metastasis, and high HMGB1 expression were independent predictors of poor overall survival. Subgroup analysis showed that high HMGB1 expression was predictive, especially in patients who did not receive adjuvant chemotherapy.ConclusionsHigh HMGB1 expression is an independent predictor of poor prognosis in patients with adenocarcinoma of the ampulla of Vater not treated with adjuvant chemotherapy.
Highlights
Ampullary cancer is a rare biliary tract cancer that accounts for 0.2% of digestive tract cancers in the USA [1]
Expression of High-Mobility Group Box 1 (HMGB1), a multifunctional protein involved in DNA function as well as other cell functions, has been shown to be a prognostic factor in many cancers, such as esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and hepatocellular carcinoma [5]
Patients who met all of the following criteria were eligible for the present study: adenocarcinoma of the ampulla of Vater confirmed by histological examination; achievement of R0 resection by pancreaticoduodenectomy (PD), pylorus-preserving PD (PpPD), or subtotal stomach-preserving PD (SSPPD) between 2001 and 2011; and availability of tissue specimens
Summary
Ampullary cancer is a rare biliary tract cancer that accounts for 0.2% of digestive tract cancers in the USA [1]. The Japanese Society of Hepato-Biliary-Pancreatic Surgery reported a total of 13,192 bile duct cancer cases, including 2161 (16.4%) ampullary cancer patients in 2016 [2]. More than half of the patients are treated with surgical resection, achieving relatively better long-term outcomes than other biliary tract cancers or pancreatic cancer [2, 3]. Expression of High-Mobility Group Box 1 (HMGB1), a multifunctional protein involved in DNA function as well as other cell functions, has been shown to be a prognostic factor in many cancers, such as esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and hepatocellular carcinoma [5]. Expression of High-Mobility Group Box 1 (HMGB1), a multifunctional protein involved in DNA function as well as cell proliferation, inflammation, and the immune response, has been reported to be prognostic in several types of malignancies. The prognostic value of HMGB1 in ampullary cancer has not been studied
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