Impact of intratumoral thymidylate synthase expression on prognosis after surgical resection for ampullary carcinoma

Abstract

This study evaluated possible prognostic value of expression level of intratumoral thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and orotate phosphoribosyltransferase (OPRT) in patients with resected ampullary carcinoma. Immunohistochemical staining evaluated intratumoral TS, DPD, and OPRT expression in 52 surgical specimens of patients with ampullary carcinoma. Relationships between clinicopathological factors including intratumoral TS, DPD, or OPRT expressions and survival was evaluated by univariate and multivariate analysis. High intratumoral DPD, OPRT, and TS expressions were found in 19 (37%), 30 (58%), and 23 (44%) of cases, respectively. Patients with high TS expression had more advanced-stage disease than those with low TS expression. Univariate analysis revealed that gender, perineural invasion, lymph node status, UICC pT factor, UICC stage, OPRT expression, and TS expression correlated significantly (P < 0.05) with disease-specific survival. Only perineural invasion (P = 0.043) and TS expression (P = 0.019) were independent prognostic factors of disease-specific survival by multivariate survival analysis. Five-year disease-specific survival rates of patients with high and low intratumoral TS expression were 47% and 91%, respectively. Intratumoral TS expression level may be a potent predictor of prognosis after surgical resection for ampullary carcinoma.