Doublecortin and CaM kinase-like-1 as an independent prognostic factor in patients with resected pancreatic carcinoma

AIM To elucidate the effect of expression of doublecortin and Ca M kinase-like-1(DCLK1) in patients with pancreatic ductal adenocarcinoma(PDAC). METHODS Tumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition(EMT) marker expression, and cancer stem cell(CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker.RESULTS In total, 48.5%(66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors(median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade(P = 0.0290), preoperative CA19-9 level(P = 0.0060), epithelial cell adhesion molecule(Ep CAM) expression(P = 0.0235), and the triple-positive expression of CD44/CD24/Ep CAM(P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4(P = 0.0091), high preoperative serum SPan-1 level(P = 0.0034), R1/2(P < 0.0001), positive expression of DCLK1(P < 0.0001) or CD44(P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio(OR) = 2.019, 95% confidence interval(CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression(OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors. CONCLUSION DCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.

Comparison of clinicopathological characteristics between resected ampullary carcinoma and carcinoma of the second portion of the duodenum

BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.