THE SIGNIFICANCE OF PROLIFERATING CELL NUCLEAR ANTIGEN (PCNA) EXPRESSION IN CANCER OF THE AMPULLA OF VATER IN TERMS OF PROGNOSIS

Seventeen patients with cancer of the ampulla of Vater were studied re trospectively using immunohistochemical staining with a monoclonal ant ibody to the proliferating cell nuclear antigen (PCNA). The relationsh ips between the PCNA-positive rate, being the number of PCNA-positive cancer cells to total cancer cells, the clinico-pathological findings, and the clinical course were evaluated. The PCNA-positive rate in pat ients with lymph node metastasis (47%) was significantly higher than t hat in patients without metastasis (29%), while that in patients with advanced cancer invading the pancreatic parenchyma (47%), was signific antly higher than that in patients with early cancer without invasion of the sphincter of Oddi (32%). All of five patients with early cancer are still alive, whereas five with semi-advanced cancer invading the sphincter of Oddi but not the pancreatic parenchyma, and two with a PC NA-positive rate of over 40% died of recurrent cancer. Of seven patien ts with advanced cancer, only one with a low PCNA-positive rate of 23% is alive, but the other six with a PCNA-positive rate of over 40% all died. The results suggest that the PCNA-positive rate provides a prog nostic index for cancer of the ampulla of Vater.