p53 accumulation confers prognostic information in resectable adenocarcinomas with ductal but not with intestinal differentiation in the pancreatic head

The aim of the study was to examine the relation between p53 protein accumu lation, clinicopathological variables and prognosis in resectable adenocarc inomas of the pancreatic head. The clinical records and tissue specimens of 82 consecutive patients resected for adenocarcinomas located in the head o f the pancreas were reviewed retrospectively. Formalin-fixed and paraffin-e mbedded specimens from each tumour were stained with the monoclonal antibod y DO7, and the nuclear p53 positivity within each tumour was assessed. Hist opathological reclassification showed that 60 rumours exhibited ductal diff erentiation and 22 rumours intestinal differentiation. Twenty-five percent (15/60) of the ductal tumours and 50% (11/22) of the intestinal tumours wer e positive for p53 accumulation. p53 immunoreactivity was significantly cor related to a worse prognosis in the tumours of ductal differentiation, with median survival 0.76 years for p53 positive and 1.44 years for p53 negativ e patients. The p53 positivity of tumours with intestinal differentiation s howed no such correlation. No correlation was found between p53 accumulatio n and other known prognostic factors in either the ductal or the intestinal type of tumours. Our results indicate that the tumour biology of ductal ad enocarcinomas differs significantly from that of adenocarcinomas of the int estinal type located in the pancreatic head, and that p53 accumulation conf ers a worse prognosis only of ductal tumours. Subclassification of these tu mours based on type of differentiation is therefore suggested since periamp ullary tumours include ductally as well as intestinally differentiated aden ocarcinomas.