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OBJECTIVES The purpose of this study was to characterize the intratumoral expression profiles of excision repair cross-complementing gene 1 (ERCC1), dihydropyrimidine dehydrogenase (DPD), and human equilibrative nucleotide transporter 1 (hENT1) in ampullary carcinomas (ACs) to evaluate their prognostic values and better tailor adjuvant chemotherapy for individual patients with AC after surgery. METHODS This study included 49 patients with AC who underwent a curative pancreaticoduodenectomy. Various clinicopathological factors, including ERCC1, DPD, and hENT1, were analyzed in relation to postoperative disease recurrence and the patients' survival. RESULTS The median recurrence-free survival and overall survival were 24.5 months and 32.4 months, respectively. Multivariate Cox regression analysis of recurrence-free survival identified a DPD expression (hazard ratio [HR], 8.18; 95% confidence interval [CI], 2.00-34.8; P = 0.003) and combined ERCC1/DPD expression (HR, 134.8; 95% CI, 11.8-1920; P < 0.001) as independent predictors of disease recurrence. Multivariate Cox regression analysis of overall survival also identified a DPD expression (HR, 8.48; 95% CI, 1.71-46.3; P = 0.008) and combined ERCC1/ DPD expression (HR, 135.6; 95% CI, 11.8-1940; P < 0.001) as independent predictors of survival. CONCLUSIONS The DPD and ERCC1 expression profile could potentially serve as a useful prognostic biomarker and therapeutic target for surgically resected patients with AC.

症例は42歳，男性．アルコール性慢性膵炎にて経過観察中に急に吐血し当院へ来院，大学病院へ救急搬送した．大学病院での緊急内視鏡検査では胃内は凝血塊で充満し，明らかな出血点は確認できなかったが出血は止まっていた．上腹部造影computed tomography（CT）を施行したが，胃内腔の血液貯留及びそれに接した膵仮性嚢胞内出血，左胃動脈仮性動脈瘤を認めた．従って，本症例の吐血は左胃動脈仮性動脈瘤の膵仮性嚢胞内への穿破により仮性膵嚢胞内出血をきたし，さらにその嚢胞が前医で施行されていた経胃的膵嚢胞ドレナージ挿入部周辺の脆弱な部位から胃体部後壁へ穿通し胃内出血を合併したと推測された．本症例に対して診断，治療を兼ね腹部血管造影を行ったところ，左胃動脈仮性動脈瘤を確認した．その後，左胃動脈仮性動脈瘤に対しマイクロカプセルとヒストアクリルリピオドールにより塞栓術を施行した．本患者は膵性疼痛が増強してきたため，膵仮性嚢胞切除を含む膵体尾部切除，左腹腔内神経叢切除を行った．慢性膵炎に仮性動脈瘤を合併する症例は稀ではないが，左胃動脈仮性動脈瘤により膵仮性嚢胞内出血，さらに胃内出血を合併した症例は本邦では文献検索上9例のみであり極めて稀な症例であった．