Periampullary cancers (PAC) including pancreatic, ampulla of Vater (AOV), and common bile duct (CBD) cancers are highly aggressive with lack of useful prognostic markers beyond T stage. However, T staging can be biased due to the anatomic complexity of this region. Recently, several markers related to cancer stem cells and epithelial-mesenchymal transition (EMT) such as octamer transcription factor-4 (Oct4) and fibroblast growth factor receptor 1 (FGFR1) respectively, have been proposed as new

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... romising markers in other solid cancers. The aim of this study was to access the expression and prognostic significance of stem cell/EMT markers in PACs. Methods: Formalin-fixed, paraffin-embedded tissues of surgically excised PACs from the laboratory archives from 1998 to 2014 were evaluated by immunohistochemical staining for stem cell/EMT markers using tissue microarray. The clinicopathologic parameters were documented and statistically analyzed with the immunohistochemical findings. Survival and recurrence data were collected and analyzed. Results: A total of 126 PAC cases were evaluated. The average age was 63 years, with 76 male and 50 female patient samples. The overall survival was statistically related to old age (over 74 years), tumor epicenter (pancreas < CBD < AOV), T stage, tumor size, N stage, lymphatic, vascular, perineural invasion, histologic grade (differentiation), subtype (pancreaticobiliary type < intestinal type), degree of fibrosis, and inflammation. The expression levels of FGFR1 as well as CK20, CDX2, and VEGF were significantly related to overall survival while other stem cell markers were not related. Similar findings were observed for tumor recurrence using disease-free survival. Conclusions: In addition to other clinicopathologic parameters, the degree of fibrosis and expression of FGFR1 were novel markers for overall survival and tumor recurrence. Histologic changes such as extensive fibrosis needs to be investigated further in relation to EMT of PACs. Background Periampullary cancers (PAC) including pancreatic, ampulla of Vater (AOV), and common bile duct (CBD) cancers are highly aggressive tumors and their 5-year survival rate is less than 4%, and 90% of the patients die from the disease within a year after diagnosis [1] . PACs are expected to rank as the The authors declare that they have no competing interest.