p53表达在儿童肾母细胞瘤中的预后价值

Skotnicka-Klonowicz G, Kobos J, Łoś E, Trejster E, Szymik-Kontorowicz S, Daszkiewicz P

Clinic of Surgery and Pediatric Oncology, Institute of Pediatrics, Medical University of Łódź, Poland.

Med Sci Monit. 2001 Nov-Dec;7(6):1224-9.

BACKGROUND

The aim of this report was to evaluate the prognostic value and clinical correlations of p53 expression in children with Wilms' tumor.

MATERIAL AND METHODS

The study comprised 61 children aged from 2 days to 13 years (median 39 months), diagnosed and treated according to SIOP and PPGGL criteria in three centers co-operating with the PPGGL. The studies were conducted on tumor tissue removed during surgery, fixed in formalin and embedded in paraffin blocks. Then 4-micron sections were evaluated by immunohistochemistry, using the peroxidase method to determine the expression of p53 in Wilms' tumor cells by means of primary monoclonal antibody NCL-p53 from Novocastra.

RESULTS

The percentage of immunopositive cells in particular fragments of the tumor ranged from 0% to 70% (mean 20.4%, median 16.0%). The mean and median values enabled the children to be divided into two groups: Group A, where the percentage of cells staining with anti-p53 antibody was >20% (23 cases), and Group B, where this percentage did not exceed 20%. The expression of p53 was then evaluated in various stages of advancement and various histological types, depending on the course of the disease. In Group A, tumors at higher stages of advancement stages were more frequent (p<0.05), and showed a higher degree of malignancy (p<0.06; EFS=56.53%). In Group B, lower stages of advancement were more frequent (p<0.05), the degree of malignancy was lower, and the EFS was 81.58%. A discrimination test, however, showed that the determination of p53 expression in Wilms' tumor cells has moderate sensitivity (58.825%), positive prediction (43.47%), and relatively high specificity (70.45%) and negative prediction (81.57%), which means that low indexes of p53 expression have higher prognostic value.

CONCLUSIONS

The index of p53 expression is not an independent prognostic factor in Wilms' tumor in children, but this determination may be helpful in identifying high-risk and low-risk patients.

背景

本报告旨在评估p53表达在儿童肾母细胞瘤中的预后价值及临床相关性。

材料与方法

本研究纳入了61例年龄从2天至13岁（中位年龄39个月）的儿童，这些儿童在与PPGGL合作的三个中心按照SIOP和PPGGL标准进行诊断和治疗。研究对象为手术切除的肿瘤组织，用福尔马林固定并包埋于石蜡块中。然后对4微米切片进行免疫组织化学评估，采用过氧化物酶法，使用来自诺华卡斯尔的原发性单克隆抗体NCL-p53来测定肾母细胞瘤细胞中p53的表达。

结果

肿瘤特定片段中的免疫阳性细胞百分比范围为0%至70%（平均20.4%，中位值16.0%）。根据平均值和中位值，可将儿童分为两组：A组，抗p53抗体染色细胞百分比>20%（23例）；B组，该百分比不超过20%。然后根据疾病进程，在不同进展阶段和不同组织学类型中评估p53的表达。在A组中，进展期较高的肿瘤更为常见（p<0.05），且恶性程度更高（p<0.06；无事件生存率=56.53%）。在B组中，进展期较低的肿瘤更为常见（p<0.05），恶性程度较低，无事件生存率为81.58%。然而，一项判别试验表明，肾母细胞瘤细胞中p53表达的测定具有中等敏感性（58.825%）、阳性预测值（43.47%），以及相对较高的特异性（70.45%）和阴性预测值（81.57%），这意味着p53表达低指标具有更高的预后价值。