Cruz I, Napier S S, van der Waal I, Snijders P J F, Walboomers J M M, Lamey P J, Cowan C G, Gregg T A, Maxwell P, Meijer C J L M
Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry Amsterdam, University Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
J Clin Pathol. 2002 Feb;55(2):98-104. doi: 10.1136/jcp.55.2.98.
No good predictive marker for the malignant transformation of potentially malignant oral lesions (PMOLs) is currently available. This study re-evaluated the value of p53 immunoexpression to predict malignant transformation of PMOLs after discounting possible confounding factors.
PMOLs from 18 patients who showed progression to carcinoma, 16 of the respective carcinomas, and PMOLs from 18 matched controls were evaluated by immunohistochemistry (IHC) for p53 expression. A mouse monoclonal antibody that detects wild-type and mutant forms of human p53 was used. The p53 immunostaining pattern was also correlated with the degree of dysplasia.
Suprabasal p53 staining was significantly associated with high grades of dysplasia (p < 0.01). The specificity and positive predictive value (PPV) for malignant transformation of suprabasal p53 staining were superior to the assessment of dysplasia, but sensitivity was inferior. All carcinomas derived from PMOLs with suprabasal p53 showed strong p53 immunostaining. However, the absence of suprabasal p53 staining and/or dysplastic changes did not preclude malignant transformation in a considerable proportion of PMOLs.
This study confirms and extends previous findings that suprabasal p53 immunoexpression has a high PPV for malignant transformation of PMOLs and can be used as a specific marker for lesions that are at high risk for malignant transformation. The absence of suprabasal p53 staining (that is, absence of, or basal, p53 staining) is non-informative for prognostic purposes. Because of its limited sensitivity, p53 IHC is not a substitute for the assessment of dysplasia in the evaluation of PMOLs. Instead, p53 IHC emerges as a clinically useful supplement of histopathological assessment in the prognosis of PMOLs.
目前尚无用于预测潜在恶性口腔病变（PMOLs）恶变的良好预测标志物。本研究在排除可能的混杂因素后，重新评估了p53免疫表达对预测PMOLs恶变的价值。
对18例进展为癌的患者的PMOLs、16例相应的癌组织以及18例匹配对照的PMOLs进行免疫组织化学（IHC）检测p53表达。使用一种能检测人p53野生型和突变型的小鼠单克隆抗体。p53免疫染色模式也与发育异常程度相关。
基底上层p53染色与高级别发育异常显著相关（p<0.01）。基底上层p53染色对恶变的特异性和阳性预测值（PPV）优于发育异常评估，但敏感性较差。所有源自基底上层p53阳性的PMOLs的癌均显示p53强免疫染色。然而，相当一部分PMOLs中基底上层p53染色缺失和/或发育异常改变并不排除恶变。
本研究证实并扩展了先前的发现，即基底上层p53免疫表达对PMOLs恶变具有高PPV，可作为恶变高风险病变的特异性标志物。基底上层p53染色缺失（即无或基底p53染色）对预后评估无意义。由于其敏感性有限，在PMOLs评估中，p53 IHC不能替代发育异常评估。相反，p53 IHC成为PMOLs预后组织病理学评估的一种临床有用补充。
