Ozalp S, Yalcin O T, Tanir H Mete, Kabukcuoglu S, Erol G
Department of Obstetrics and Gynecology, Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
Eur J Gynaecol Oncol. 2003;24(3-4):275-8.
To investigate the prognostic value of p53 overexpression in endometrial adenocarcinoma cases of different stages and histologic subtypes.
One hundred and eleven surgically staged endometrial carcinoma (EC) cases from 1996 to 2000 constituted this retrospective study group. Prognostic factors determined through the evaluation of surgery specimens by co-author pathologist, were surgical stage, tumor size, histology, histologic and nuclear grade, myometrial invasion, adnexal/serosal metastasis, peritoneal cytology, retroperitoneal lymph node involvement p53 overexpression was assessed via immunohistochemical staining. Tissues that expressed p53 were considered as positive p53 staining. In terms of degree of staining, 1-29%, 30-90% and 80-100% of tumoral tissue stained with p53 were considered to be mild, moderate and high p53 staining, respectively.
Mean age and follow-up period of the study group were 58.2 +/- 10.6 years and 33.4 +/- 2.7 months, respectively. Percentages of cases surgically staged as early (I-II) and advanced (III-IV) FIGO stages were 65.8% (n: 73) and 34.2% (n: 38), respectively. Cases with positive p53 staining had a significantly high mean survival period compared with those with negative p53 staining (86.6 +/- 6.0 vs 49.1 +/- 8.1, p < 0.001). p53 overexpression was statistically detected to be high in Stage III-IV tumors, non-endometrioid histologic subtypes (p = 0.019), histologic and nuclear grade 2-3 tumors (p < 0.001), adnexal/serosal metastasis (p = 0.001), lymph node involvement (p = 0.012), and positive peritoneal cytology (p = 0.017). The degree of p53 staining was remarkably correlated with survival. In cases with mild and high p53 staining, mean survival times were 47.1 +/- 7.0 months and 57.0 +/- 13.1 months, respectively (p = 0.0003) compared to those with high p53 staining. On univariate analysis, all of the prognosticators, including p53 staining (p < 0.001) and degree of p53 staining (p < 0.001) appeared to be independent risk factors for poor prognosis. On multivariate analysis, only pelvic lymph node involvement (p = 0.03), serosal/adnexal involvement (p = 0.004), and positive peritoneal cytology (p = 0.01) were found to be independent prognosticators of survival while p53 expression (p = 0.743) and degree of p53 staining (p = 0.802) were not detected as independent prognosticators.
p53 overexpression is strongly related to poor prognostic indicators in endometrial adenocarcinoma. Although in this study p53 overexpression was not detected as an independent prognosticator, additional studies with large data set are needed to evaluate the prognostic value of p53 expression.
探讨p53过表达在不同分期及组织学亚型的子宫内膜腺癌病例中的预后价值。
本回顾性研究组由1996年至2000年的111例经手术分期的子宫内膜癌（EC）病例组成。通过共同作者病理学家对手术标本的评估确定的预后因素包括手术分期、肿瘤大小、组织学、组织学和核分级、肌层浸润、附件/浆膜转移、腹腔细胞学检查、腹膜后淋巴结受累情况。p53过表达通过免疫组织化学染色进行评估。表达p53的组织被视为p53染色阳性。就染色程度而言，p53染色的肿瘤组织占1-29%、30-90%和80-100%分别被认为是轻度、中度和高度p53染色。
研究组的平均年龄和随访时间分别为58.2±10.6岁和33.4±2.7个月。国际妇产科联盟（FIGO）分期为早期（I-II期）和晚期（III-IV期）的病例百分比分别为65.8%（n=73）和34.2%（n=38）。p53染色阳性的病例与p53染色阴性的病例相比，平均生存期显著更长（86.6±6.0对49.1±8.1，p<0.001）。在III-IV期肿瘤、非子宫内膜样组织学亚型（p=0.019）、组织学和核分级为2-3级的肿瘤（p<0.001）、附件/浆膜转移（p=0.001）、淋巴结受累（p=0.012）和腹腔细胞学检查阳性（p=0.017）中，p53过表达在统计学上被检测为高表达。p53染色程度与生存期显著相关。与高度p53染色的病例相比，轻度和高度p53染色病例的平均生存时间分别为47.1±7.0个月和57.0±13.1个月（p=0.0003）。单因素分析显示，所有预后因素，包括p53染色（p<0.001）和p53染色程度（p<0.001）似乎都是预后不良的独立危险因素。多因素分析发现，只有盆腔淋巴结受累（p=0.03）、浆膜/附件受累（p=0.004）和腹腔细胞学检查阳性（p=0.01）是生存的独立预后因素，而p53表达（p=0.743）和p53染色程度（p=0.802）未被检测为独立预后因素。
p53过表达与子宫内膜腺癌的不良预后指标密切相关。尽管在本研究中p53过表达未被检测为独立预后因素，但需要更多大数据集的研究来评估p53表达的预后价值。
