Sankalecha Tushar H, Gupta Sudhir J, Gaikwad Nitin R, Shirole Nikhil U, Kothari Harit G
Department of Gastroenterology, Government Medical College and Super Speciality Hospital, Nagpur, Maharashtra, India.
Saudi J Gastroenterol. 2017 Sep-Oct;23(5):281-286. doi: 10.4103/sjg.SJG_56_17.
BACKGROUND/AIMS: Esophageal squamous cell carcinoma (ESCC) is the most aggressive type of cancer. Mutation of tumor suppressor gene p53 is observed in many gastrointestinal malignancies including ESCC. The immunohistochemical protein expression of mutant p53 has been proposed as a potential tool to evaluate the biological behavior of ESCC. Predictive value of p53 for survival is debatable, hence this study was formulated to know the survival of patients with p53 expression in ESCC.
We prospectively included 91 consecutive patients of ESCC from August 2014 to August 2016. Biopsy specimens were treated immunohistochemically and expression of p53 gene was analyzed by Immunoreactive Score (IRS). These findings were then compared with clinicopathological parameters such as age, gender, histological grades, and TNM stages. All patients received treatment and were kept under regular follow-up.
M: F ratio was 2.03:1. p53 expression analyzed by IRS showed low expression (score ≤6) in 35 patients (38.46%) and high expression (>6) in 56 patients (61.54%). Level of p53 expression increased significantly with increasing histological grades of ESCC and TNM stage (P ≤ 0.001). Multivariate analysis shows p53 expression as independent predictor of survival. After 1 year of follow up, survival in the p53 high-expression group was 67.86% [standard error (SE) = 0.0473, confidence interval (CI) = 0.75-0.97) and in low p53 expression group was 91.43% (SE = 0.06, CI = 0.53-0.78) with statistically significant difference P = 0.0001 when analyzed with Kaplan-Meier method.
Expression of p53 correlates with the survival and is a simple, effective and reproducible modality to determine the prognosis and survival in ESCC.
背景/目的：食管鳞状细胞癌（ESCC）是侵袭性最强的癌症类型。在包括ESCC在内的许多胃肠道恶性肿瘤中都观察到肿瘤抑制基因p53的突变。突变型p53的免疫组化蛋白表达已被提议作为评估ESCC生物学行为的一种潜在工具。p53对生存的预测价值存在争议，因此本研究旨在了解ESCC中p53表达患者的生存情况。
我们前瞻性纳入了2014年8月至2016年8月连续的91例ESCC患者。活检标本进行免疫组化处理，并通过免疫反应评分（IRS）分析p53基因的表达。然后将这些结果与年龄、性别、组织学分级和TNM分期等临床病理参数进行比较。所有患者均接受治疗并定期随访。
男性与女性比例为2.03:1。通过IRS分析的p53表达显示，35例患者（38.46%）为低表达（评分≤6），56例患者（61.54%）为高表达（>6）。p53表达水平随着ESCC组织学分级和TNM分期的增加而显著升高（P≤0.001）。多因素分析显示p53表达是生存的独立预测因素。随访1年后，p53高表达组的生存率为67.86%[标准误（SE）=0.0473，置信区间（CI）=0.75 - 0.97]，p53低表达组为91.43%（SE = 0.06，CI = 0.53 - 0.78），采用Kaplan-Meier方法分析时，差异具有统计学意义（P = 0.0001）。
p53表达与生存相关，是确定ESCC预后和生存的一种简单、有效且可重复的方式。
