Starzynska T, Markiewski M, Domagala W, Marlicz K, Mietkiewski J, Roberts S A, Stern P L
Depart of Gastroenterology, Medical Pomeranian Academy, Szczecin, Poland.
Cancer. 1996 May 15;77(10):2005-12. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2005::AID-CNCR7>3.0.CO;2-P.
Alterations in the expression of p53 tumor suppressor protein is a frequent event in human cancer but the practical implications of this phenomenon are yet to be fully exploited. The objective of this study was to determine the value of p53 accumulation as a marker of tumor progression and prognosis of gastric carcinoma patients and to evaluate whether this parameter can be properly assessed prior to surgery.
The expression of p53 was studied immunohistochemically in 200 gastric carcinomas using paraffin embedded surgical specimens and endoscopic biopsies. The correlation between p53 expression in tumor tissue, selected clinicopathologic variables, and the course of the patients' disease were analyzed.
Results showed that 42.5% of the gastric carcinomas expressed elevated levels of p53 protein. P53 accumulation positivity correlated with increasing tumor stage and size (P < 0.001 and P = 0.025, respectively). P53 positive tumors had a higher propensity for lymph node and distant metastases (P < 0.001). P53 accumulation was also more frequently detected in carcinoma from proximal rather than distal stomach (P = 0.027). In patients receiving potentially curative resection for advanced cancer, p53 accumulation was an independent parameter and the strongest for poor prognosis (RR = 3.7, P < 0.001). There was complete concordance between immunohistochemical detection of p53 in endoscopic and surgical material.
A preoperative assessment of p53 expression in gastric carcinoma can be helpful to identify patients at high risk of metastatic spread to regional lymph nodes and independently to identify those with especially poor prognosis. When combined with routine procedures, this simple and inexpensive test might allow appropriate planning of better treatment strategies.
p53肿瘤抑制蛋白表达的改变在人类癌症中是常见事件，但这一现象的实际意义尚未得到充分利用。本研究的目的是确定p53蓄积作为胃癌患者肿瘤进展和预后标志物的价值，并评估该参数在手术前能否得到准确评估。
采用石蜡包埋的手术标本和内镜活检对200例胃癌进行免疫组织化学研究，分析肿瘤组织中p53表达与所选临床病理变量及患者病程之间的相关性。
结果显示，42.5%的胃癌p53蛋白表达水平升高。p53蓄积阳性与肿瘤分期增加和肿瘤大小增大相关（分别为P<0.001和P=0.025）。p53阳性肿瘤发生淋巴结转移和远处转移的倾向更高（P<0.001）。p53蓄积在胃近端癌中比远端癌中更常见（P=0.027）。在接受晚期癌症根治性切除的患者中，p53蓄积是一个独立参数，也是预后不良的最强指标（相对危险度=3.7，P<0.001）。内镜和手术材料中p53的免疫组织化学检测结果完全一致。
术前评估胃癌中p53的表达有助于识别有区域淋巴结转移高风险的患者，并独立识别预后特别差的患者。当与常规检查相结合时，这种简单且廉价的检测可能有助于制定更好的治疗策略。
