Dalquen P, Sauter G, Torhorst J, Schultheiss E, Jordan P, Lehmann S, Solèr M, Stulz P, Mihatsch M J, Gudat F
Institute for Pathology, University of Basel, Switzerland.
J Pathol. 1996 Jan;178(1):53-8. doi: 10.1002/(SICI)1096-9896(199601)178:1<53::AID-PATH415>3.0.CO;2-T.
The prognosis of operated patients with non-small cell lung cancer (NSCLC) is poor despite thorough pre-operative staging. An improved preselection is needed of patients likely to profit from surgery. This study was undertaken to evaluate the prognostic significance of nuclear p53 overexpression in a cohort of 247 surgically treated patients with NSCLC. It showed that the prevalence of immunohistochemically detectable p53 overexpression varied between different tumour types. p53 overexpression was equally frequent in large cell carcinoma (53 per cent) and in squamous cell carcinoma (54 per cent), but significantly less frequent in adenocarcinoma (34 per cent; P = 0.009). p53 overexpression was particularly rare in bronchioloalveolar carcinoma (positivity in 1 of 17 cases). These variations may reflect aetiological differences between the histological subtypes. p53 overexpression was also associated with high tumour grade (P = 0.0157) and the presence of lymph node metastasis (P = 0.0259), but not with advanced tumour stage. Survival analysis showed no difference in clinical outcome between p53-positive and p53-negative tumours within 101 node-positive tumours. In contrast, survival time was significantly better in p53-negative tumours than in p53-positive tumours within the group of 113 node-negative tumours (P = 0.032). Stepwise regression analysis showed that p53 overexpression is an independent prognostic factor in node-negative NSCLC.
尽管进行了全面的术前分期，但非小细胞肺癌（NSCLC）手术患者的预后仍然很差。需要对可能从手术中获益的患者进行更好的预选。本研究旨在评估247例接受手术治疗的NSCLC患者队列中核p53过表达的预后意义。结果显示，免疫组化可检测到的p53过表达的发生率在不同肿瘤类型之间有所不同。p53过表达在大细胞癌（53%）和鳞状细胞癌（54%）中同样常见，但在腺癌中明显较少见（34%；P = 0.009）。p53过表达在细支气管肺泡癌中尤其罕见（17例中有1例阳性）。这些差异可能反映了组织学亚型之间的病因学差异。p53过表达还与高肿瘤分级（P = 0.0157）和淋巴结转移的存在（P = 0.0259）相关，但与肿瘤晚期无关。生存分析显示，在101例淋巴结阳性肿瘤中，p53阳性和p53阴性肿瘤的临床结局没有差异。相反，在113例淋巴结阴性肿瘤组中，p53阴性肿瘤的生存时间明显优于p53阳性肿瘤（P = 0.032）。逐步回归分析表明，p53过表达是淋巴结阴性NSCLC的独立预后因素。
