Younes M, Ertan A, Lechago L V, Somoano J R, Lechago J
Department of Pathology, Baylor College of Medicine and the Methodist Hospital, Houston, Texas 77030, USA.
Dig Dis Sci. 1997 Apr;42(4):697-701. doi: 10.1023/a:1018828207371.
Our aim was to determine the sensitivity and specificity of p53 accumulation as a marker of malignant potential in Barrett's metaplasia (BM). One hundred eighty biopsies from 61 patients with BM were evaluated for p53 accumulation by immunohistochemistry. Of 25 patients with LGD, 9 had p53-positive biopsies, and of these 5 (56%) developed HGD/CA, whereas 16 had p53-negative biopsies and none (0%) developed HGD/CA after similar follow-up times (P = 0.0108). As a marker of malignant potential in BM, p53 accumulation has a sensitivity of 100%, specificity of 93%, and a predictive value of a positive test of 0.56, compared to sensitivity of 100%, specificity of 64%, and predictive value of a positive test of 0.2 for a histologic diagnosis of LGD. We conclude that: (1) p53 accumulation is more specific and has better predictive value for subsequent development of HGD/CA than histologic diagnosis of LGD. (2) Patients with LGD and p53-positive biopsies are more likely to develop HGD/CA; therefore, they should be followed up more closely than those with LGD and p53-negative biopsies.
我们的目的是确定p53蛋白积累作为巴雷特化生（BM）恶性潜能标志物的敏感性和特异性。通过免疫组织化学对61例BM患者的180份活检样本进行p53蛋白积累评估。在25例低级别异型增生（LGD）患者中，9例活检样本p53呈阳性，其中5例（56%）进展为高级别异型增生（HGD）/癌，而16例活检样本p53呈阴性，在相似随访时间后无一例（0%）进展为HGD/癌（P = 0.0108）。作为BM恶性潜能的标志物，与组织学诊断LGD相比，p53蛋白积累的敏感性为100%，特异性为93%，阳性试验预测值为0.56，而组织学诊断LGD的敏感性为100%，特异性为64%，阳性试验预测值为0.2。我们得出结论：（1）与LGD的组织学诊断相比，p53蛋白积累对HGD/癌的后续发生更具特异性且具有更好的预测价值。（2）活检样本p53呈阳性的LGD患者更有可能进展为HGD/癌；因此，与活检样本p53呈阴性的LGD患者相比，对他们应进行更密切的随访。
