p53过表达并非原发性卵巢上皮癌患者的独立预后因素。

p53 overexpression is not an independent prognostic factor for patients with primary ovarian epithelial cancer.

作者信息

Eltabbakh G H, Belinson J L, Kennedy A W, Biscotti C V, Casey G, Tubbs R R, Blumenson L E

机构信息

Department of Gynecology, the Cleveland Clinic Foundation, Ohio, USA.

出版信息

Cancer. 1997 Sep 1;80(5):892-8.

PMID:9307189

Abstract

BACKGROUND

The clinical significance of p53 overexpression in patients with ovarian carcinoma is uncertain. Previous studies have yielded conflicting results and have been hampered by small patient populations, failure to account for other well-known prognostic variables in multivariate analysis, and failure to account for the grade of p53 overexpression. The aim of this study was to investigate the independent prognostic significance of p53 overexpression in patients with primary ovarian epithelial cancer (POEC).

METHODS

Tumors obtained from 221 patients with primary ovarian epithelial cancer (POEC) (Stages I-IV) were studied for p53 overexpression semiquantitatively by immunohistochemical techniques. The median duration of follow-up of surviving patients was 7 years. The presence or absence and degree of p53 overexpression were correlated with the clinicopathologic features of the study population and overall survival. Survival curves were constructed according to the Kaplan-Meier method, and differences in survival were assessed with the log rank test. The prognostic significance of p53 overexpression for survival was assessed in a multivariate analysis with the Cox proportional hazards model.

RESULTS

One hundred seven tumors (48.4%) exhibited p53 overexpression. The overexpression was graded as mild in 16.7% of cases, moderate in 5.9%, and strong in 25.8%. p53 overexpression was associated with advanced stage (P = 0.04), higher grade (P = 0.0003), serous histology (P = 0.0018), and patient age > 61 years (P = 0.013). In univariate analysis, p53 overexpression was a significant prognostic factor (P = 0.049 for any degree of overexpression, P = 0.03 for strong overexpression). However, in multivariate analysis, after adjustment for stage and size of residual tumor following cytoreductive surgery, p53 overexpression did not retain statistical significance. Survival curves for patients with different stages and grades of tumor differentiation did not demonstrate a difference in survival among patients with no p53 overexpression, compared with those who demonstrated any degree of p53 overexpression or compared with those who demonstrated strong p53 overexpression.

CONCLUSIONS

p53 overexpression is not an independent prognostic factor for patients with primary ovarian epithelial cancer.

摘要

背景

p53过表达在卵巢癌患者中的临床意义尚不确定。既往研究结果相互矛盾，且受限于患者数量少、多变量分析中未考虑其他已知的预后变量以及未考虑p53过表达的程度。本研究旨在探讨p53过表达在原发性卵巢上皮癌（POEC）患者中的独立预后意义。

方法

采用免疫组化技术对221例原发性卵巢上皮癌（POEC）（I - IV期）患者的肿瘤进行p53过表达的半定量研究。存活患者的中位随访时间为7年。p53过表达的有无及程度与研究人群的临床病理特征和总生存期相关。根据Kaplan - Meier方法构建生存曲线，并用对数秩检验评估生存差异。采用Cox比例风险模型在多变量分析中评估p53过表达对生存的预后意义。

结果

107例肿瘤（48.4%）表现出p53过表达。过表达分级为轻度的占16.7%，中度的占5.9%，重度的占25.8%。p53过表达与晚期（P = 0.04）、高分级（P = 0.0003）、浆液性组织学（P = 0.0018）以及患者年龄>61岁（P = 0.013）相关。在单变量分析中，p53过表达是一个显著的预后因素（任何程度的过表达P = 0.049，重度过表达P = 0.03）。然而，在多变量分析中，在调整了细胞减灭术后的分期和残留肿瘤大小后，p53过表达不再具有统计学意义。不同分期和肿瘤分化等级患者的生存曲线显示，与未表现出任何程度p53过表达的患者相比，或与表现出重度p53过表达的患者相比，无p53过表达患者的生存无差异。