PROGNOSTIC VALUE OF P53 NUCLEAR OVEREXPRESSION IN PATIENTS WITH INVASIVE BLADDER-CANCER TREATED WITH NEOADJUVANT MVAC
PROGNOSTIC VALUE OF P53 NUCLEAR OVEREXPRESSION IN PATIENTS WITH INVASIVE BLADDER-CANCER TREATED WITH NEOADJUVANT MVAC
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DOI：
10.1200/jco.1995.13.6.1384
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发表时间：
1995-06-01
影响因子：
45.3
通讯作者：
SCHER, HI
中科院分区：
文献类型：
--
作者：
SARKIS, AS;BAJORIN, DF;SCHER, HI
目的：本研究旨在探讨p53细胞核过度表达在肌肉浸润性膀胱癌的预后作用，因为它与浅表性膀胱cancer.Patients和方法的进展：90 111例新辅助甲氨蝶呤，长春碱，阿霉素，顺铂（MVAC）治疗的中位随访时间为5.8年进行了评价。在脱蜡组织切片上通过免疫组织化学测定p53核过表达。根据阳性核反应性肿瘤细胞的百分比将患者分为两组。结果：47例肿瘤细胞核过表达，43例肿瘤细胞核非过表达。肿瘤中p53过表达的患者的癌症死亡比例显著较高。一项多变量分析评估了治疗前变量p53核过表达、年龄、性别、可触及肿块、化疗前肿瘤分期、体力状态、输尿管梗阻、肿瘤大小、多灶性和分级，结果显示p53过表达对生存率具有独立意义（P= 0.001;相对风险比3.1）。p53过表达对生存的影响主要在T2和T3 a肿瘤中。17例p53过表达的患者中有7例（41%）长期生存，而p53未过表达的患者中有20例（77%）长期生存（P=.007）。结论：p53核过表达对浸润性膀胱癌患者新辅助化疗的生存具有独立的预后价值。(C)1995年，美国临床肿瘤学会。
Purpose: This study sought to examine the prognostic role of p53 nuclear overexpression in muscle-invasive bladder cancer because of its correlation with progression of superficial bladder cancer.Patients and Methods: Ninety of 111 patients treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) with a median follow-up duration of 5.8 years were evaluated. p53 nuclear overexpression was determined by immunohistochemistry on deparaffinized tissue sections. Patients were stratified into two groups according to the percent of tumor cells with positive nuclear reactivity. Overexpression was defined as tumors with greater than or equal to 20% cells with positive nuclear reactivity and nonoverexpression as tumors with less than 20% reactivity.Results: Nuclear overexpression was observed in 47 patients and nonoverexpression in 43 patients. Patients whose tumors had p53 overexpression had a significantly higher proportion of cancer deaths. A multivariate analysis that evaluated the pretreatment variables p53 nuclear overexpression, age, sex, palpable mass, pre-chemotherapy tumor stage, performance status, ureteral obstruction, tumor size, multifocality, and grade showed that p53 overexpression had independent significance for survival (P=.001; relative risk ratio, 3.1). The impact of p53 overexpression on survival was predominantly in T2 and T3a tumors. Long-term survival was evident in seven of 17 patients (41%) with p53 overexpression versus 20 of 26 (77%) in whom p53 was not overexpressed (P=.007).Conclusion: p53 nuclear overexpression has independent prognostic value for survival in patients with invasive bladder cancer treated with neoadjuvant chemotherapy. (C) 1995 by American Society of Clinical Oncology.