A team from Kansas City, Missouri, USA, evaluated the prognosis of the immunohistochemical over-expression of p53 protein in Barrett's esophagus co-localized to low-grade dysplasia.
48 consecutive Barrett's patients in whom low-grade dysplasia was found had a repeat gastroscopy within 8-12 weeks. They were observed for a mean of 41 months.
At each gastroscopy, a therapeutic scope was used in conjunction with the Seattle Biopsy Protocol.
Patients were observed until development of multifocal high-grade dysplasia (mHGD), presence of an HGD dysplasia-associated lesion or mass (DALM) lesion, or frank adenocarcinoma.
|60% of patients with progressive low-grade dysplasia had co-localization of p53.
|American Journal of Gastroenterology|
p53 protein over-expression was determined on step serial-sectioned specimens of Barrett's segments harboring low-grade dysplasia.
Kaplan-Meier survival curves were made on the ability of p53 staining co-localized to areas of low-grade dysplasia to predict progression to mHGD, HGD DALM, or cancer during prospective follow-up.
During the study period, one of the 48 patients progressed to mHGD and two to mHGD/DALM, with foci in which intramucosal cancer could not be excluded. One patient developed cancer and one developed mHGD.
12 patients were found to have persistent low-grade dysplasia, and 31 had regressed to no dysplasia.
p53 staining was positive and co-localized to areas of low-grade dysplasia in 4/31 of patients that regressed, 3/12 that persisted, and 3/5 that progressed.
Kaplan-Meier curves differed significantly between p53 positive and negative patients for outcome defined as progression of low-grade dysplasia.
Dr Allan P. Weston, of the University of Kansas Medical Center said on behalf of the group, "p53 co-localization with low-grade dysplasia is a risk factor for progression of low-grade dysplasia.
"This can potentially be used to risk stratify Barrett's esophagus low-grade dysplasia patients in terms of surveillance intervals or enrollment into secondary prevention studies," he concluded.