Overexpression of p53 protein in primary Ewing's sarcoma of bone: relationship to tumour stage, response and prognosis

Biopsy tissues of 52 patients with Ewing's sarcoma of bone treated between 1983 and 1993 were examined immunohistochemically to determine the signific ance of p53 protein in diagnosis and prognosis of Ewing's sarcoma. Mean age at diagnosis was 17 years (range 6-36) and minimum follow-up was 30 months . The tumours were located in the extremities and central bones in 35 and 1 7 patients respectively. Metastases were present in seven patients at diagn osis. Treatment consisted of chemotherapy, surgery and/or radiotherapy in a ll the patients. Overexpression of p53 protein was demonstrated in seven pa tients (14%). There was no relationship between expression of p53 and site of tumours. Patients who overexpressed p53 protein appeared to have more ad vanced diseases at diagnosis and poorer response to chemotherapy than those without p53 overexpression. The 5-year relapse-free survival and overall s urvival in patients without metastases at the time of diagnosis were 66% an d 71%, respectively, in p53 protein-negative patients compared with 20% rel apse-free and overall survival in those with p53 protein overexpression (P= 0.01). The poorer prognosis in p53 protein-positive patients was independen t of site, local treatment or necrosis of the tumours (P < 0.05). Over-expr ession of p53 protein is an independent poor prognostic factor in Ewing's s arcoma of bone.